ASHINGTON — As the White House and Republican-led Congress take aim at federal funding for health providers that offer abortion services, some state lawmakers may step in to fill the breach.
Last month, Maryland became the first state to guarantee funding for its Planned Parenthood clinics should the federal government strip funding, and similar efforts are afoot farther west.
A pair of bills in Nevada would create a state family planning fund to plug gaps in contraceptive coverage and codify Obamacare regulations into state law. And in Oregon, Democrats are optimistic about the chances of legislation that would guarantee that insurers cover contraceptive care and even abortion services at no out-of-pocket cost to plan beneficiaries.
The moves come amid growing signs that federal funding for Planned Parenthood and other groups that provide abortions is at risk.
The American Health Care Act, the Republican attempt to repeal Obamacare, would have stripped away that funding. The bill failed, but the Republican-led Congress last month passed legislation unraveling an Obama-era regulation that had prevented states from denying Title X family planning grants to health providers that offer abortions.
Vice President Mike Pence cast the tie-breaking vote, and the bill was later signed by President Trump.
“In my opinion, it’s an assault on women’s health issues,” Nevada state Senator Yvanna Cancela, a Democrat, said of the developments in Washington.
Cancela is a sponsor of the legislation to create a new funding mechanism for contraceptive and preventive screening coverage in her state, expanding the web of states whose laws guard against policy shakeups in Washington. Cancela said her legislation is largely influenced by a similar family planning program in Minnesota.
“This bill is a direct response to what’s happening at the federal level, which may leave the status quo in place but could do serious harm,” she said.
Other states are taking advantage of newfound political flexibility to move in the opposite direction. Since 2011, legislators in 16 states have attempted to block certain providers from receiving Title X funds. But even over the past several months, a number of states have tried to find other ways to restrict spending on reproductive health services.
In Iowa, for instance, a bill moving rapidly through the Legislature would remove funding for Planned Parenthood and create a state family planning network that excludes clinics where abortion is available. A number of other states have also reduced family planning funding at a rate disproportionate to broader cuts in public health spending.
But it is the action at the federal level that most alarms reproductive rights activists. Even in the absence of further restrictions on funding for Planned Parenthood, the looming federal budget process could see less money appropriated for family planning grants, leading advocates and health officials at the state level to determine how they can take action.
“We’re not an abortion provider, but we could be adversely affected depending on what the federal government decides to do with the grants,” said Dr. Joseph Iser, the health officer for the Southern Nevada Health District.
New Jersey, where state-level cuts were enacted in 2010, has already felt the impacts of cuts to family planning funds. In 2010, Governor Chris Christie slashed $7.5 million from the cause, and his veto pen has hamstrung repeated efforts by the Democratic-controlled Legislature to replace the money.
“We’re certainly looking at other states to see what sort of proactive measures they’re taking,” said Kate Clark, the external relations director for the New Jersey Family Planning League. “Our main focus is shoring up state support for family planning funding.”
The Congressional Budget Office estimated the impact of the effort to defund Planned Parenthood through the ACA repeal bill, projecting that 15 percent of people in areas served primarily by the group and affiliated clinics would lose access to “services that help women avert pregnancies.”
Those populations’ access to care worries legislators in Nevada, where a measure separate from Cancela’s bill would also codify Affordable Care Act women’s health protections into state law, then go a step further by requiring insurers to cover birth-control prescriptions good for a full year instead of the typical three months.
In Oregon, where the full-year provision is already law, Democrats seem likely to succeed in mandating that insurers cover contraceptive care and — unlike most taxpayer-funded programs — abortion services at no out-of-pocket cost.
“We got this bill up and running when we figured Hillary Clinton would be president, though Trump made it much more urgent,” said state Representative Jeff Barker, a Democrat pushing the measure.
The landscape surrounding abortion is less politically fraught in left-leaning Oregon than in other states, Barker acknowledged. He emphasized the importance of covering abortion services despite fears that insurance providers would effectively price them into all plans, even those to employers requesting exemptions on religious grounds.
“If a woman — take a lower-income woman who has insurance with a $1,500 deductible — she needs an abortion, she can’t get one because she doesn’t have the $400 or $500,” Barker said. “We want to be sure that everybody has access to all reproductive care. … We all pay insurance premiums to go to something we don’t need.”
Oregon’s bill also finds a way around federal regulations preventing some payments to some non-citizens and undocumented immigrants, guaranteeing benefits regardless of immigration status.
There is precedent for what happens when funding for family planning is cut, according to Audrey Sandusky, the director of advocacy and communications at the National Family Planning and Reproductive Health Association.
She pointed to Christie’s actions in New Jersey, which came amid a recession but also bucked a trend of advancements in reproductive health spearheaded by the ACA.
From 2009 to 2015, the state saw a 35 percent increase in bacterial cases of sexually transmitted disease — a trend that began before the nation’s STD rate began to increase. The changes disproportionately affected women of color, too: The uptick in breast and cervical cancer cases among Latina women in New Jersey, at 25.1 percent, was nearly five times higher than for women overall in the state.
Those numbers, say advocates of family planning and preventive care, should speak for themselves. The question is simply how many states are willing to listen.