The Trump administration released its first official budget proposal, and boy, is it unsurprising in its cruelty when it comes to women’s health care.
President Trump has already reversed an Obama-era rule that blocked states from denying family planning grant funds to Planned Parenthood and other abortion providers, and now his administration is going further by suggesting all federal funds, whether they be grant or Medicaid dollars, be withheld from any healthcare center that also provides abortions. Of course, all presidential budget proposals are just a starting point, a statement of priorities for Congress to consider as they get down to the real business of budget negotiation. But what’s really worrying about this is that while there’s a lot even Republicans disagree with in the 62-page document, “defunding Planned Parenthood” is something that seems to bring the fractured Republican caucus together in a way no other issue can.
The Trump Administration proposal in fact goes a step further than the House Republicans’ wet dream of simply cutting Planned Parenthood out of Medicaid reimbursements because it cuts Planned Parenthood out of all federal funds. That includes Title X family planning grants, grants aimed at cancer or Zika prevention, and Violence Against Women Act grants.
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This is extreme, but it’s not unheard of: It’s really just a larger-scale version of a policy change made by the Texas state legislature back in 2011 — one that Texan women have been paying for ever since. In fact, what has transpired in Texas after the legislature voted to punish abortion providers with cuts, and block Medicaid reimbursement payments for Planned Parenthood offers the best (worst?) example of just how cruel and stupid this proposal really is.
Back in 2011, the first order of business for the rabidly anti-choice Texas state legislature was to shut out Planned Parenthood from the state’s Medicaid program. What they found out was that it’s not so easy to do that without hurting family planning clinics in general because you first have to scrap the entire family planning program and then re-make it to exclude Planned Parenthood from the list of eligible providers. By the time they finished this process, they had also gone ahead and cut the state’s general family planning budget by two-thirds (from $111 million to $37.9 million).
The result: More than 80 family planning clinics closed, most of which were in rural areas where there were no other clinics offering affordable care. Only a third of them were run by Planned Parenthood.
The Texas legislature’s argument for doing this is the same one Congressional Republicans and President Trump lean on: State dollars should not go to abortion providers, period, and Planned Parenthood patients can easily get other needed reproductive health services, such as contraception, pap smears, and STI tests, at other state-funded community health clinics.
But, in case you weren’t convinced by report after report after report showing that is not the case, that is also not what happened in Texas. Two years after the cuts went into effect, the state’s remaining women’s health clinics only managed to serve half the number of women who were served before, suggesting that many simply went without care, according to a University of Texas study. The state’s Legislative Budget Board estimated that the cuts would result in more than 20,000 unplanned pregnancies and ultimately cost the state more than $230 million dollars.
Then, it got worse: In 2013, Texas went on to pass House Bill 2, or HB2, a sweeping anti-abortion law that levied onerous restrictions on abortion clinics. It required doctors who provide abortions to get admitting privileges at local hospitals (which the hospitals refused to provide) and required clinics to meet the same operating standards as surgical centers. It banned most abortions at 20 weeks post-fertilization or later (which Congressional Republicans are trying at a federal level, too), unless the woman’s life was in danger. And it required women who wanted medication abortion to take their pills supervised by a physician, which along with Texas’ already intense waiting period laws, meant women had to come into the clinic a total of four full times so a doctor could hand them a glass of water and watch them swallow a pill on two separate days in an operating room, says Amy Hagstrom Miller, owner of Whole Women’s Health, a chain of abortion clinics that challenged the law in the 2016 Supreme Court case.
More than half of Texas’ 41 abortion clinics were forced to close as a result of these onerous restrictions. During the first six months of HB2, abortions decreased in the state of Texas by 13%, and medication abortions decreased by 70%, compared to the year before, reductions that could only be attributed to clinic closures making this care impossible to get in that state, according to Daniel Grossman, MD, Director of Advancing New Standards in Reproductive Health at the University of California, San Diego.
“Think of the care these people lost access to — birth control, STD screenings, cancer screenings, diabetes screenings — and add that to the closing of over half of the state’s abortion clinics,” says former State Senator Wendy Davis, who voted against the family cuts in 2011 and filibustered the law that ultimately became HB2. “Teenage pregnancy went up. The self-induced abortion rate in the state has gone up. But the most dramatic of the statistics that we see, in my opinion, is the fact that from 2011 to today, the maternal death rate in Texas has doubled.”
Texas is now home to the highest maternal mortality rate in the U.S., and one of the highest maternal mortality rates in the industrialized world. That’s thanks in part to this chain of events, and the state’s refusal to expand Medicaid under the Affordable Care Act (which Republicans in Congress are damn near close to dismantling with AHCA being deliberated in the Senate).
“Texas should be a warning to the rest of the country of the dire consequences of taking away reproductive health care,” said Nan Little Kirkpatrick, executive director of the Texas Equal Access fund in a conference call with the press all the way back in January.
Sadly, it doesn’t look like the Trump Administration is at all interested in taking that warning seriously.
The only (sort of, marginally) hopeful news here: This is just the beginning of a long process of budget talks.That means now’s the time to raise your voice. Call your representatives and demand they see these cuts for what they really are: a horribly cruel and dreadfully stupid idea.