The Indiana state legislature is on the verge of becoming the first state to block Medicaid reimbursements for low-income patients seeking basic health services at Planned Parenthood clinics.
House Bill 1210, introduced by state Rep. Eric Turner (R-Cicero) in January, takes a number of swipes at abortion rights and includes a provision that would prohibit the state of Indiana from contracting with "any entity that performs abortions or maintains or operates a facility where abortions are performed." While the provision does not name a specific health provider, it effectively singles out Planned Parenthood, which receives $3 million dollars a year from the state.
"We have patients booking appointments for pap smears as we speak, but if the bill passes and the intent is met, we would literally have to get in touch with these patients and say, 'You come prepared to pay for your services, or you will need to find another medical home,'" said Betty Cockrum, president of Planned Parenthood Indiana, which currently serves about 22,000 low-income patients under Titles X, V, and XX and through Medicaid.
Republican lawmakers are advancing the bill to prevent taxpayer-funded abortions, even though federal law already prohibits them. "The fundamental issue is that when we take tax dollars and fund any entity that performs abortions, we're forcing taxpayers to support a practice that many feel is objectionable," State Sen. Scott Schneider (R-Indianapolis), the author of the provision to cut Planned Parenthood's funding, told HuffPost in an interview.
Yet opponents say the bill will cost taxpayers more in the long run, since cutting funding to Planned Parenthood would actually increase costs to the state. The Indiana Family and Social Services Administration reported in 2008 that over half of all Indiana births were financed by Medicaid, averaging a cost of $11,250 per birth. Indiana spends over $450 million on the pregnancies of women with Medicaid and their deliveries annually. Planned Parenthood estimates that cutting funds to family planning would increase the amount of unintended pregnancies in Indiana and increase the state's Medicaid costs by roughly $96 million per year, not counting the expensive follow-up care required with many low-income births and the cost of new dependents being born into the Medicaid system.
Conservative lawmakers pushing the bill are not convinced by the numbers.
"That's nonsense. I don't know where they come up with that figure," Schneider said. "Planned Parenthood has a choice. If they want to continue to receive taxpayer subsidies, they can stop a portion of their business which they say is very low: their abortion services."
Planned Parenthood estimates that abortions count for about 3 percent of its services -- the rest are preventative care, testing for sexually transmitted infections, cancer screenings, and contraceptive services.
The author of the Indiana House bill signed off on the state Senate version Tuesday night, but it still may have some legal hurdles to clear before it makes it to Gov. Mitch Daniels' desk. Federal Medicaid rules prohibit states from discriminating against a provider for any reason other than its ability to provide quality health services, and state officials worry that violating that rule by discriminating against Planned Parenthood could cost Indiana all $4 million of the federal funds it receives for family planning.
"If funding is cut off, CMS could look at that, and that could jeopardize the other funding that we get from them around family planning services," FSSA Secretary Michael Gargano told the Indianapolis Star. "That's our concern -- that they would cut those funds off."
The Centers for Medicare and Medicaid Services confirmed on Wednesday that states "cannot pick and choose who gets family planning funds," but would not comment on whether Indiana would face sanctions for violating this rule.
Either way, Planned Parenthood of Indiana is prepared to sue.
"We have said all along that we would challenge [House Bill] 1210 in court if it became law," Cockrum told HuffPost. "It's important to remember that abortion is a legal procedure here in this country, and the federal government does not look kindly upon singling out an entity for punitive action because they are providing a constitutionally protected service."