Iowa's social conservatives have suffered several setbacks lately in their crusade against Planned Parenthood. The Iowa Supreme Court unanimously struck down an administrative rule that would have banned the use of telemedicine for medical abortions in several Planned Parenthood clinics. Iowa Attorney General Tom Miller informed a large group of Republican lawmakers that his office has neither "jurisdiction over transfers of fetal tissue" nor the "authority to investigate or demand information about the transfer of fetal tissue." (Not that it mattered, since Planned Parenthood clinics in Iowa have never participated in fetal tissue donation programs.)
Governor Terry Branstad, who has always opposed abortion rights, acknowledged two weeks ago that "we cannot defund Planned Parenthood," because a review of Planned Parenthood's contracts with the state revealed that the health care provider has not "violated their responsibilities under the grants that they have received" for family planning services. An official review also confirmed no taxpayer money goes toward abortion services at Planned Parenthood clinics in Iowa.
During this year's legislative session, Republicans successfully pushed for ultrasound requirements for women seeking abortions, but the final adopted language on ultrasounds did not add any new roadblocks or delays to the process of getting an abortion in Iowa.
Advocacy groups like Bob Vander Plaats' FAMiLY Leader organization continue to pressure Branstad to keep his 2010 campaign promise to end Planned Parenthood's state funding. Last week, Iowa House Republicans indicated that they plan to continue their "deliberate and unwavering battle" for the "pro-life" agenda.
Here's how efforts to defund Planned Parenthood are likely to play out during next year's Iowa legislative session. What happens after that depends mostly on whether the 2016 general election changes the balance of power at the statehouse.
Background on Planned Parenthood's state funding in Iowa
Let's get a couple of red herrings out of the way first.
First, the current debate about government funding for Planned Parenthood is not about the controversy over handling of fetal tissue used for medical research. Despite the impression conveyed in a series of undercover videos an anti-abortion group released this summer, no evidence has emerged that any Planned Parenthood clinics anywhere are "selling baby parts for a profit," as many Republicans claim. Investigations in at least five states have shown Planned Parenthood clinics to be in full compliance with federal law regarding fetal tissue donation, receiving partial reimbursement for costs. Moreover, Planned Parenthood clinics in Iowa do not participate in fetal tissue donation programs, and have never done so.
In any event, many Iowa House Republicans have been trying to redirect state funding away from Planned Parenthood since long before the undercover videos made news. Most recently, they sought to exclude Planned Parenthood from receiving Medicaid funds in their version of the health and human services budget for the current fiscal year (more details on that below).
Second, Republican efforts to target Planned Parenthood are not related to taxpayer funding of abortions in Iowa. Medicaid has not covered abortions at any Planned Parenthood clinics in Iowa. The University of Iowa Hospitals & Clinics perform a small number of abortions for Medicaid recipients each year, but UIHC has not asked the state to reimburse for those abortions since 2013.
Tony Leys reported for the Des Moines Register on September 18,
[Governor Terry] Branstad asked the Iowa Department of Human Services and Department of Public Health last month to review their contracts with Planned Parenthood. [...]
Spokeswomen for the state agencies said Thursday [September 17] that the reviews have confirmed no state money goes for abortions. [...]
Planned Parenthood of the Heartland has said about 26 percent of its Iowa financing, or nearly $2.7 million a year, comes from public sources. Most of that money comes from programs under Medicaid, which is jointly financed by the federal and state governments. It is used for such things as family planning programs, the private agency has said. [...]
When asked if the governor would try to revoke any of Planned Parenthood’s Medicaid money, spokesman Jimmy Centers replied: “The governor will continue reviewing what options the state has moving forward while continuing to fight for policies that protect the unborn.”
William Petroski reported on Branstad's comments late last month:
Gov. Terry Branstad said Tuesday [September 29] he doesn’t have legal authority to strip Planned Parenthood of taxpayer funding and any effort to do so would probably result in state officials being sued and losing in court. [...]
The governor told reporters at the Iowa Capitol he is willing to work with Republican legislators on the issue, but he also wants to make sure whatever is done complies with state and federal laws.
“It appears to me, and the advice that we have received from the attorney general’s office, is that we cannot defund Planned Parenthood," Branstad said. “The attorney general’s office has notified us that we don’t have reasons; they haven’t violated their responsibilities under the grants that they have received from the state.”
But Branstad, a Republican, suggested he is open to exploring future moves to block taxpayer funding for Planned Parenthood in Iowa [...].
Planned Parenthood has long been one of the providers in the Iowa Department of Public Health's Iowa Family Planning Network. Click through for more information on eligibility for that program. The covered services are:
• Birth control exams and advice.
• Limited testing and treatment for sexually transmitted infections (STIs).
• Pap tests
• Birth control supplies for men and women (see page 2).
• Voluntary sterilization for men and women who are over the age of 21
and have signed a valid Sterilization Consent Form.
• Pregnancy tests.
Family planning services provided as part of or as follow-up to a family planning visit are covered. Examples include services such as: colposcopy, repeat Pap smear, drugs for the treatment of STIs and treatment of yeast infections.
Last month, the Republican Party of Iowa's State Central Committee approved a resolution stating in part,
We, the Republican Party of Iowa, acknowledge and applaud the past and ongoing efforts of Governor Branstad and the Republican caucuses in the Iowa House and Iowa Senate to advance the cause of life, stand with them in their efforts, and now encourage them to remove all state and state-controlled funding from Planned Parenthood as soon as possible using all means and methods at their disposal, including all funding for non-abortion related services.
David Chung, who proposed that resolution, confirmed by e-mail that only one of his colleagues on the Iowa GOP's governing body voted against the resolution, "not because they [sic] are in favor of abortion or Planned Parenthood, rather because they [sic] do not believe that the SCC is the appropriate vehicle for issue advocacy. I will not be sharing the name of this individual."
Eliminating state funding for Planned Parenthood would require new law, which will not reach Branstad's desk in the coming year.
The Iowa Senate would block any bill to defund Planned Parenthood
During the last five years of divided control at the Iowa Capitol, the state Senate, where Democrats hold a 26 to 24 majority, has rejected many attempts by Republican lawmakers to restrict access to or funding for abortions.
This spring, House Republicans added language that would have defunded Planned Parenthood to their version of Senate File 505, the health and human services budget for fiscal year 2016. From pages 70 and 71 of the House-approved bill:
DISCONTINUATION OF MEDICAID FAMILY PLANNING NETWORK WAIVER —— ESTABLISHMENT OF STATE FAMILY PLANNING SERVICES PROGRAM
Sec. 94. DISCONTINUATION OF MEDICAID FAMILY PLANNING NETWORK WAIVER —— ESTABLISHMENT OF STATE PROGRAM.
1. The department of human services shall discontinue the Medicaid family planning network waiver effective July 1, 2015, and shall instead establish
a state family planning services program. The state program shall replicate the eligibility requirements and other provisions included in the Medicaid family planning network waiver as approved by the centers for Medicare and Medicaid of the United States department of health and human services in effect on June 30, 2015, but shall provide for distribution of family planning services program funds in accordance with this section.
2. Distribution of family planning services program funds shall be made to eligible applicants in the following order of priority:
a. Public entities that provide family planning services including state, county, or local community health clinics and federally qualified health centers.
b. Nonpublic entities that, in addition to family planning services, provide required primary health services as described in 42 U.S.C. §254b(b)(1)(A).
c. Nonpublic entities that provide family planning services but do not provide required primary health services as described in 42 U.S.C. §254b(b)(1)(A).
3. Distribution of family planning services program funds under this section shall be made in a manner that continues access to family planning services.
4. Distribution of family planning services program funds shall not be made under this section to any
1 entity that performs abortions or that maintains or
2 operates a facility where abortions are performed.
3 For the purposes of this section, “abortion” does not
4 include any of the following:
5 a. The treatment of a woman for a physical
6 disorder, physical injury, or physical illness,
7 including a life-endangering physical condition caused
or arising from the pregnancy itself, that would, certified by a physician, place the woman in danger death.
b. The treatment of a woman for a spontaneous
12 abortion, commonly known as a miscarriage, when not all
13 of the products of conception are expelled.
For the last five years, Iowa's health and human services budget has typically been one of the last bills agreed to by conference committee negotiators. In fact, the 2011 session went to the final day of the fiscal year over an abortion funding dispute.
This year, a disagreement over budget language on ultrasound requirements for women seeking abortions was particularly difficult for lawmakers to resolve. Bleeding Heartland discussed the final compromise on ultrasound language in detail here.
In contrast, Republican negotiators including House Human Resources Committee Chair Linda Miller agreed much earlier during conference talks to discard language stripping funds from Planned Parenthood, according to several statehouse sources. Media reports from late May and early June support that information; those stories show no hint that eliminating the Medicaid Family Planning Waiver (under which Planned Parenthood receives most of its state funding in Iowa) was still part of the final deal-making on the health and human services budget. The October 8 edition of the Iowa House Republican newsletter proudly recounted the attempt to "exclude Planned Parenthood from receiving any state funds," but explained, "The Senate did not agree to the state-funded [contraception] program and therefore House Republicans were unable to discontinue the Family Planning Waiver program and limit the list of eligible providers."
Incoming House Speaker Linda Upmeyer has not emphasized social issues as much as some conservatives would like, but that October 8 House Republican newsletter suggested she will support further legislative efforts to undermine Planned Parenthood: "Over the last five years it has become clear that House Republicans are the leading voice for pro-life issues at the Statehouse. [...] While House Republicans have fallen short of some objectives, the deliberate and unwavering battle continues."
Nevertheless, Iowa Senate leaders will certainly not agree to revoke state funding for Planned Parenthood during the 2016 legislative session.
If Republicans regain the Iowa Senate majority and hold their House majority in the 2016 elections, a bill defunding Planned Parenthood would have a good chance of reaching the governor's desk in 2017, however. At this writing, Branstad's office has not responded to my request for comment on whether the governor would sign into law a plan to create a new state-funded contraception program, in which Planned Parenthood could not participate.
Why Branstad can't immediately end state funding for Planned Parenthood
The FAMiLY Leader and Louisiana Governor/presidential candidate Bobby Jindal insist that Branstad already has the power to revoke Planned Parenthood's funding in Iowa. They are wrong.
Louisiana and Alabama have removed Planned Parenthood as a provider eligible for Medicaid reimbursements. But as first reported by the Wall Street Journal's Stephanie Armour in August, the federal government has warned those states,
Federal law requires state Medicaid programs to cover family-planning services and supplies for anyone of child-bearing age. Ending the agreements with Planned Parenthood would limit beneficiaries' access to care and services from qualified providers of their choice, according to HHS.
RH Reality Check's senior legal analyst Jessica Mason Pieklo explained further:
The warning came in a letter from the Centers for Medicare and Medicaid Services, the federal agency within the Department of Health and Human Services that runs the Medicaid program. The agency warned officials in both Louisiana and Alabama that plans to terminate Medicaid provider agreements with Planned Parenthood likely violates a 2011 agency guidance that says that states cannot discriminate against Medicaid health-care providers simply because they provide abortion services with non-federal dollars.
The Medicaid statute defines which providers qualify for funding, and states that the only way funding can be limited is to establish that a particular provider is not “qualified” under the statute.
Peter Sullivan reported for The Hill in August,
Federal courts have in the past blocked state attempts by states including Indiana and Arizona to cut Planned Parenthood out of Medicaid, citing the law that gives consumers a choice in providers.
That's one reason the Iowa Attorney General's Office informed Branstad that trying to defund Planned Parenthood through executive action would prompt a lawsuit state officials would lose.
Despite the legal reality, I expect Vander Plaats and conservative politicians like State Senator Jason Schultz will keep up the pressure. Branstad did say during the 2010 GOP primary campaign, "I don't think the state should be funding" Planned Parenthood. This summer's undercover videos didn't hurt Planned Parenthood's approval ratings among Americans as a whole; national polling shows a majority still support government funding for non-abortion-related services at Planned Parenthood clinics. But among social conservatives, the videos increased the sense of urgency to stop all taxpayer funding for the health care provider. Although defunding Planned Parenthood won't happen in the coming year in Iowa, Republicans have a chance to win this fight eventually--which is more than anyone can say about the defense of "natural marriage," which used to be the FAMiLY Leader's signature issue.
Any relevant comments are welcome in this thread.