Planned Parenthood is in a crisis — and the Supreme Court could make it worse
Last month, Planned Parenthood of Greater New York announced it will list its Manhattan clinic building for sale due to budget shortfalls, a move that would leave the national organization with zero presence in the borough where it was founded a century ago. It was the most visible sign of the crisis that has hit Planned Parenthood and other abortion providers since the end of Roe v. Wade. With Trump back in office, that crisis could intensify even further — starting at the Supreme Court.
Even before the closure of the Manhattan clinic, PPGNY's budget picture was already so dire it had to close four clinics — one in Staten Island and three others upstate — and stop offering abortions after 20 weeks due to the cost of sedation. Planned Parenthood of Northern New England expects an $8.6 million deficit over the next three years. And Planned Parenthood of Illinois announced in January that it would shutter four clinics that provided abortion pills amid a 'financial shortfall' stemming from rising costs of care, inadequate insurance reimbursement, and an influx of patients who need assistance.
While the Planned Parenthood Federation of America raised several hundred million dollars in 2022 alone, little of that goes to state affiliates that actually provide care. The money affiliates receive doesn't fund medical services, but rather pays for legal support, political advocacy, and some technology upgrades. Affiliates do accept donations directly, but they raise far less than the national office can.
How is this financial strain happening, even in states where abortion is still legal? It's a confluence of crises after the end of Roe, with more than a dozen states banning nearly all abortions, plus rising costs, and the design of the U.S. healthcare system.
The number of abortions has actually increased after the Dobbs decision that ended Roe, as abortion support and financial assistance became more visible. Donations surged and more people traveled out of state than ever before, and demand has increased wait times, which pushes people further into pregnancy when abortion is more expensive. Because many abortion seekers are low-income and don't have insurance that covers abortion, the cost of that care (and the related plane tickets and hotels) increasingly falls on nonprofit groups like abortion funds and clinics themselves.
Last year, one large fund, the National Abortion Federation, had to cap the amount it gives per patient to stretch its budget for the year. Though the need for abortion support is higher than it's ever been, donations to abortion funds and other groups have been declining since 2022. If a state Medicaid program does cover abortion, the rate it pays the clinic is not enough to cover the cost of the service. Add to those problems the loss of patients during the pandemic and several years of inflation, and it's a full-blown catastrophe.
As the second Trump administration enacts more of its policy goals, abortion opponents are trying to starve abortion providers of any federal funding. They refer to that goal as 'defunding,' but it's important to note that Planned Parenthood does not have a line item in budgets. It receives payment for health care services provided and grant funding approved by the U.S. Department of Health and Human Services. One major goal for abortion opponents is to block abortion providers from receiving any money from Medicaid. In the year ending in June 2023, Planned Parenthood's 49 affiliates across the country received $699 million in government grants and reimbursements for health services, including Medicaid payments.
This Wednesday, the Supreme Court will hear arguments in a case that arose after South Carolina said Planned Parenthood was not a qualified Medicaid provider for non-abortion services like birth control because — you guessed it — it separately performs abortions. Since that fact has nothing to do with the quality of care Planned Parenthood provides, a patient sued the state for violating her right under the Medicaid Act to see any qualified provider of her choosing. South Carolina claims individuals can't actually vindicate this right in court.
If at least five justices agree, that could lead to more states kicking Planned Parenthood out of Medicaid. Plus, Project 2025 calls for Trump's Health and Human Services Department to nationalize the South Carolina strategy and officially interpret the Medicaid statute as disqualifying abortion providers from the program in all 50 states. If either outcome comes to pass, more clinics will undoubtedly close, shrinking access to abortion care even in legal states.
Another bucket of funding that Trump could revoke is via a federal family planning program known as Title X. Congress allocates about $285 million yearly to support low- and no-cost access to birth control, STI testing, and cancer screenings. Grantees include state and local health departments and clinics like Planned Parenthood. During Trump's first term, he excluded providers that even make referrals for abortion services, via what's known as a 'gag rule.' Rather than halt referrals to patients interested in abortion, Planned Parenthood affiliates left the program in 2019 and lost about $60 million. Though President Joe Biden rescinded the eligibility changes, clinics serving low-income patients took a financial hit in the interim.
It appears that Trump isn't waiting for the next Title X grant cycle to reshape the program. The Wall Street Journal recently reported that the administration will soon freeze current grants to, in its telling, investigate whether recipients comply with executive orders on diversity, equity, and inclusion. Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, told the Journal of the Title X freeze: 'The Trump-Vance-Musk administration wants to shut down Planned Parenthood health centers by any means necessary, and they'll end people's access to birth control, cancer screenings, STI testing and treatment, and more to do it.'
One vehicle is the federal budget: groups like Students for Life and Susan B. Anthony Pro-Life America want Republicans to include a provision in the forthcoming reconciliation bill that would bar Planned Parenthood from receiving any federal funding, including Medicaid or Title X. SBA president Marjorie Dannenfelser told the Associated Press, 'I believe this is the moment they will be defunded, and this is the blow that will bring them down.'
There's a problem though: reconciliation bills can't increase deficits long-term, but 'defunding' Planned Parenthood actually costs the government money in the long run because fewer people would be able to prevent pregnancies and Medicaid would end up covering more births. In 2015, the Congressional Budget Office estimated that a ban on funding to Planned Parenthood would increase spending $130 million over 10 years.
While independent clinics provide the bulk of abortions in the U.S., Planned Parenthood is the single biggest provider, which is why it has an outsized target on its back. The reality is that, even if Trump hadn't won, the organization's affiliates would be facing financial cliffs and now the pressure is exponentially greater. More clinics will close in the coming months and years, which will harm patient care and further wound a symbol of reproductive rights.
This article was originally published on MSNBC.com
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