Iowa winnowing of health care begins

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News that health care advocates had been dreading came Thursday: Planned Parenthood of the Heartland will shutter a third of it’s Iowa clinics.

Locations in Bettendorf, Sioux City, Burlington and Keokuk will close at the end of June. Only one of those locations offered abortion services, and it will continue to provide those procedures until the building is sold.

Soon to be lost is what more than 70 percent of Iowans supported — access to family planning services like contraceptives, prenatal vitamins and cancer or other disease screenings. More than 14,000 Iowans utilized the clinics now slated for closure.

Planned Parenthood clinics statewide serve nearly half of residents who use publicly-funded family planning services. Looking only at the four counties impacted by the closures, Planned Parenthood clinics served, at a minimum, 67 percent of these patients.

Winnowing of health care in the Hawkeye State is a reality because of decisions at the state level. In their haste to decry a legal medical procedure, Iowa legislators cast federal Medicaid dollars aside in favor of a state-funded program that discriminates against medical providers who offer abortion services.

Republicans supporting the plan fretted about taxpayer dollars indirectly supporting abortion. They preferred for people to believe that piles of money were being indiscriminately delivered to abortion providers. That simply was not and is not true.

Abortion providers, like all Medicaid recipients, are reimbursed for services. Every Medicaid dollar that flowed to Planned Parenthood was for a service already rendered, and abortion has long been excluded from the federal list of reimbursable services.

And, sadly, Iowa Republicans aren’t the first to employ this ruse.

Former Indiana Gov. and current Vice President Mike Pence declared a 2015 public emergency in his state due to HIV outbreaks. The county at the epicenter of the problem had been without a testing center since 2013, when the local Planned Parenthood clinic closed.

Just like three out of the four Iowa clinics now caught in the GOP’s defunding snare, the Indiana facility did not offer abortion services — none of the five Indiana clinics forced to close offered abortions, but they all provided HIV testing. Instead of being able to rely on ongoing prevention efforts provided by those local clinics, Indiana taxpayers took on the added cost burden of erecting pop-up clinics. Worst of all, Indiana residents needlessly suffered.

The state of Texas, which set aside federal dollars in 2013 in its own misguided battle against abortion providers, has experienced dramatic drops in contraceptive use and significant increases in unplanned pregnancies in counties once served by Planned Parenthood.

Now Texas is petitioning the federal government in hope the Trump administration will allow it to continue to discriminate against abortion providers and allow it to reclaim the Medicaid funds it cast aside. The reasoning behind that petition should have given Iowa lawmakers pause before they pitched the Hawkeye State down the same, ugly road.

Texas state officials write that they have one of the nation’s highest teen birthrates and the highest total birthrate. Half of those births, they say, are by women eligible for their newly established state-run program; women that would be eligible for federal Medicaid.

Texas women, state officials admit, are not able to access the family planning care they need under the limitations of the state-run plan they crafted. One third of Texas’ pregnancies are now unplanned.

Teen childbearing alone costs the state of Texas $1.1 billion each year.

The dirty little truth that Republicans supporting these changes don’t want you to know is that every dollar invested in family planning saves taxpayers an average of five. When the state knowingly and deliberately excludes family planning services providers, they increase taxpayer cost fivefold. When they choose to also institute arbitrary taxpayer funding caps on their newly established limited services, they are cutting off access to the prenatal services pregnant women need, and setting the stage for poor health outcomes for those women and their children.

As Texas discovered, it’s a vicious circle that only gets worse with time.

Limited public investment leads to more unplanned pregnancies with less medical access. Less medical access leads to more children born into poverty. More children born into poverty requires more public investment.

At the time Texas lawmakers began their switch, they knew their action would result in more than 20,500 extra unplanned births, costing the state and country millions. Iowa lawmakers didn’t even bother to produce a similar estimate, or fully explore the range of services their funding plan extinguishes.

“The only reason these patients are losing their health care provider, the only reason these closings are happening and the only reason that longtime valued employees at Planned Parenthood of the Heartland are subsequently losing their jobs is the budget Gov. Branstad signed into law last week that defunded Planned Parenthood of the Heartland,” Suzanna de Baca, president of the local affiliate, said.

The organization and its supporters are pledging to hold elected officials accountable. Even if they are successful, however, thousands of Iowans will have already paid the price of ideological ignorance.

l Comments: @LyndIowa, (319) 339-3144, lynda.waddington@thegazette.com

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