The Iowa Senate Votes to Defund Abortion Providers

(Des Moines, IA) The Iowa Senate on Thursday afternoon voted 30 to 20 in favor of SF 2, a bill that would reallocate state taxpayer funding away from abortion providers to federally qualified health centers and family planning organizations who do not provide abortion services.

The party line vote had all of the Senate Republicans (who also co-sponsored the bill) and State Senator David Johnson (I-Ocheydan) voted in favor of SF 2. The entire Democratic caucus voted against the bill.

The bill reads, “Distribution of family planning services program funds shall not be made to any entity that performs abortions or that maintains or operates a facility where abortions are performed.”

Additionally the bill also says, “Family planning services program funds distributed in accordance with this section shall not be used for direct or indirect costs, including but not limited to administrative costs or expenses, overhead, employee salaries, rent, and telephone and other utility costs, related to providing abortions as specified in subsection 4.”

State Senator Amy Sinclair (R-Allerton) was the floor manager for the bill and gave opening remarks to introduce what the bill does and doesn’t do.

Sinclair provided Caffeinated Thoughts with the transcript of her remarks as prepared for delivery.

Thank you, Mr. President.

Colleagues in the Senate, ladies and gentlemen here to observe these proceedings, I’d like to bring before you SF 2, a bill for the establishment of a State Family Planning Services Program.

The program outlined by this bill will replace the current Medicaid Family Planning Network waiver. This change makes Iowa’s family planning services ostensibly state funded (though it’s possible federal money will still be used through a block grant, which allows the state more discretion in how that money is spent than through Medicaid). This change will allow Iowa to restrict government funding of family planning services away from organizations that perform abortions that are not medically necessary.

The bill directs DHS to discontinue the Medicaid Family Planning Network waiver, effective 7-1-17, and instead establish a State Family Planning Services Program. The Program is to replicate eligibility and other requirements from the Waiver and distribute funds in a manner that continues access to family planning services. However, none of the funds are to be distributed to any entity that performs abortions or that maintains or operates a facility where abortions are performed. The bill specifies that this prohibition includes funds for indirect costs or expenses, overhead, employee salaries, rent, and telephone and other utility costs, related to providing abortions.

For purposes of the bill “abortion” does not include:

• Treatment for a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would as certified by a physician, place the woman in danger of death
• Treatment of a woman for a spontaneous abortion, commonly known as a miscarriage, when not all of the products of human conception are expelled

The bill requires DHS to submit a report to the Governor and the General Assembly annually by January 1 listing any entities that received program funds that are in the lowest position of priority described as nonpublic entities that provide family planning services but do not provide required primary health services as defined in federal law, as well as the amount and type of funds received by such entities during the preceding year. The report is also to include a detailed explanation of how DHS determined that distribution of program funds to such an entity was necessary to prevent severe limitation or elimination of access to family planning services in the region of the state where the entity is located.

Many Iowans have brought questions to me and concerns regarding how this will affect women’s reproductive health. In response to those concerns, I reached out to the executive branch and received guidance from the Department of Human Services, who will be tasked with administering the new State Family Planning Services Program.

First, this bill will not completely eliminate tax funding to Planned Parenthood in the state of Iowa. This bill deals specifically with the Medicaid Family Planning Network waiver, which utilizes state tax dollars, but does not address the Medicaid Title X program nor the teen pregnancy and sex education grant programs. These are fully federally funded programs totaling approximately $1.5 million with different funding requirements.

Second, this bill will not eliminate family planning funding for services for needy Iowa women. Last year, approximately $3 million was spent, using a combination of state and federal monies. This bill would actually transition the same requirements for covering these women for birth control, PAP tests, STI tests, all the same services as currently covered. While this bill is a purely policy bill, it is the intent of this body to actually expand the amount committed to the purpose to over $3 million, as it is anticipated that the access to providers will increase usage of the program.

Next, this bill does not change laws regarding abortion. Currently, tax funding cannot cover elective abortions, so there will be no change related to that. This bill does not limit or infringe the legal option of a woman to seek an abortion. It is a measured attempt to balance the reproductive healthcare needs of Iowa’s working poor with the objections of the taxpayers to tangibly subsidize that option through public support of shared facilities.

Another misconception is that family planning services will be provided by people unqualified to do that job. There is zero allowance in this bill for allowing family planning services to be provided by anyone other than trained medical providers. The added benefit is that those healthcare services will be, in many cases, provided by people also qualified to address the woman’s overall health and identify needs that may currently go unnoticed. The positive implications of that alone are enough to garner support of SF2.

It has been stated that 80,000 Iowa women will lose access to healthcare. That statement is false. 80,000 is the total number of Iowans who have been covered under over the life of the current program. DHS confirmed that approximately 12,000 individuals received care under the current family planning system during the past year. To quote Senator Charles Schneider, “That’s not a political statement; that’s just math.” And while that’s still a significant number of Iowa men and women receiving treatment, none of those individuals will lose care under the newly designed family planning services program.

Some question has been raised about the process of prioritizing providers and the impact of a huge influx of patients to the first tier providers. While on the surface that could be of concern; DHS guidance on the matter quickly alleviates it. To quote directly from the proposal for implementation of the State Family Planning System, “The $3,383,880 funding level is expected to fully-fund the program. Prioritization will only be needed if funding is exhausted.” To put it simply: all Medicaid approved providers will be able to provide care to patients, and the expanded group of providers will ensure that the first tier providers are not overwhelmed, nor cause a backlog in service. The prioritization exists as a mechanism for allocating funds to make it a priority to connect women with a primary care provider first, as we see that as the direct benefit to transitioning to a state run program

A final concern brought to my attention was that DHS would be unable to implement the program by the date provided in the bill. Upon request for information, DHS guidance rejects that notion. They will utilize the same delivery model currently used. They will use the same MOU process with providers as they have used in the past. They will operate under the same qualifying process for patient access that currently exists. In short, according to their own documentation, “The SFPSP will improve access to eligibility for family planning and family planning-related services and increase the number of low-income people receiving family planning and family planning-related services throughout Iowa.”

I’d like to share some final thoughts regarding SF2 before I conclude my opening comments. There are zero planned parenthood clinics located in Senate District 14 and in many other rural areas across the state. That means that anyone I represent would have to drive to one of only 12 clinics, all located in urban areas, to access their needed services under the current system. Transitioning to the state option will allow every Medicaid waiver eligible clinic, in conjunction with private, non-profit family planning facilities to provide the same services right where our sisters and daughters and mothers live. The increased access, in scope of available service, is why I am such an advocate for the transition.

This plan intends to provide a higher level of funding than is currently allocated through the future appropriations process. The same rules for qualifying stand for both the providers and the clients. The only thing that changes is that any provider who also provides abortions will be excluded from eligibility. As a state, we are clarifying the guidelines for participating in a taxpayer funded function, which is a standard practice. If Planned Parenthood, or any other abortion provider, wishes to receive state family planning dollars, they could easily discontinue offering abortions, which I am advised is only 2.5% of their activity. We are not closing clinics nor prohibiting their legal activity. We are not interfering with a private entity in the conducting of their business. Women will not go without exams or care or screenings. They will just receive those services where they live and in conjunction with their broader healthcare needs.

Mr. President, those are my opening statements.

Speaking in opposition to the bill were State Senators Janet Petersen (D-Des Moines), Matt McCoy (D-Des Moines), Herman Quirmbach (D-Ames), Joe Bolkcom (D-Iowa City), and others.

State Senator Julian Garrett (R-Indianola) provided a rebuttal to Petersen’s assertion that when Texas defunded Planned Parenthood they saw an increase in maternal deaths.

Garrett pointed out that the defunding did not take effect until 2013 and the increase in maternal deaths in Texas happened before that. He also noted that Petersen neglected to mention in 2014 there was a decrease in deaths. He pointed out as well that many of these deaths were not necessarily health related as well.

State Senator Jason Schultz (R-Schleswig) pointed out the fact that Planned Parenthood of the Heartland is federal court because of alleged Medicaid fraud.

State Senator Brad Zaun (R-Urbandale) responded to the claim that abortion is only 2 percent of what Planned Parenthood does. He asked why they didn’t stop doing abortions then so they would be qualified to receive the money.

He also shared the experience that one of his constituents had with Planned Parenthood.

State Senator Ken Rozenboom (R-Oskaloosa) attempted to “give the unborn a voice” by reading a story about what a Biology professor at Calvin College said about the reborn. He was never able to finish as he was interrupted twice by State Senators Liz Mathis (D-Cedar Rapids) and Bolkcom.

The bill goes to the Iowa House where it is expected to pass.