Conservative lawmakers have had it out for the Affordable Care Act (ACA) since the health insurance reform law was implemented seven years ago. They haven't had much success, but with Donald Trump as president, the Republican-led Congress sought to toss out the ACA and replace it with the American Health Care Act (AHCA).
The AHCA -- aka Trumpcare -- would have achieved a major GOP goal: defunding Planned Parenthood entirely. If the AHCA had passed, people enrolled in Medicaid wouldn't have been able to use Planned Parenthood services. But, on Friday, about an hour before the U.S. House was set to vote, Republicans pulled the proposed health care bill from consideration. This means the Affordable Care Act sticks around, at least for now.
However, it doesn't mean Planned Parenthood is safe. Over 20 states have already made moves to cut off Planned Parenthood from public funding. Currently, in Iowa, lawmakers are considering a bill that would replace its state family-planning program with an alternative version in order to deny Planned Parenthood state money -- an action first taken by Texas five years ago.
Any cuts to Planned Parenthood's funding would force the organization to cut services or close clinics all together; in states that have defunded the group, such as Texas, the loss of public health funding has led to widespread clinic closures, including non-Planned Parenthood centers. In some places, defunding could mean losing the only health clinic. And that would have huge consequences for HIV prevention and treatment services.
How Defunding Planned Parenthood Would Harm HIV Services
Vice President Mike Pence has led the charge to defund Planned Parenthood since 2007 -- first as a member of Congress, then as governor of Indiana. He saw some success in 2011, when the House passed his amendment to strip the health care provider of federal monies. That same year, Pence's home state of Indiana made dramatic cuts to state public health spending that by 2014 cost Planned Parenthood of Indiana $1.4 million in funding.
Pence made deeper cuts to public health spending in 2013, during his first year as governor of Indiana. That forced the Planned Parenthood health center in the city of Austin, Indiana, to close -- a loss that helped fuel a major HIV outbreak. Losing the clinic meant residents of the rural Southern Indiana town, which had only one doctor back in 2015, lost the only place they could get free HIV testing. By 2016, there had been 190 new cases of HIV transmission in the small town.
Advocates fear the possibility of a nationwide outbreak if conservative lawmakers successfully defunded Planned Parenthood at the federal level -- a move even 57% of Trump supporters don't agree with, according to PerryUndem poll data. Right now, Planned Parenthood is one of the larger providers of HIV screening services in the country, administering more than 650,000 tests each year across its nearly 700 clinics, according to its latest annual report. Testing and treatment for sexually transmitted infections (STIs), including HIV, accounted for 45% of services provided by Planned Parenthood affiliates in 2014.
Recently published research conducted by Yale University lecturer Miranda Yaver, Ph.D., found that states with a higher number of Planned Parenthood clinics have lower rates of STIs and also teen births.
The AHCA may have been defeated, but states continue to chip away at Planned Parenthood's budget, seeking to weaken the organization until it no longer exists. Texas, for example, has performed budget gymnastics to steer money away from Planned Parenthood since 2011. After the federal government squashed efforts to exclude Planned Parenthood from Texas' Medicaid program, lawmakers created a state-funded replacement in 2013 that denied Planned Parenthood public funds. (A federal judge once again blocked Texas from excluding the organization from Medicaid last month.) Iowa's bill seeks to do the same.
"That becomes a huge challenge for us about how do you protect people and how do you protect the system in a world where there aren't federal dollars," Matthew Rose, policy and advocacy manager for NMAC told TheBody.com.
If Iowa defunds Planned Parenthood, that would devastate populations already facing barriers to accessing health care. Nationally, at least 60% of the 2.5 million people Planned Parenthood serves rely on Medicaid for insurance, according to data provided by a Planned Parenthood spokesperson. And recent Kaiser Family Foundation research shows that Medicaid covers more than 40% of people living with HIV in care. Losing Planned Parenthood could mean that people living with HIV who are low income would lose their only source of treatment, advocates say.
Other marginalized communities would also feel the consequences of a defunded Planned Parenthood. A recent Williams Institute report revealed that roughly 25% of lesbian, gay, bisexual and transgender people nationwide cannot afford health insurance. This is particularly a concern for black gay men and black transgender women -- two groups that are at highest risk for HIV transmission and have some of the higher rates of HIV in their communities, according to the U.S. Centers for Disease Control and Prevention (CDC).
"With funding cuts, folks would be left to figure out where to get HIV tests, and that alone is work," Louis Ortiz-Fonseca, Advocates for Youth's senior program manager for LGBTQ Health and Rights told TheBody.com. "Some people do not have that privilege in exploring [options] because folks are surviving poverty. They're surviving racism and homophobia and transphobia."
Planned Parenthood's efforts to expand access to pre-exposure prophylaxis (PrEP) could also be stalled if the organization were defunded, even at the state level. It takes money to educate and train medical providers and to dispense the medication. So, any loss of funding could slow down Planned Parenthood's rollout efforts.
"That right there would be a dramatic impact on folks who feel themselves to be at risk for HIV," Ernest Hopkins, legislative affairs director for the San Francisco AIDS Foundation, told TheBody.com.
Advocates understand that states such as New York, Washington and California will continue to protect funding for HIV services. Efforts in those states have led to lowered HIV transmission rates and longer life expectancies for people living with HIV, Rose said. But any cuts to funding could undermine much of the progress that has been made in the last 30 years.
"Some of the great advances in HIV are going to require some more strategic investments," Rose said. "We are very, very efficient with the money that we have, but that money has never been enough."