The federally funded family planning clinics that are supposed to offer a safety net for low-income Americans are in crisis.
The clinics in the Title X network provide confidential reproductive health services on a sliding pay scale, including STD screening, Pap smears, and birth control consultations. Most of the patients who rely on these health centers are low-income and uninsured and would struggle to get that care elsewhere. Others may have private insurance, but prefer the confidentiality of the family planning network.
Clare Coleman, the president and CEO of the National Family Planning & Reproductive Health Association, which represents Title X providers, is worried about being able to reach the Americans who need those services the most.
“We’re now in the fifth year where the network hasn’t seen any increase in service dollars — there’s no new money to provide health services,” Coleman told ThinkProgress. “So now you’ve got a system that’s dropped a significant number of patients.”
According to the federal government’s latest report on the Title X network, which was released this week, the program’s clinics served about 206,000 fewer patients in 2013 compared to the year before. There were 21 fewer service sites available to visit. Since 2010, more than 670,000 patients have dropped out of the system.
We don’t have clear data about where exactly those people are going. It’s possible that some of them gained new coverage under the health reform law and have since been absorbed into the private insurance market. It’s also possible that recent shifts in the field of reproductive health — more women are opting for long-acting forms of birth control, and women have also been instructed to get Pap smears less frequently — have resulted in fewer regular appointments at Title X clinics.
But it’s also likely that many of those patients are simply unable to get the health services they need because the Title X network isn’t able to accommodate them.
According to research from the Guttmacher Institute, about 20 million women in the United States need access to publicly funded contraception. Coleman says that Title X clinics have historically only been able to meet about a third of that need. Because it’s a discretionary program, it often gets trimmed when lawmakers are trying to figure out how to reduce spending. As more Americans slipped into poverty after the recent economic recession, Title X’s patient load increased, but its budget didn’t.
“The Title X program is woefully underfunded,” Kinsey Hasstedt, a public policy associate at Guttmacher, told ThinkProgress. “On the whole it certainly has not grown as it should to keep up with the demands for services.”
On top of that, Title X has also been caught up in politics. As part of a crusade against abortion providers, Congress attempted to wholly defund the program in 2011. Although that effort was unsuccessful, abortion opponents simply took the fight to the states, where it’s gained more traction. Over the past three years, states like New Jersey, Montana, Texas, and Maine have all slashed family planning funding.
Those funding cuts have forced some publicly funded clinics to close, or significantly cut back on their hours and services.
“We’ve certainly felt the impact of flat funding, and we’ve actually experienced some cuts at the state level as well. There have been some tough decisions we’ve had to make,” Jennifer Thibodeau, the director of communications and marketing for Maine Family Planning, which operates 18 clinics across the state, told ThinkProgress.
Thibodeau’s clinics have reduced the number of hours that nurse practitioners are available to meet with patients, as well as lowered the number of different birth control pill options that patients can choose from. They’ve tried to ease the direct impact on the population they serve by increasing options for electronic communication, and offering some consultations over the phone.
“We’ve tried to be really creative and innovative so it’s not affecting patients as much as it could be,” Thibodeau said. In the absence of sufficient Title X funding, her group has also been seeking grant money and private donations.
Although Title X’s budget has recently been on the chopping block, Guttmacher’s research has actually shown that the program is one of the best investments that lawmakers can make. U.S. taxpayers save $7 for every dollar the government spends on family planning, largely because the care provided at publicly funded family planning clinics can help prevent millions of unplanned pregnancies.
Even some GOP leaders recognize the financial benefits of Title X. Earlier this year, House Budget Committee Chairman Paul Ryan (R-WI)’s audit of federal anti-poverty programs conceded that the program is “moderately effective,” concluding that the low-income women who rely on those clinics “have significantly greater odds of receiving contraceptive services and/or care for sexually transmitted diseases” than the women who rely on private physicians.
“It’s just really staggering that instead of investing money into this program, Congress has of late been cutting it,” Hasstedt said.
Texas provides a particularly dramatic example of what can happen when states stop investing in family planning. There, anti-abortion lawmakers’ battle against Planned Parenthood has upended the entire family planning landscape over the past two years, leaving low-income and rural women struggling to get the basic care they need. The National Latina Institute for Reproductive Health has recently been compiling data on the health care crisis, collecting stories from women who have been waiting for years to afford mammograms after finding lumps in their breasts, or have been forced to stop using their birth control because they can’t spare the extra money for it.
“The first thing that could help us turn this situation around is to stop attacking the provider networks — leave them alone and let them rebuild their systems,” Coleman said. “We need to attack this fallacy that everyone is going to have insurance and the safety net doesn’t need to survive.”