The latest Trump administration proposal slashes the budget of several key governmental agencies — the National Institutes of Health, the Department of Housing and Urban Development and the Environmental Protection Agency.

One of the bigger concerns for the health care community is the elimination of funding for one of the social safety net programs, Planned Parenthood. Without the funding in place from the care of patients with government insurance programs like Medicaid, these facilities may no longer be able to operate.

Planned Parenthood has never used federal funding for abortions. But it does perform the service on a cash basis or for those who have insurance coverage for this procedure. However, the federal funding has helped provide birth control access to millions of lower income women over the last 100 years.

This population often has limited access to doctor’s offices for many reasons including their low reimbursing insurance plan, and may not have a nearby alternative to Planned Parenthood where they can receive medical care. The services available through Planned Parenthood include cervical cancer screening, breast cancer screening, sexually transmitted infection treatment and much more than just birth control and family planning. but limiting the funding for these clinics will lead to a considerable decrease in access for contraceptive services.

How much?

Cuts to Planned Parenthood will have ripple effects through much of the health care sector, especially Medicaid.

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Statistics show Planned Parenthood’s access to contraceptive services helps to avoid almost 600,000 unplanned pregnancies nationwide and an estimate of almost 200,000 abortions are averted as a result.

What happens when birth control access goes away? Well, unplanned pregnancies.

What happens if abortion access isn’t available? More child births.

In a perfect world each these children would be welcomed into loving homes that could afford to take care of their basic needs and there would be no concerns with an increase in the population. But in the real world, nationwide almost 50 percent of births are already paid for by Medicaid, an insurance that preferentially covers pregnant women and children who are living at or below the poverty line of income. For each child born into Medicaid, the number of eligible recipients goes up, but the previous increased federal funding may not be there anymore.

With the current proposal of Medicaid block grant funding, the same amount of money has to be shared by a greater number of people, which leads to lower coverage for everyone, or exclusion of care for those who would have otherwise qualified but are not mothers or children. Where would the budget get slashed? Adults without children, and the elderly.

As it stands, Hawaii has almost 300,000 Medicaid enrollees with a total annual spending of more than 12 percent of the state budget at over $1.4 billion. This is matched by the federal government, for now. Almost 60 percent of the payments go to take care of elderly and disabled individuals, who only make up approximately 20 percent of those enrolled.

If block granting is passed, then Hawaii will have a fixed amount of money to provide services for those already receiving Medicaid benefits, and may have to take a second look at the types of benefits it provides, or the qualification for enrollment — or both. Some of the required services provided by Medicaid include hospital coverage, emergency care, newborn care, laboratory studies, physician office visits.

The Medicaid expansion done as part of the Affordable Care Act also included prescription drug medication and substance abuse and mental health treatment. Optional coverages currently offered in Hawaii, which may be subject to budget cuts include dental care, eye care, physical therapy, psychologists, speech/language therapy and more.

If Planned Parenthood funding goes away, what could replace its services for family planning and birth control, in order to avoid the potential increase in unwanted births and higher numbers of Medicaid enrollees?

Birth control could be legalized for over-the-counter sale, without a prescription. Currently, other forms of contraception are available at pharmacies, like condoms for men and women, contraceptive sponges and spermicides. Hormonal options for morning-after pills also can be purchased without a prescription. But not daily use estrogen/progesterone pills as birth control. However, providing this option would be safe, and eliminate the barrier of having to see a doctor to get a supply, if the availability of doctors is limited with decreased funding for Planned Parenthood.

Increased funding may be necessary at other federally qualified health care centers, which currently serve approximately 150,000 patients in Hawaii. This may help, but the staffing and doctor shortage need to be addressed as well. Hawaii lacks enough ob/gyns to meet the needs of our population already. A study done by the University of Hawaii in 2015 concluded there is a need for at least 20 more full time ob/gyn doctors, assuming that all of the providers practice both obstetrics and gynecology, which is sometimes not the case.

The political will to defund Planned Parenthood is shortsighted at best, looking at the potential results of an increase in unplanned pregnancies, and family planning services for low-income women. This will eventually increase the enrollment in Medicaid, the very federally funded health care system that is also being cut by millions of dollars over the next 10 years.

One decision can have many downstream effects. Less Medicaid funding will stretch the current level of services even further, leading to a lack of available sources for seniors, the disabled, low-income individuals, and not just the women who have unplanned pregnancies and the babies that follow.

In order to really change the system, birth control has to be more accessible, not less, and clinics that provide it need more funding, rather than a defunding mandate.

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