The Republican-led House Appropriations Committee’s FY 2016 Labor, Health and Human Services funding bill contains a single sentence that could dramatically set back public health: “None of the funds appropriated in this Act 4 may be used to carry out title X of the PHS Act.”
Title X is a federal grant program that funds a network of 4,400 centers that provide high-quality, cost-effective family-planning services for approximately five million clients each year. These centers also offer breast and cervical cancer screening and pregnancy testing, and they provide both men and women with HIV testing and screening and treatment for sexually transmitted infections. They serve low-income clients and base fees on clients’ ability to pay; in 2011, 91% of clients had incomes at or below 250% of the federal poverty level. Many of these clients live in medically underserved areas and would find it difficult to access care from another provider.
By providing important health services to low-income clients, Title X saves the federal government money. Last year, the journal The Milbank Quarterly published an analysis of return on investment of the US publicly funded family planning program (which includes Medicaid family-planning spending as well as Title X). Jennifer J. Frost and her Guttmacher Institute colleagues found:
The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births.
This investment resulted in net government savings of $13.6 billion in 2010, or $7.09 for every public dollar spent.
Even if these investments didn’t have such an impressive return on investment, I’d argue that spending on family-planning and preventive services for low-income women is a worthwhile investment in public health. As the CDC noted when it included family planning among its Ten Great Public Health Achievements of the 20th Century, “Smaller families and longer birth intervals have contributed to the better health of infants, children, and women.” When spending on Title X leads to both improved public health and substantial federal savings, it’s a win-win … right? Not to the House Appropriations Committe, it seems.
The House Appropriations Committee press release about the spending Labor-HHS spending bill proclaims, “Funding within the bill is targeted to proven programs with the most national benefit, including medical research, public health, and biodefense, as well as activities to ensure Social Security, Medicare, and Medicaid services are efficient, effective, and accountable to those Americans they serve. While making these important investments, the bill reduces funding in lower-priority areas, and cuts ineffective or wasteful programs and agencies.” Title X is the opposite of ineffective and wasteful, and it improves public health — so why cut it?
The New York Times editorial board suggests that it’s about abortion: Planned Parenthood is Title X’s biggest recipient. Federal rules prohibit Planned Parenthood centers from using Title funds for abortions, and 90% of its clients go there for services other than abortions. In fact, many of the services women receive at Planned Parenthood and other Title X centers help prevent abortions. A Guttmacher Institute analysis found that in 2010, family-planning services from Title X-supported sites helped women avert 1.2 million unintended pregnancies, which prevented 403,000 abortions. The New York Times editorial concludes:
Sadly, that’s no surprise coming from the House Republicans, whose zeal to stop the government from providing an essential service like health care to lower-income Americans has also resulted in dozens of votes to cripple or repeal the Affordable Care Act. (The new spending bill would also roll back much of the health care law.)
This latest bill aims squarely at one of the nation’s most vulnerable groups — poorer women, many of whom live in rural areas with little access to health care of any kind. So much for compassionate conservatism.
I’d like to know what the thought process was behind this spending bill provision. Is being able to cut $300 million in FY 2016 more important than the billions more in future federal spending that will result? Is being able to say “I cut funding for Planned Parenthood” on the campaign trail more valuable than continuing a program that prevents hundreds of thousands of abortions each year? Does low-income women’s access to contraception and cancer screenings just not matter to high-income men (or Representatives Kay Granger (R-TX), Jaime Herrera Butler (R-WA), or Martha Roby (R-AL) )?
This House proposal isn’t the last word on 2016 spending. The Senate Appropriations Committee’s Labor-HHS FY 2016 funding bill would fund Title X at $257.8 million, which is 10% lower than FY 2015 levels. Senators Patty Murray (D-WA), Mark Kirk (R-IL), and Susan Collins (R-ME) offered amendments that would have funded the program at higher levels, but these did not pass. (In the House, amendments from Representatives Nita Lowey (D-NY) and Rosa DeLauro (D-CT) to fund Title X at $300 million also failed.) Advocacy efforts are underway, and anyone who’s been following politics for the past few years knows that budget battles can drag on for months. Title X isn’t dead yet, but I’d still like to know why House Republicans think it’s okay to cut a money-saving program that’s so good for public health.
Liz Borkowski, MPH is managing editor of the journal Women’s Health Issues and a researcher with the Jacobs Institute of Women’s Health at the George Washington University Milken Institute School of Public Health. Her research projects include the Confidential & Covered project, which works to help Title X providers continue protecting patient confidentiality while pursuing reimbursement in a new insurance environment. Her views are her own, and do not represent the views of any employer or funder.