WISCONSIN — They came with wire coat hangers and shoved them through the mail slot on Paul Ryan's office door.

"(Ryan) has to understand that in this community, in terms of reproductive health, men and women, Planned Parenthood is a very large part of (their) support system," Kenosha County Hallmon told the Kensoha News as they stood outside his locked office.

Demonstrators in House Speaker Ryan's home district of Wisconsin were met with no response during normal office hours Monday when they attempted to reach the Republican congressman over imminent Republican-led efforts to defund Planned Parenthood.

Ryan announced Thursday, Jan. 5 that Republicans will quickly move to strip all federal funding for Planned Parenthood through Medicare, as part of the legislation they expect to pass to repeal the Affordable Care Act.

Days earlier, supporters of Planned Parenthood tried to deliver more than 87,000 petition signatures to Ryan in his Washington, D.C., office. As they wore "I Stand With Planned Parenthood" shirts, they hit one obstacle after another when they arrived at the Longworth House Office Building, the Huffington Post reported Friday. Once Planned Parenthood Supporters arrived at Ryan's office, it was locked. Six guards stood at the door.

Republican lawmakers have seen a groundswell of opposition against defunding Planned Parenthood — yet whether it's in Kenosha, Wisconsin, or Washington, D.C., the incidents outside Ryan's offices suggest the tacit admission that when it comes to supporting Planned Parenthood, "we're not listening."

In Wisconsin, 50,000 of Planned Parenthood's 60,000 patients have either all or part of their services covered by Medicaid. It grants people at or below poverty levels access to routine health care services like birth control, cancer screenings, STD testing and treatment, well-woman exams and sex education, Planned Parenthood officials say. (Planned Parenthood claims that abortion services make up approximately 3 percent of all services and are not eligible for Medicaid funding in most cases based on federal law).

As Republican lawmakers talk about defunding the organization through Medicaid, the result could mean preventing 50,000 people - equivalent to the entire population of Sheboygan - access to health care at Planned Parenthood.

But even in places where there are alternative health clinics, Nicole Safar, Government Relations Director at Planned Parenthood Advocates of Wisconsin, says they won't be able to pick up the slack.

And while critics of Planned Parenthood suggest turning to alternative providers, Planned Parenthood official Iris Riis states that in 50% of the counties Planned Parenthood of Wisconsin serves, there is no alternative provider to turn to if they close, or stop providing services.

"In 73% of the counties PPWI serves, there is not a provider who could absorb Planned Parenthood's patients. In those rare communities where there are other community health care providers, many would be unable to meet our patients' need if Planned Parenthood could not provide care," she said. "In fact, more than 6,000 people living in Speaker Ryan's own district rely on Planned Parenthood for cancer screenings, STD testing and treatment and birth control. On behalf of these patients, we ask Speaker Ryan where these people go for health care?"

According to a national study by the Guttmacher Institute, of the 491 U.S. counties that have a Planned Parenthood health center, Planned Parenthood handles a majority of all safety net family planning center clients in 332 of them. In 103 of these counties, Planned Parenthood is the only safety-net family planning center available.

According to a national study, of the 491 U.S. counties that have a Planned Parenthood health center, Planned Parenthood handles a majority of all safety net family planning center clients in 332 of them. In 103 of these counties, Planned Parenthood is the only safety-net family planning center available.



Ryan's Response

Congress took its first step toward repealing the Affordable Care Act - and defunding Planned Parenthood - Friday by passing a budget measure that allows Republicans to use procedures to repeal major parts of the law without involving Democrats. The final vote to begin the repeal process was 227-198, with all Republicans voting yes and all Democrats voting No.

Asked about Planned Parenthood, Paul Ryan says he wants federal community health centers to be supported instead https://t.co/rZtBD8s9qn

— CNN (@CNN) January 13, 2017

During a Thursday Town Hall meeting broadcast live on CNN, when a female college student asked Ryan where women would go in the event Planned Parenthood were defunded, Ryan touted his primary replacement option.

"We want to make sure that all women get the kind of care they need, like preventative screening," Ryan said. "We believe that this can better be done by putting that money in federal community health centers. Federal community health centers, I have a lot of experience with them myself. They're all throughout Wisconsin; they're in virtually every community."

Ryan continued, "For every Planned Parenthood...there are 20 federal community health centers. They are vastly bigger in network, there are so many more of them, and they provide these kinds of services without all the controversies surrounding this issue."

Here are the number of Federal Community Health Centers in area states, according to the U.S. Department of Health and Human Services - although the department does not differentiate between primary care, mental health or other service providers.

Yet In Wisconsin, that ratio isn't 20-to-1 as Ryan suggests. In Wisconsin, there are 21 Planned Parenthood health centers, and 116 facilities that qualify as Community Health Centers - although data provided by the U.S. Department of Health and Human Services does not differentiate between primary care, dental and mental health centers.



On top of that, according to the U.S. Department of Health and Human Services, the primary care needs of residents in Ryan's home state of Wisconsin are not met.

According to data, as of Jan. 1, 2017, the U.S. Department of Health and Human Services data indicates that only 71 percent of his state's population's medical needs are met - with a total of approximately 88 more practitioners needed to make up the shortfall.

Those number fall dramatically across the U.S. where the Department of Health and Human Services reports that approximately 57 percent of U.S. residents have their medical needs met. An army of 9,376 additional practitioners would be necessary to mind the gap, the department says.



According to a U.S. Department of Health and Human Services report, only about 57 percent of U.S. residents have their medical needs met. An army of 9,376 additional practitioners would be necessary to mind the gap. The areas shown in blue are what the department considers "Medically Underserved Areas/Populations" and make up approximately one-fourth of the U.S.

More Babies in Texas



The State of Texas may serve as a bellwether for what's coming next. Texas lawmakers excluded Planned Parenthood and other clinics with ties to abortion providers from taxpayer funding in 2011, banning them from the state-funded Medicaid Women's Health Program, according to an ABC report.

And according to a New England Journal of Medicine study, when Texas lawmakers swapped Planned Parenthood for a plan of their own design, Texas women enrolled in the replacement health program saw a 35 percent decline in claims for contraceptives and a 35 percent increase in births.

HIV Outbreak in Indiana

While Texas may have seen an uptick in unplanned pregnancies, that struggles in comparison with events that took place in Indiana after several Planned Parenthood facilities - all of which provided HIV testing - closed after state lawmakers slashed funding to the health service provider.

According to a Huffington Post report, Scott County was the center of an exploding HIV outbreak. That happened in 2013, when the county's sole HIV testing provider - a Planned Parenthood clinic - was forced to close its doors.

Less Planned Parenthood Services = More Medicaid Expenses in the Long Run

When the Congressional Budget Office was asked to assess the financial implications of a 2015 bill aimed at defunding of Planned Parenthood, they found that just like Texas, fewer services would result in higher birth rates - and also a greater need for Medicare.

According to the Congressional Budget Office:

... some of the services that would not be used if [this bill] was enacted would include those that help women avert pregnancies and deliveries. Reduced use of such services would be expected to lead to additional births, increasing federal spending, primarily for Medicaid. In addition, some of those children would themselves qualify for Medicaid and possibly for other federal programs.

Donald Trump = "Fight of our Lives"

When Republicans introduced a bill in 2015 to repeal the Affordable Care Act and defund Planned Parenthood, it passed the House and Senate - but was vetoed by President Obama.

President-elect Donald Trump has indicated he would sign such a bill and could do so in early 2017. Planned Parenthood anticipates it will to lose up to 40 percent of its funding if the bill becomes law, according to a Washington Post report.

As Tayna Atkinson of Planned Parenthood wrote this week, "we know that we are facing the fight of our lives to continue to provide the compassionate care Wisconsin relies on."

>>> Photo credit: Paul Ryan - Gage Skidmore via Flickr Commons ; Planned Parenthood - Flickr: planned parenthood supporters Author S. MiRK