The proposed American Health Care Act targets the health provider Planned Parenthood with a set of proposed limits on Medicaid payments to the organization.
Monday, the nonpartisan Congressional Budget Office confirmed the magnitude of those limits. The CBO found the Republican plan would reduce overall federal spending on reproductive care for women by $178 million in 2017. In all, it would block about $400 million in Medicaid reimbursements to Planned Parenthood each year, according to Jacqueline Ayers, the director of legislative affairs for the organization.
"The vast majority of our patients are on some kind of federal program," Cecile Richards, president of Planned Parenthood, told NPR's Ari Shapiro on Tuesday.
In all, she said, about 1.6 million patients receive health care from the organization each year through federal programs such as Medicaid.
"Planned Parenthood operates just like every other health care provider in this country that provides abortion services. We get reimbursed for preventive care," she explained.
"I guess if you want to reduce unintended pregnancy and the need for abortion, the last thing you should do is try to deny women the access to family planning," Richards said.
Tom Glessner, the president of the National Institute of Family and Life Advocates, which gives legal advice and other support to faith-based pregnancy clinics, is optimistic about the projected savings for the federal government.
"On the positive side, taxpayers benefit from this provision," he told NPR.
"Taxpayers would spend $156 million less, over a decade, by defunding Planned Parenthood, even if women used more Medicaid dollars during their pregnancies."
Glessner was referring to the increase in births the CBO projects if Medicaid patients are cut off from Planned Parenthood. The costs associated with about 45 percent of all births in the U.S. are paid for by the Medicaid program.
"In the one-year period in which federal funds for Planned Parenthood would be prohibited under the legislation, the number of births in the Medicaid program would increase by several thousand, increasing direct spending for Medicaid by $21 million in 2017," the CBO report notes.
The Republican plan technically cuts off funding to Planned Parenthood for only one year. If the organization stops providing abortions, it will be eligible for Medicaid reimbursements again. But Richards said there is no chance that will happen.
"We provide full reproductive health care for people in this country," she said. "And even though abortions may make up a small portion of what we do, women and families and young people come to Planned Parenthood because they count on us to be on their side, and to provide them with health care they need."
Federal spending on abortions is already illegal, except in the case of pregnancies that are the result of rape or incest or that threaten the life of the mother, as NPR has reported.
Republican lawmakers and some clinicians have said that if Planned Parenthood closes clinics, other health providers would try to take on those patients. But community health clinics say they are already overburdened.
The Republican plan currently calls for tens of billions of dollars for states to spend as they see fit, including on preventive care for women.
"How will the states use that money? They have great flexibility," Douglas Holtz-Eakin, former director of the Congressional Budget Office and current president of the conservative think tank American Action Forum, told Ari on Tuesday.
"They can give it to insurers as reinsurance for expensive patients; they can give it directly to individuals to cover out-of-pocket costs; they can create a variety of other programs like high-risk pools for expensive patients."
But Richards argued that spending would need to address a supply problem in rural or poor communities.
"The public health community has been abundantly clear that they cannot absorb the 2.5 million patients that Planned Parenthood sees each year," she said. "And particularly for women who have found a lump in their breast or need birth control immediately, and maybe a community health center can see them in a month or two months, that's not good enough."
ARI SHAPIRO, HOST:
The Republican health care proposal includes a section on Planned Parenthood. The American Health Care Act would deny federal funds to Planned Parenthood for a year unless the group stops performing abortions. Republicans have been trying for years to defund the organization. This is just the latest effort. Planned Parenthood's president, Cecile Richards, joins us now in the studio. Hi there.
CECILE RICHARDS: Hi.
SHAPIRO: How much money would Planned Parenthood stand to lose under the American Health Care Act, and how big an impact would that have?
RICHARDS: Well, the vast majority of our patients are on some kind of federal program and so see us through the Medicaid program or Title X. It's about upwards of $400 million in reimbursements. But what's really important, Ari, to understand is that we actually are not in the federal budget. We get reimbursed for the care we provide. And we have about 2 and a half million patients who come to see us every year.
SHAPIRO: So if you're talking about $400 million a year in federal reimbursements, if that were to disappear tomorrow, what would that mean for Planned Parenthood?
RICHARDS: It would mean millions of patients would actually go without care. And Speaker Ryan's whole message has been somehow that people should be able to pick their health care provider but, it seems to me, unless they go to Planned Parenthood or unless they're a woman who's looking for birth control services.
SHAPIRO: This bill says if funding to Planned Parenthood was cut off, there will be supplemental funding for other community health clinics. Would that make up the difference that you're talking about? It's just that these clinics would not perform abortion.
RICHARDS: The public health community has been abundantly clear that they cannot absorb the 2 and a half million patients that Planned Parenthood sees each year. In fact I was just in Speaker Ryan's own district where we have three health centers that provide only preventive services 'cause that's actually what we're talking about here 'cause federal funds don't pay for abortion services.
And in one of those towns - Racine, Wis. - in his district, there is no other safety net health care provider that provides family planning. And the women I spoke to who are our patients are desperately concerned, as are millions of people across the country - is where they're going to go.
SHAPIRO: Beyond the question of reimbursements for Planned Parenthood, there is a provision in this bill that would not allow people to use their tax credits to purchase health care plans that cover abortions. Who would be most impacted by that, and what would the likely outcome be?
RICHARDS: Yes, for women in the marketplace, in the exchange, you can't buy health insurance coverage that would include abortion coverage. And of course, like all of these attacks on women's health, they hurt low-income women the most.
SHAPIRO: Many Americans who oppose abortion say they do not want their taxpayer dollars going to an organization that performs a third of the country's abortions even if their tax dollars are not funding abortions, even indirectly. How do you respond to those American taxpayers who say they're offended by any of their dollars going to Planned Parenthood?
RICHARDS: Well, actually that's not really true. The vast majority of Americans want Planned Parenthood funded. And so that's actually not accurate. And I think...
SHAPIRO: Well, Americans who oppose abortion...
RICHARDS: Well, but - again, Planned Parenthood operates just like every other health care provider in this country that provides abortion services. We get reimbursed for preventive care. And I guess, you know, if you want to reduce unintended pregnancy and the need for abortion, the last thing you should do is try to deny women the access to family planning. This is a public good. It's a public health good. And the vast majority of people in this country support not only Planned Parenthood but the health care services that we provide.
SHAPIRO: There are at least two Republican senators - Susan Collins of Maine and Lisa Murkowski of Alaska - who have said they don't want Planned Parenthood funding to be part of this health care bill. What kind of signals are you getting from Capitol Hill about the likelihood that this provision will stay in?
RICHARDS: Well, I mean we're working every day to make sure that members of Congress and members the United States Senate are hearing from patients back home 'cause we are in every single state in America. One in 5 women in this country have received health care from this organization, and to somehow wrap it up in the repeal of the Affordable Care Act, as Senator Collins and Senator Murkowski have said, is completely inappropriate and is literally going to create total chaos for women in America.
SHAPIRO: President Trump says funding will flow in full if Planned Parenthood just agrees to stop performing abortions. Would you ever?
RICHARDS: Absolutely not. You know, we provide full reproductive health care for people in this country. And even though abortions may make up a small percentage of what we do, women and families and young people come to Planned Parenthood 'cause they count on us to be on their side and to provide them the health care they need. Our motto is, care no matter what. And we take that promise very seriously.
SHAPIRO: Cecile Richards is the president of Planned Parenthood. Thanks for coming in today.
RICHARDS: Yeah, thanks for having me. Transcript provided by NPR, Copyright NPR.