Now that an anti-abortion group has released two inflammatory videos selectively edited to cast Planned Parenthood in an unflattering light, the national women’s health organization is embroiled in controversy that’s already showing signs of influencing the 2016 presidential campaign. But much of the political bluster doesn’t reflect what’s actually at stake if abortion opponents successfully leverage a legislative campaign against Planned Parenthood’s funding.
The videos, released by a group called the Center for Medical Progress, depict secret recordings of Planned Parenthood employees speaking frankly about fetal tissue donation, which has been characterized on the right as “selling aborted baby parts.” Anti-choice activists with a long history of targeting the organization are seizing on the materials as new evidence to support their position that Planned Parenthood employs immoral practices and should be defunded.
Plenty of national lawmakers are calling for congressional action to end Planned Parenthood’s federal funding, and legislation to accomplish that goal was introduced this week in both the House and the Senate. Republican candidates are vowing to focus on the issue if they’re elected. Some lawmakers are making sweeping statements about ending Planned Parenthood — and, by extension, legal abortion services — for good.
Despite the current rhetoric, the most serious threat to one of the country’s largest health providers will likely unfold on the state level. The situation is an important reminder that the most serious consequences of anti-abortion policies occur in the states — and a woman’s access to health services is more dependent on where she lives than on who the presidential front runners are.
As Vox details, Planned Parenthood receives about $500 million in both federal and state dollars through two major funding streams: from Title X, the network of taxpayer-funded family planning programs, and from Medicaid, the federal insurance program for low-income Americans. The biggest chunk of the organization’s funding comes from providing basic health services — like birth control consultations, STD testing, and cancer screenings — to people enrolled in Medicaid.
When national lawmakers move to defund Planned Parenthood, they’re typically talking about barring the group from receiving federal Title X funds. While that would deal a blow to the organization’s budget, it wouldn’t wipe out most of it, since the Medicaid reimbursements and the state-level funding would remain intact. Politically speaking, it’s also unlikely that such a measure would make it through Congress thanks to Democratic opposition.
But that doesn’t mean Planned Parenthood is safe from the fallout from the current controversy. As Politico reports, at least eight GOP-controlled states have already responded to the allegations in the recently released videos by going after Planned Parenthood. Some states, like Louisiana, have launched investigations into the group’s activities that will have the immediate impact of preventing new health clinics from being able to open their doors. Other states are renewing their efforts to defund the group.
This should worry reproductive rights proponents. It’s much easier for Republican-controlled state legislatures to push through legislation to defund Planned Parenthood than it is to get that kind of bill approved on the federal level. There’s plenty of evidence of this dynamic. In 2011, after federal efforts to attack Planned Parenthood fizzled, conservative states were all too happy to take up the cause. Since then, seven states have passed laws making it harder for Planned Parenthood to receive Title X or Medicaid funding.
In fact, state-level attacks on Planned Parenthood can be so successful that presidential contenders are touting their efforts at home. As Gov. Scott Walker (R) hits the campaign trail in Wisconsin, he’s has been boasting, “We defunded Planned Parenthood.”
The funding cuts that Walker is celebrating had a concrete impact on Planned Parenthood’s ability to provide health services to low-income residents in the state. In 2013, the group was forced to close four of its clinics in Wisconsin because it couldn’t afford to keep them open.
Family planning experts agree that the most dire consequences of Republicans’ state-level crusade against Planned Parenthood are on display in Texas, which pursued a particularly aggressive legislative strategy against the organization. Texas lawmakers accomplished what most other states couldn’t: They stripped all of Planned Parenthood’s Medicaid funding, which has crippled the family planning network in the state and forced dozens of clinics to close.
In other states, courts have stepped in to prevent that outcome, arguing that the Medicaid program cannot legally bar qualified health providers like Planned Parenthood from providing care to its patients. Texas found a way around that by creating an entirely new family planning network — called the Women’s Health Program — with the specific goal of keeping out Planned Parenthood. The consequences have been dire. Clinics have been shuttered, women have been forced to find new doctors, and more than half of women say they’ve faced at least one barrier to getting the reproductive health services they need.
Planned Parenthood is often the largest provider in states’ family planning networks, so state-level efforts to exclude the group can make a big difference for patients. According to the Guttmacher Institute, more than one-third of the low-income women who relied on a safety net provider for their birth control in 2010 got those services at a Planned Parenthood clinic.
Plus, in addition to the challenges that arise from receiving fewer patients and less state funding, Planned Parenthood providers also struggle when they’re drawn into political battles that require them to play defense.
“When we see attacks on family planning providers, one major issue is that the providers and the advocates spend their time fighting the attacks instead of helping women access services,” Elizabeth Nash, the senior states associate at the Guttmacher Institute, a think tank that tracks state-level abortion policy, told Politico.
As lawmakers on the left are growing concerned about the potential ripple effects of the current video campaign — which evokes similar efforts to use heavily edited videos to successfully smear another progressive group, ACORN, which used to focused on voter registration and community organizing — some public figures are hinting about the potential risks in store for the struggling Americans who rely on Planned Parenthood.
“Planned Parenthood still remains a very important part of the whole health care delivery system, particularly but not exclusively for poor women,” Hillary Clinton, the Democratic presidential candidate who’s responded most directly to the controversy so far, said on Thursday. “I strongly believe that we need to make sure it can do that well into the future.”