Guy Boulton, and Jason Stein

Milwaukee Journal Sentinel

Planned Parenthood of Wisconsin estimates it could keep open only two of its 19 family planning clinics — those in Milwaukee and Madison — if it was barred from billing Medicaid programs.

That was one of the provisions in the Republican plan to replace the Affordable Care Act. And though that plan was withdrawn last month, the organization is sure to remain a target.

Yet, paradoxically, cutting off Medicaid funding for Planned Parenthood would not affect its two clinics that provide abortions in Wisconsin. Those clinics, which do not receive government dollars, are separate from its family planning clinics. They would remain open.

“That’s why Republicans are being disingenuous about this,” said Nicole Safar, director of government relations for Planned Parenthood Advocates of Wisconsin.

The Republican plan to replace parts of the Affordable Care Act would have prevented any provider of abortions, except in rare cases, from billing Medicaid programs for one year.

More than 6 in 10 patients who receive care at a Planned Parenthood clinic in Wisconsin are covered by a Medicaid program. For its fiscal year ended Sept. 30, that meant 37,675 of its 59,762 patients.

Medicaid programs accounted for $10.8 million, or almost 44%, of its $24.8 million in revenue that fiscal year.

“We don’t have a way to fill the gap,” Safar said.

Almost certain to be closed would be clinics in smaller cities such Delavan, Portage and Wisconsin Rapids.

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Conscience issue

Planned Parenthood — the country’s largest provider of abortions — was not explicitly named in the failed Republican plan. But the organization is almost certain to face new threats. That could happen as early as this month, when Congress must approve an increase in the national debt to continue funding the federal government. The bill could include a provision aimed at the national organization.

Planned Parenthood of Wisconsin performed 3,889 abortions in its 2016 fiscal year. Federal dollars cannot be used to fund abortions. But many people oppose tax dollars going to organizations that provide abortions.

“It’s a significant conscience issue for many taxpayers,” said Chelsea Shields, legislative director for Wisconsin Right to Life. “That really is the root and heart of the issue.”

Planned Parenthood and other clinics in Wisconsin can bill Medicaid primarily through BadgerCare Plus, which covers adults with very low incomes, and the Family Planning Only Services Program.

The Family Planning program, which has broader eligibility than other Medicaid programs, covers contraceptives as well as tests and treatment for sexually transmitted diseases, screenings for cervical cancer and some other services.

The federal government pays 90% of the cost of the Family Planning program, compared with about 58% for other Medicaid programs.

Twenty-seven states participate in programs similar to the Family Planning program in Wisconsin.

About 45% of the births nationally and roughly half of the births in Wisconsin are paid for by Medicaid. A disproportionate number of family planning clinics are in low-income areas. And in all, more than 1 in 5 low-income women receives birth control from family planning clinics, according to the 2013 Kaiser Women’s Health Survey.

Supporters of proposals to bar Planned Parenthood clinics from billing Medicaid programs — including House Speaker Paul Ryan (R-Wis.) — contend that people would be able to get birth control and other reproductive health services at community health centers.

But Racine, West Bend, Delavan, Portage and Wisconsin Rapids — all cities with Planned Parenthood clinics — don't have community health centers.

And though some community health centers have the capacity to accept new patients, others have waiting lists, said Lisa Olson, director of policy and programs for the Wisconsin Primary Health Care Association, which represents the state’s community health centers.

“Reduction in any part of the safety net has ripple effects across the entire delivery system,” Olson said in an email. “In many areas of the state, the loss of our partner providers may mean that patients go without care.”

The Wisconsin Primary Health Care Association opposes cutting off Medicaid funding for Planned Parenthood.

Series of closures

Planned Parenthood closed its clinics in Shawano, Chippewa Falls, Beaver Dam and Johnson Creek in 2013, in part because of losing state grants. A fifth center closed in Fond du Lac in 2014.

Gail Scott, director of the Jefferson County Health Department, said the July 2013 closure of Planned Parenthood’s Johnson Creek clinic is still affecting patients in her county.

She personally does not support abortion, Scott said, but the Planned Parenthood clinic in Johnson Creek provided other services.

Low-income residents in Jefferson County now must travel to Madison or Waukesha to receive many of the services formerly available at the Planned Parenthood clinic, including contraceptives, pap tests for cervical cancer and tests for sexually transmitted diseases.

“I don’t know of any other providers in our community that would provide all the services,” Scott said.

An estimated 75% of the public — including 57% of Republican women and 55% of Republican men — support paying Planned Parenthood for non-abortion services provided to people covered by Medicaid, according to the Kaiser Family Foundation’s Health Tracking Poll.

The survey also found that only one-fourth of Republican women and men knew of the federal ban on paying for abortions.

Planned Parenthood estimates that 1 in 5 women in Wisconsin has been to a Planned Parenthood clinic.

“We have support across the state except in the U.S. Congress and the Wisconsin Legislature,” said Safar of Planned Parenthood Advocates of Wisconsin.

To Safar, abortion is a constitutionally protected right.

If Congress wants to stop abortion, it should pass a law doing that, Safar said. The U.S. Supreme Court could then determine if the law is constitutional.

Although Republicans, who generally oppose abortion, now control Congress and the White House, that hasn’t happened.

Shields, of Wisconsin Right to Life, said the makeup of the U.S. Supreme Court would need to change first.

“We don’t think Congress is ready for that because the Supreme Court is not ready for it,” she said.

For now, the main focus has been on limiting Planned Parenthood’s access to Medicaid dollars.

On Thursday, Senate Republicans voted to undo an Obama administration rule that prevented states from blocking some federal funding — the grants used to fund the Family Planning Only Services Program in Wisconsin and similar programs in other states — for organizations that also provide abortions.

Two Republican senators — Susan Collins of Maine and Lisa Murkowski of Alaska — voted against the bill, and Vice President Mike Pence’s vote was needed to break the tie.

Several federal courts have ruled that states can’t discriminate against a Medicaid provider that also provides abortions. But federal law could change in the coming years.

“Our worst-case scenario,” Safar said, “is we would not be able to maintain our network of family planning clinics.”