Planned Parenthood patients in Iowa hit with new out-of-pocket costs after federal funding loss

On Monday, 14 people did not show up for appointments at a Planned Parenthood clinic in Des Moines.

Summer Fischer, who helps process around 30 patients at the clinic in a day, had seen maybe two or three people fail to show for their appointments every day in her four years at the facility.

"Maybe, say, seven were here for birth control. The other ones were here for (sexually transmitted infections testing)," Fisher, a medical office specialist, said with a long pause. "Think about that."

All the patients had been called ahead of their appointments with the news that Planned Parenthood would withdraw from the family planning program known as Title X. Title X has provided affordable birth control and reproductive health care to young and poor women since its inception nearly half a century ago. The national organization and its affiliates had opposed a Trump administration rule known as the "gag rule" that prohibited clinics from providing abortion referrals to women.

National anti-abortion groups, like Live Action, have criticized Planned Parenthood for rejecting the money and claim the rule does not prohibit "non-directive" counseling about abortion.

The impact in Iowa is immediate: New out-of-pocket costs for patients visiting six of the eight Planned Parenthood clinics in the state that receive Title X funding, particularly low-income people.

Fisher keeps thinking about the teenagers with whom she interacts daily, who don't want their parents to know they're sexually active. She also thinks about the older immigrant women who come to the clinic to access affordable care despite being in the country illegally.

"What are they going to do?" Fisher asked from the clinic, which does not perform abortions but its staff can refer a patient to another clinic for the medical procedure.

Impact on low-income people

Planned Parenthood North Central States, the national organization's Iowa affiliate, has now implemented a sliding fee scale for patients based on income to offset the sudden loss of nearly $1 million in Title X funding in Iowa.

Before Planned Parenthood refused the federal money, low-income patients could receive treatment at no cost. Without federal funding, low-income patients may have to pay for 60% of their costs.

A teenager who showed up Monday nearly burst into tears when she was told the birth control she had picked up for free during her last visit would now cost about $120 out of pocket, according to Fisher. She left without the birth control.

The sliding fee scale also has implications for patients with insurance. Before, an insured patient sometimes had their co-pay — often part of insurance plans — waived. Now, they will have to pay the co-pay, a dollar amount that varies.

Ebby Biegger, who has insurance, visited the Des Moines clinic on Tuesday to access birth control. She left with a new $25 bill.

"For me, that's a tank of gas to get to work," she said.

'I feel sad that we're moving backward'

Every morning, Linh Ha enters the Planned Parenthood clinic in Des Moines with a checklist: a huddle with her small staff, a review of the patients to come. Will there be any need for special care for a transgender patient? Should there be language translations available?

For the fiscal year that ran from July 2018 to June 2019, the clinic saw 3,568 individual patients, for a total of 6,265 visits.

Ha, the clinic manager at the Des Moines facility, has worked for Planned Parenthood in Iowa for 14 years, in several locations. During that time, Republicans in both the Iowa Legislature and Congress have worked to limit access to abortion.

Ha, who spoke from her small, windowless office, described the whiplash of having reproductive health care become more accessible just a few years ago with the Affordable Care Act passed under former President Barack Obama.

"It's really kind of up and down," she said. "I feel sad that we're moving backward."

In 2016, a new trifecta of Republican control in the Iowa House, Senate and the governor's office allowed a more conservative agenda to advance.

In 2017, lawmakers gave up about $3 million in federal Medicaid dollars — which is separate from Title X funding — to exclude Planned Parenthood from accessing family planning money. No state or federal dollars are used to pay for abortions in the state.

Data released later showed a decline in services in the state-run family planning program that excludes Planned Parenthood. The affiliate closed four clinics around the state in the weeks after it stopped receiving state funding.

Long-term ramifications

The long-term ramifications for Planned Parenthood patients in Iowa are still being sorted out.

Planned Parenthood North Central States had received its Title X funding from the Family Planning Council of Iowa, a not-for-profit that distributes money for reproductive health care and family planning services. The Iowa affiliate notified the council on Monday afternoon that it would withdraw from receiving the funding. The new budget year for the council began on April 1, according to Jodi Tomlonovic, its executive director. The council and the Iowa Department of Public Health distributes Title X funding to other health clinics.

Katie Thompson, an advanced registered nurse practitioner-clinician who works with Ha and Fisher, said the uncertainty of what will happen in Iowa weighs on her.

"We see a lot of people without any insurance, falling on hard times, between jobs, have kids at home that they're taking care of," she said, tearing up. "To me, to not be able to take care of those patients because they can no longer afford it is really sad to me."

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.

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