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The Family Planning Choices Low-Income People Should Have

Efforts to cut Planned Parenthood's funding show a lack of understanding of the needs of millions of Americans.

Last week, Wisconsin Gov. Scott Walker signed two bills to restrict public funding of Planned Parenthood. The first pulls federal Title X family planning funding from Planned Parenthood of Wisconsin, which has been the sole Title X grantee in the state, and redirects the money to the state's Well Woman program. The second bill limits how much Planned Parenthood can be reimbursed under Medicaid for contraception.

Proponents of the legislation asserted that defunding Planned Parenthood would have no impact on patients' access to high-quality family planning services. Unfortunately, however, the Wisconsin bills and comparable efforts in other states -- on Sunday, Ohio Gov. John Kasich signed legislation blocking public funds from Planned Parenthood in his state -- come amid continuing congressional attempts to erode publicly funded family planning across the country. All of these efforts seek to shrink the capacity of long-trusted safety net providers to leverage scarce public resources for delivering subsidized care to millions of poor and low-income individuals.

The fact that Planned Parenthood provides abortion care is, of course, the issue driving these ongoing efforts to punish the organization, even though by law federal funds cannot be used to cover the costs of abortions. Despite that restriction, since last summer Congress has advanced a number of proposals to divert public resources from Planned Parenthood, suggesting that there is a larger, ready-made network of other trained providers that can provide family planning care.

This argument demonstrates a fundamental lack of understanding of how millions of individuals across the country have their preventive-care needs met. The debate should not be about whether or not other providers in the area have the capacity to handle the influx of patients who would be seeking care after Planned Parenthood affiliates are banned from receiving Title X funding. What's really at stake is whether low-income women and men should have the same right to choose their care providers as do those with private health insurance.

No two patients are the same. That's particularly true in family planning. People seeking care -- both women and men -- make different decisions and have unique needs based on individual health and life circumstances. In the private insurance market, most women have direct access without a referral to obstetrics/gynecology specialists separate from their primary-care providers. The same is true in the Medicaid program: Federal law protects the right of enrollees to freely choose to receive family planning services from any qualified provider. This should be true for all individuals, not just those with insurance.

And you can't just whimsically shift Title X funding, which pays for birth control, cancer screenings, STD services and well-woman exams for more than 4.1 million people annually. Title X is a competitive grant program that funds applicants, including state health departments, family planning councils, hospitals, community health centers or Planned Parenthood affiliates, that demonstrate a strong capacity to deliver high-quality family planning care to primarily low-income and uninsured women and men. These provider networks look different from state to state because they are designed to meet the specific needs of the communities they serve.

That is why it is important for Title X to support a diverse network of providers, with nurse practitioners, doctors and educators trained and focused on providing high-quality, compassionate and confidential care. Low-income, uninsured or underinsured women and men should have the same access to care as their insured counterparts. And they should be able to seek that care from the provider of their choice -- even if that provider is Planned Parenthood.

It is a disservice to a patient to tell her she can no longer see her trusted family-planning provider based solely on her income or insurance status. Yet by giving states or Congress the discretion to restrict longstanding provider protections, we risk reversing the recent advances we've made in eliminating gaps in gender equality and care delivery in our nation's health-care system.

While demand for publicly funded family planning has continued to grow, the Title X budget has been cut year after year. We don't need any more damaging policies that limit provider choice and block access to care. We need real, lasting support to help the millions of women and men served in the safety net get the information and care they need from the providers they trust.

Clare Coleman is president and chief executive officer of the National Family Planning & Reproductive Health Association.
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