Planned Parenthood funding a dilemma for Obama administration

WASHINGTONIndiana’s
move to cut off federal funding to Planned Parenthood clinics has not
only created a national abortion controversy, but also posed a dilemma
for the Obama administration.

While the state’s action appears to violate the
Medicaid Act, federal officials have few obvious remedies other than to
cut off money that pays for health care for low-income women.

The controversy revolves around abortion even though the federal law says none of the Medicaid money can be used to pay for them. Indiana
Republicans say, however, that paying for medical services provided by
a Planned Parenthood clinic supports the facility and indirectly
subsidizes abortion.

Indiana Gov. Mitch Daniels, a possible Republican contender for the White House,
set the stage for a legal and political clash with the administration
last weekend when he announced he will sign legislation requiring the
funding cut off for Planned Parenthood. An “overwhelming majority of
Hoosiers” are opposed in principle to any use of “tax dollars to
support abortion,” he said.

But the federal Medicaid Act, which pays for care
for patients who are poor, says these persons may choose any provider
who is “qualified” and “willing” to provide the service. In many
states, Planned Parenthood clinics provide basic health care and
medical tests for low-income women.

Still, the federal money flows through the states. And this week, Indiana
will become the first to bar funding for “any entity that performs
abortions or maintains or operates a facility where abortions are
performed.”

The measure targets the 28 clinics run by Planned Parenthood in Indiana, four of which offer abortions, according to Betty Cockrum, the group’s president.

This week, U.S. health officials have been pondering how to respond.

“If the state denies payment to these providers, that would be illegal,” said Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services,
the U.S. agency that administers the two huge health care programs.
“There are some options available to us. But I can’t say what action
will be taken to bring the state into compliance. All we can say now is
we will review the matter once Indiana decides.”

The long-standing assumption has been that the
federal government and the states would work together to provide health
care for poor patients, said George Washington University law professor Sara Rosenbaum. “I have never seen a situation quite this,” she said.

In the past, disputes arose over whether to cut off
funding to nursing homes or clinics because of questions about the
quality of their care. “This is radically different. This is about the
exclusion of a qualified provider over something that is unrelated to Medicaid,”
Rosenbaum said. “But the Secretary (of Health and Human Resources)
doesn’t have an obvious remedy other than a total cutoff of federal
funds.”

In February, House Republicans, led by Rep. Mike Pence, R-Ind., voted to cut off all federal funding to Planned Parenthood. Senate Democrats and President Barack Obama blocked that bill from becoming law. But Republican-led states could partly achieve the same goal by following Indiana’s lead.

“I expect a lot of states will try to do this,” Rosenbaum said.

Daniels, a former budget director for President George W. Bush,
has strong support in Republican circles because of his background in
overseeing state and federal budgets. He irritated some social
conservatives earlier this year when he called for a “truce” on social
issues. But his announcement last week that he will sign the Indiana bill into law instantly raised his standing with them.

Lawyers for Planned Parenthood say they will quickly go to federal court seeking an order that stops the Indiana measure. “Our contention is that Indiana can’t do this,” said Kenneth Falk, an American Civil Liberties Union lawyer in Indianapolis. “Medicaid says patients have a right to choose their health care provider. Indiana seems to have forgotten this is a federal program.”

Cockrum says federal funding provides about $3 million, or about 20 percent of her group’s overall budget of $15 million
a year. She argues that a cutoff in funds would not only hurt health
care for low-income women, but also increase the incidence of abortion.

“They are attacking the largest provider of family
planning services. Nobody does more than we do to reduce the incidence
of unintended pregnancies and abortions,” she said. “If this goes
forward, it will cause Indiana to see more abortions, not fewer.”

Daniels, however, argued that low-income women will
still have plenty of options for health care beyond Planned Parenthood.
“I … can confirm that all non-abortion-services, whether family
planning or basic women’s health, will remain readily available in
every one of our 92 counties,” he said.

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(c) 2011, Tribune Co.

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