Why Do Politicians Target Medicaid Users to Shut Down Planned Parenthood?

This is the second post in a three-part blog series on why some abortion politicians want to block Medicaid patients from Planned Parenthood. Our first blog was about why Planned Parenthood provides abortion. Next up: why people use Medicaid for preventive care at Planned Parenthood health centers.

For over a decade, politicians have repeatedly tried to block people from using Medicaid at Planned Parenthood health centers. So far, they've tried using “defund” tactics that largely failed or were blocked in the courts — with two big exceptions: Arkansas and Texas.

The "defund" tactic is so central to politicians' playbooks that it raises a question: Why do politicians specifically target people with MEDICAID in their strategy to damage Planned Parenthood?

The answer has 3 parts: money, elections, and abortion.

People with low incomes use Medicaid at Planned Parenthood health centers for preventive health care.

Nearly half of Planned Parenthood’s 2.4 million patients get preventive sexual and reproductive health care services through Medicaid, a program that provides health insurance to people with low incomes.

Politicians are exploiting people with low incomes.

Politicians are using people with low incomes as pawns to win elections

With an eye toward elections (see next section), politicians in Arkansas and Texas have blocked thousands of Medicaid patients from accessing care at Planned Parenthood health centers. Politicians in other states are trying to do the same.

Politicians are using abortion as a political ploy with single-issue voters.

The politicians using “defund” attacks are pandering to the small minority of single-issue voters who want to make abortion illegal. In addition to preventive care, Planned Parenthood proudly provides safe, legal abortion at manyof its health centers around the country. That makes Planned Parenthood and Medicaid patients targets f agenda-driven politicians.

It’s important to note that Medicaid at the federal level solely covers preventive care, not abortion — save for extremely narrow exceptions. Medicaid does cover abortion when continuing the pregnancy will endanger the patient’s life, or when the pregnancy results from rape or incest. And some states will pay for abortions with state-only Medicaid dollars.

Why do people with Medicaid come to Planned Parenthood health centers?

People who rely on Medicaid choose to come to Planned Parenthood for their preventive health care for many of the same reasons as other patients. Here’s why.

One-Stop Shop for Essential Health Care

People with all types of health insurance and people with not health insurance at all come to Planned Parenthood for high-quality and compassionate preventive care and abortion.

Planned Parenthood is a vital safety-net provider, and abortion is a health service that is just as essential to people with Medicaid as anyone else. Planned Parenthood has a more than 100-year history providing care — no matter what.

Care Over Profit

Planned Parenthood has always been a nonprofit organization. In fact, its first birth control center opened in a working class area of Brooklyn — largely through donations. At the time, rich women had a lot more access to birth control and sex education than the immigrant women who lined up around the block at the health center. Writings of the day describe people who suffered serious health problems and died from being unable to control the number of times they got pregnant.

A Vital Safety-Net Provider

Today, Planned Parenthood remains committed to increasing access to sexual and reproductive health care for all people, including people with low incomes. Planned Parenthood’s 600 health centers play a core role in the nation’s social safety net.

Since 1965, Medicaid has provided free and low-cost health insurance coverage to people with limited incomes and resources in the United States. It just so happens that Medicaid is also the primary source of public funding for reproductive services, including birth control and education about fertility.

Because of Planned Parenthood’s mission to expand access to health care, a significant number of patients in Planned Parenthood health centers are covered by Medicaid. Outside of Planned Parenthood health centers, many doctors’ offices do not accept Medicaid patients at the same volume — if it all.

Why is a safety-net provider also an abortion provider?

Historic patriarchy and systemic barriers in U.S. health care have meant that sexual and reproductive health care is disproportionately relegated to certain health care providers.

Intersections: Reproductive Health and Insurance for People with Low Incomes

In many cases, health care is out of reach for people who work for employers that don't provide health insurance (such as farm workers and part-time retail workers). The U.S. health care system prioritizes private, employer-sponsored health insurance. And THAT makes safety-net providers especially important for people without employer-sponsored coverage.

What’s more, many people who need an abortion cannot get one at their private doctor's office — even with employer-provided health care coverage. Four factors make it less likely for private doctors’ offices to provide abortion and create a greater need for health centers like Planned Parenthood to provide abortion:

Barriers to becoming an abortion provider
Restrictions on health care providers
Restrictions on health care facilities
The unique mission of abortion providers

Remember: Medicaid does not cover abortion for 56% of women of reproductive age.

Since 1976, a misguided and discriminatory policy called the Hyde Amendment has blocked federal health care programs like Medicaid from covering abortion. (Some states have enacted a workaround where state Medicaid funds can be used to pay for abortions — but just 44% of women of reproductive age live in those states). That means Planned Parenthood patients generally pay for abortion services in ways that do not involve the federal government, such as private health insurance, abortion funds, state funds in some places, or their own resources.

That means blocking people with Medicaid from Planned Parenthood essentially blocks them from getting preventive care — such as birth control, STD testing, and breast and cervical cancer screenings — and treatments, such as medication to heal STDs and UTIs.

Since Planned Parenthood is not a line item in the federal budget, a literal “defund” is not possible. But many politicians use misinformation to further their ideology. What is being called "defund" is simply blocking Medicaid reimbursement for the preventive care and treatments Planned Parenthood provides. Medicaid reimburses Planned Parenthood for the health care services it provides, just as it reimburses any other health care provider — so when politicians block the use of Medicaid coverage to access potentially lifesaving care at Planned Parenthood health centers, patients are most hurt.

Access To Care Needs To Be Restored to People with Medicaid in Arkansas and Texas

In several states, as well as Congress, Planned Parenthood’s Medicaid patients have been used as pawns in political games.

Federal Medicaid law guarantees patients the freedom to choose their provider of family planning services. That means ALL Medicaid programs across the country should ensure ALL Medicaid patients receive this protection and can go to their chosen provider for their care — including when their chosen provider is Planned Parenthood. However, hostile politicians in Texas and Arkansas cut off access to preventive care at Planned Parenthood for people who use Medicaid. So, Texans and Arkansans get less access to health care than those in other states.

Arkansas

Since 2017, people with Medicaid have been unable to access care at any Planned Parenthood health centers in Arkansas.

In 2015, Arkansas Gov. Asa Hutchinson blocked Medicaid users from receiving care at any Planned Parenthood health center in the state. Planned Parenthood and its patients sued, and Gov. Hutchinson’s mandate was originally blocked by a federal district court.
In 2017, the 8th U.S. Circuit Court of Appeals panel held that patients lacked the ability to go to court to vindicate their right to free choice of provider, and permitted Arkansas to exclude Planned Parenthood as a provider in the state’s Medicaid program.
Legal challenges are ongoing.

Texas

After being blocked by litigation for nearly six years, Texas politicians removed Planned Parenthood from the state’s Medicaid program in March 2021. The move jeopardizes care access for more than 8,000 Texans. This attack on health care access came after an already harrowing power outage, which caused thousands of people across Texas to delay their appointments for a range of services, including STD treatment and birth control.

Tags: Medicaid, Health Equity

Protect access to Planned Parenthood health centers for Medicaid patients