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Dark future of US healthcare without Planned Parenthood

As Republicans prepare to defund Planned Parenthood nationally, those left to provide contraception and other services in US states that have already done so say women of color and from low-income groups will be hit the hardest

By Molly Redden  /  The Guardian

Illustration: Tania Chou

In the remote western plains of Texas, the Midland-Odessa region is separated from the nearest major city by hours of open road. So when the Planned Parenthood clinic in Midland closed down in late 2013 — a casualty of legislative cuts that targeted Planned Parenthood directly — it served as an isolated experiment in what happens when the government defunds the largest women’s healthcare provider around.

“I hate to say it, but I think an awful lot of women just opted to go without care,” Midland Community Healthcare Services (MCHS) chief executive Mike Austin said.

MCHS is a federally funded network of providers that has emerged as the only major alternative to Planned Parenthood in the area. His clinic offers all of the same services the Midland Planned Parenthood once did, including contraception, cancer screenings and sexually transmitted infection (STI) tests, to the same kind of patients, low-income women who rely on the public safety net for their healthcare.

In fact, just before the Planned Parenthood clinic shut down, the two providers made a plan to minimize the fallout. Planned Parenthood sent nearly 5,000 patient medical records — up to 1,000 belonging to active patients — directly to MCHS.

To Austin’s dismay, only about 100 former Planned Parenthood patients ever showed up at his door.

“We are seeing a subsequent rise in sexually transmitted diseases and a subsequent rise in unplanned pregnancies,” Austin said.

He believes they could be linked.

“And I’m sitting here going, ‘See? I told you so. This is what happens,’” he said.

In the weeks ahead, members of the US Congress will replicate Midland’s experiment on a grand scale by defunding Planned Parenthood across the country. They will do so in the form of a budget that blocks Planned Parenthood from accepting Medicaid, the government-funded insurance for low-income individuals.

It is a move Republicans have long framed as a rebuke of Planned Parenthood’s role in providing abortions — even though Medicaid is prohibited from covering abortions by law, and only half of Planned Parenthood clinics even offer the procedure.

What Medicaid does do is allow Planned Parenthood to provide contraception, cancer screenings and STI tests to 1.5 million patients in the public safety net at some 650 health centers for no cost. About two-fifths of the organization’s US$1.3 billion annual budget derives from public funding. Without the reimbursements Medicaid provides, a spokeswoman for Planned Parenthood said, an unknown number of those centers will have to close.

US House of Representatives Speaker Paul Ryan recently predicted that federally funded health centers — like the one in Midland — could pick up where Planned Parenthood left off.

“They’re in virtually every community,” he said at a recent town hall, “providing the same kinds of services.”

However, public health officials such as Austin, who work in states where Planned Parenthood’s presence is already in decline, are sounding the alarm. They say the loss of Planned Parenthood would imperil the health of thousands of women who already face high barriers for care.

Some of the strongest voices in opposition come from Ryan’s own backyard.

“They’ve never replaced the services of Planned Parenthood,” said Gail Scott, director of health in Jefferson County, Wisconsin.

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