Data show drop in Iowa family planning program enrollment after Planned Parenthood's exclusion

Iowa had a nearly 50 percent drop in the number of people enrolled in its family planning program since it switched to a state-funded system that excludes abortion providers including Planned Parenthood, according to preliminary data obtained by the Associated Press on the program's first three months.

The information, which is in a report from the Iowa Department of Human Services, shows there has been a reduction in the number of health care providers participating in the program and in requests for services during that time. The AP received the report, which hasn't been released publicly, as part of a records request.

DHS officials emphasized the data are incomplete because health care providers have several more months to submit claims for services covered during the highlighted period, which was for July 1 through Sept. 30, 2017. The report adds: "Drawing conclusions from three months of data should be cautioned."

While providers have ample time to file claims for services — which include birth control and treatment for sexually transmitted diseases — they also try to do so in a timely fashion in order to get paid. It's at the heart of a separate issue involving health care providers seeking reimbursement for claims from private insurances companies now running Iowa's Medicaid program for the poor and disabled.

Final information on the family planning program won't be available for months, and it may include data from claims initially considered incomplete. Still, the report offers a glimpse at the emerging effects of a decision last year by Republican lawmakers in the new GOP-controlled Legislature to create the program, which excluded organizations that provide abortions. The move affected Planned Parenthood and providers affiliated with some larger hospital systems.

Even before the legislation, no state or federal funding went toward paying for abortions in Iowa, but anti-abortion groups and some Republicans contended that family planning money could indirectly support abortion services.

Jodi Tomlonovic, the executive director of the nonprofit Family Planning Council of Iowa, expressed concern over the decreases in enrollment and providers.

"Overall, this shows whatever table you want to look at, people have less access," said Tomlonovic, whose organization receives and distributes federal funds to organizations that provide family planning services. It helped compile the report along with DHS, the Iowa Department of Public Health and the anti-abortion-rights group Iowa Right to Life.

According to the data, 6,897 people were enrolled in Iowa's new family planning program during its first three months, compared with 13,166 during the same period the previous year when the program was still part of a Medicaid waiver program that included federal funding.

The program has seen a steady decline in enrollment since at least 2013, when there were 28,935 people enrolled in the program during the first three months. A large drop the following year for the same period is tied to people seeking coverage elsewhere under the Affordable Care Act.

The latest reduction of about 48 percent in enrollment compares with about a 15 percent drop the previous year.

In the first three months, claims were submitted from 957 unique health care providers, according to the data. That's compared with 1,432 for those months in the previous year. The count for services accessed in the first three months was 2,664, compared with 3,866 during that time the previous year.

DHS Director Jerry Foxhoven referenced the enrollment decline during a public meeting with lawmakers on Jan. 17, but he didn't provide specific numbers. He later told reporters that the agency must do more to inform the public about the new program and provide information on health care providers on its website.

"What we want to make sure is that the people who need services know where to find it," he said at the time.

Republican lawmakers agreed to give up about $3 million in federal money to create the state family planning program. That came amid constraints within Iowa's roughly $7.2 billion state budget, which led lawmakers to make agency cuts and tap emergency reserves. Republican lawmakers argued that a state-funded family planning program was a priority.

Those lawmakers also argued there would be no decline in available family planning services because other providers would step up. The preliminary data shows no uptick in rural health care providers participating in the program.

Planned Parenthood of the Heartland, the local Iowa affiliate, announced in May it was closing four of its 12 clinics in Iowa as a result of the Legislature's actions. Spokeswoman Becca Lee said that while the organization is cautious about drawing conclusions from the preliminary data, it's also critical.

"Bottom line is that fewer patients, fewer providers means less health care is being delivered," she said.

Texas gave up federal money several years ago in order to create its own state-funded family planning program. Data later showed a decline in the number of people accessing services. Texas is now seeking approval from President Donald Trump's administration to allow the state to get its federal funding restored while still excluding abortion providers and affiliates.

Missouri made a similar switch last year, though complete data is not available.

Kinsey Hasstedt, a policy expert for the Guttmacher Institute, a research group that supports abortion rights, said Iowa's data is reflective of broader activity against family planning programs.

"We're seeing this kind of ideologically motivated campaign against women's access to reproductive health across the country," she said.