Delivering on a high-profile campaign promise, President Trump on Thursday signed legislation allowing states to cut federal family planning funds for doctors and clinics that provide abortions, including Planned Parenthood. The action reverses the Obama administration’s last-minute ban on states withholding federal Title X family planning funds from abortion providers.
Before and after the ban was in place, 13 states had already tried to block abortion providers from getting Title X money, according to The Washington Post. That number is now expected to climb. Meanwhile, the Republican-controlled Congress is likely to cut family planning funds in general in the first budget that Trump signs.
But not every GOP-led state will strip funds from abortion providers.
Earlier this month, Maryland's Republican governor, Larry Hogan, let a first-in-the-nation bill become law that promises to fill gaps in Planned Parenthood's funding if it's reduced. Last month, Massachusetts GOP Gov. Charlie Baker made the same promise, although a plan hasn’t yet been presented. A similar bill has emerged in Nevada, another state with a moderate Republican in charge.
Under its new law, Maryland is prepared to replace the $3 million Planned Parenthood got in Title X funding last year with $2 million coming from Medicaid and $700,000 from the state’s general fund. Massachusetts would need to find $2 million to fill a potential federal funding hole; Nevada would need about $3 million.
Numbers like those are a small fraction of states' Medicaid spending.
“Three million dollars is nothing when you look at the grand scale of Medicaid, which can be up to 40 percent of a state’s budget,” says Judy Solomon, vice president of health policy at the Center on Budget and Policy Priorities (CBPP).
Last year, Planned Parenthood alone received approximately $390 million from Medicaid and just $60 million from Title X. (Federal law already bans Title X money from being used to pay for abortions; instead it's used for birth control, cancer screenings, and testing and treating sexually transmitted infections.) While Planned Parenthood has become the most visible -- and the most vilified -- advocate of abortion rights, it only performs roughly one-third of abortions in the U.S. Laws like Maryland's aren't designed to protect all the other clinics that are impacted by potential cuts.
Of course, both Maryland's Hogan and Massachusetts' Baker are moderate Republicans in a state with a strongly Democratic legislature. Other states with more conservative GOP leaders will assuredly move to defund Planned Parenthood and other similar facilities.
But cutting off funding to abortion providers isn't that simple. States first need to figure out which clinics and physicians do and do not provide abortions.
“It’s not like Planned Parenthood funding is this separate, add-on family planning program,” says Elizabeth Nash, state policy expert at the Guttmacher Institute, which tracks reproductive rights policies.
In addition, courts have upheld most of the attempts to withhold Title X funds, but not Medicaid dollars, often citing that states had no medical reason to do so. A few states, however, have found a legal way around that restriction.
In 2013, Texas started rejecting federal Medicaid money for women's health programs and instead created its own state-funded program that offers pregnancy testing and counseling, cancer screenings, immunizations and other family planning services -- but no abortions. By creating a program with its own money, Nash says the state is no longer bound by federal Medicaid rules and can exclude any organization it wants, including abortion providers.
Earlier this year, Missouri decided to follow Texas' lead. The new law, which is set to take effect July 1, could close the state's only Planned Parenthood facility that offers abortions. According to Jennifer Tidball, the state's Department of Social Services acting director, the other 10 Planned Parenthood clinics have already stopped performing them because of a variety of abortion restrictions over the years.
The Congressional Budget Office concluded last month that completely defunding Planned Parenthood would leave many women without access to any family planning services (irrespective of abortion), resulting in thousands of additional births per year.
“Medicaid ends up paying for that anyway,” says the CBPP's Solomon.