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What Happens to Washington State Women if Title X Falls?

"It is my view that no American woman should be denied access to family planning assistance because of her economic condition. I believe, therefore that we should establish as a national goal the provision of adequate family planning services within the next five years to all those who want them but cannot afford them. This we have the capacity to do."

-- President Richard Nixon, 1970

We need to make population and family planning household words. We need to take sensationalism out of this topic so that it can no longer be used by militants who have no real knowledge of the voluntary nature of the program but, rather are using it as a political steppingstone. If family planning is anything, it is a public health matter."

-- Congressman George H.W. Bush, 1969


“What is more fiscally responsible than denying any and all funding to Planned Parenthood of America?” demanded Representative Mike Pence of Indiana, the chief sponsor of a bill to bar the government from directing any money to any organization that provides abortion services.

You’d think Rep. Mike Pence’s (R-IN) bill to defund Planned Parenthood, an organization which provides preventive health care to millions of Americans around the country, would be enough of a blow. They are going for the deep, painful cuts leaving many millions of Americans who are already at their most vulnerable even more exposed with a House leadership budget proposal to completely eliminate Title X, one of the most successful federal safety net programs this country has ever seen. It’s not a political game, as much as Live Action hoax video-makers Lila Rose and James O’Keefe seem to think it is. As states grapple with similar budget cutting, our friends, family and community members will find themselves without basic healthcare and as tax-payers we’ll literally pay the price of the decimation of a crucial public health safety net. In Washington State, with a multi-billion dollar budget shortfall, residents are already bracing for the impact of state cuts to family planning, maternity health services, health insurance for lower-income residents, prescription drug benefits for seniors and more. The elimination of the federal Title X program would be disastrous.

This may feel like a swipe out of nowhere but it’s been a long time in the making for the GOP. An extremely well-funded, coordinated attack has been waged and despite what it may be portrayed as in the mainstream media, this is far from only an attack on Planned Parenthood. This is an attack on millions of Americans. Title X does contribute towards the 97 percent of Planned Parenthood’s health care services which are preventative: annual exams, HIV testing, family planning, birth control, STI testing and treatment. However it also helps to fund public health centers around this country  - health centers which are often the only sources of health care for our country’s lower-income women, men and children. On a conference call with the press, Senate Democrats spoke of these proposed cuts, as well as the legislative attacks in the form of HR 3 and HR 358, as the most comprehensive threat to women’s health in our lifetime.

Senator Blumenthal called it:

“an unprecedented assault on women’s health....It creates reprehensible risks for the health of countless women across the country, puts them in jeopardy of losing vital health services, and it imperils not just them, but their families.”  

In Washington State, the public health clinics around the state served by our country’s Title X program provide care to a majority of the state’s uninsured population. Sixty percent of the clients of the Public Health Department’s family planning clinics have no insurance; not even Medicaid. Another 25 percent use Medicaid as insurance coverage and the rest utilize Take Charge.

James Apa, Communications Manager Public Health Seattle-King County (PHSKC) told RH Reality Check:

“These proposed federal cuts would wipe out family planning services for thousands of low income and uninsured women who visit our Public Health Centers across King County, piling on top of new and devastating state cuts to family planning and other Medicaid-supported services.”

We’re talking about women, men and young people who use family planning clinics, in particular, as a primary source of care throughout the state. Title X helps to fund family planning clinics that cover a broad range of services. According to PHSKC, for 3 out of every 4 poor women, family planning clinical services comprise their usual source of health care; especially when it comes to African-American or Latina women, uninsured people or those born outside of the United States. According to Dana Laurent, Political Director for Planned Parenthood Votes! WA, 60 percent of Planned Parenthood patients in Washington State utilize Planned Parenthood for their primary health care.

In addition, adds Laurent, 65 percent of their contraceptive clients rely on Title X to fund their care:

“Our Title X clients are not just receiving contraception, they receive breast exams, pap smears for early detection of cervical cancer, high blood pressure screenings – these women depend upon Title X for basic health care.”

And though Planned Parenthood provides services using Title X funds, they cannot afford to do so for free or on a sliding scale, the way family planning public health clinics do. City and state public health departments rely heavily on a variety of funding sources in the absence of other forms of revenue like fundraising and substantial client payments.

In King County for example, the Public Health Department for Seattle-King County is the only Title X provider for STD services. Title X programs do not need to cover STI services but King County does so anyway. The state is facing an STD crisis of immense proportions and more providers are unable to offer services to clients who are unable to pay. When a client visits a health care provider for care and he or she cannot afford the STD fees (upwards of $300 to $400), they are referred to Public Health. The Guttmacher Institute found that one in three women who received HIV testing or other STI testing did so at a publicly funded family planning center. Where do we think women, men and young people will go when their very last option is taken from them?

Says Laurent:

“They won’t have anywhere to go. We serve 140,000 patients around Washington State each year. The impact of eliminating Title X would be devastating to women’s health.”

The economic impact of eliminating Title X, on top of harsh state budget cuts, would reverberate for years and, in fact, add to federal, state and local public health costs. Nationally, for every 1000 women who lose access to publicly-funded family planning, 25 percent will become pregnant within the first year. In Washington State, for every $1 spent on family planning for lower income Americans, we save over $4 in Medicaid-covered pregnancy-related care. 

Apa says:

“Cutting proven health-promoting and cost-saving programs for our most vulnerable women makes no sense, particularly when such cuts would lead to thousands of additional unintended pregnancies each year.”

Laurent agrees:

“There are tens of thousands of women in Washington State who, if Title X funding is eliminated, will have virtually nowhere else to go. Our state’s public health safety net is really crumbling because of our state budget crisis and the percentage of our public health partners able to offer family planning services have dwindled. Planned Parenthood has tried to pick up those pieces even though our budget has been cut.”

Some of those partners – like Maternity Support Services in the state, for example – are being hit hard as well. If family planning access dwindles, women who need public funding for pregnancy and birth related care will increase. According to the Public Health Department, one in three women giving birth in Washington receives Maternity Support Services. However, what happens to those women who can no longer receive support from the program? Without the ability to access safe prenatal and childbirth care, plan for pregnancy and birth, and space out pregnancies, our poorest and most vulnerable women become that much more vulnerable to life and health threatening conditions. As well, we’re placing newborn’s health and lives in danger. Washington State residents – and taxpayers across the country – will pay for the Republican-proposed budget cut to Title X - not only in increased costs related to emergency care and unintended pregnancy - but with the health and lives of our women and babies.

And Laurent says Planned Parenthood is shocked for other reasons as well.

“This was a Congress that came in saying they’d fix the economy and create jobs and instead they’ve launched an attack on women under guise of deficit reduction when we all know the opposite is true – family planning saves money. This attack is not solution oriented. But we are making a loud and powerful noise and we are absolutely going to send a message to the extreme leadership: They need to stop the assault on women’s health!”

Title X is the only federal program with guidelines that ensure that no one can be turned away from accessing family planning services, because of inability to pay. In Washington State, as is the case around the country, the funding for family planning is thrown together a bit like those dinners you make from whatever's left in the fridge; a sprinkling of something here, a dash of something else there. Each piece, though, is critical to ensure that family planning access remains intact for our most at-risk residents. Title X has been an extraordinarily effective program created as a public health tool to help provide care for millions of Americans over the last forty years. Though the GOP has turned the public health program into an ideological and political game on the federal level, the consequences of cutting it for communities around the country are very real.


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