History of the Diversion of Family Planning Funds in Ohio
by Gary Dougherty
Tomorrow, after the subcommittees have completed their work, the full Senate Finance Committee will hear additional testimony on HB 59, the state budget bill. This could be one of the last opportunities to advocate for the removal of language proposing to change the way federal family planning funds are distributed in Ohio.
Budget bills have long been a popular vehicle for enacting public policy in Ohio. Because the bills are thousands of pages long (currently at 4,509 pages, HB 59 is approximately a foot and a half thick!) and contain several hundred provisions, they are often the preferred method of addressing controversial policy initiatives.
Whereas the spotlight is placed squarely on an issue that is considered in a separate, standalone piece of legislation, it is diffused across the scores of issue areas contained in a budget bill. Language can be “hidden” among other provisions and the effect of testimony can be “diluted” as interests from every corner of the state (and beyond) advocate for or against language that may affect their clients, membership, and the general public.
It should come as no surprise that, of the six most recent attempts to alter the way family planning funds are distributed in Ohio, four have come by way of a budget bill (indicated by an asterisk below). Two attempts have been successful, one was rebuffed, and HB 59 represents the current attempt.
1) HB 95* (125th General Assembly) changed the way that $1.7 million in state family planning funds were distributed, giving priority to local health departments, effectively eliminating Planned Parenthood from qualifying for these limited funds as of January 1, 2004.
2) The following session, this language was made permanent in HB 530*, the capital reappropriations bill.
The most aggressive attempts to divert federal family planning funds have occurred over the last two years.
3) On July 13, 2011, HB 298 was introduced by Reps. Kristina Roegner (R-Hudson) and Cliff Rosenberger (R-Clarksville). This bill sought to change the way that certain federal funds administered by the state, including Title X family planning funds, are distributed. It would have scrapped the current competitive grant process which ensures that those applicants that can provide high quality family planning services to more people in a more cost-effective manner will score higher and be more likely to be awarded these federal funds. Competitive – inclusive (meaning anyone providing family services can apply) – cost-effective…sounds like a good way to distribute public funds, right?
Well, HB 298 proposed the establishment of a tiered eligibility structure whereby about 130 public health departments would have the first priority for these funds. Then, if there was any money left, about 150 federally qualified health centers would be considered. Then, if there was any money left, several hundred (or more) primary care providers would be next in line. Finally, after every public health department, every FQHC, and every primary care provider in the state had a chance to apply for funding – and if there was any money left – standalone family planning providers would be eligible.
Whereas the bill sponsors and key supporters, primarily Ohio Right to Life and their allies, acknowledged that the target of this redistribution scheme was Planned Parenthood, it’s worth noting that the proposal would have had the collateral effect of denying other private family planning providers from accessing these funds, notably Family Planning Association of Northeast Ohio (serving Lake, Geauga, and Ashtabula counties), Family Planning Services of Lorain County, and Family Health Services of East Central Ohio (serving Licking Muskingum, Perry, and Fairfield counties).
In other words, this diversion would have ensured that the experts in providing family planning services are placed at the bottom of the eligibility ladder.
Whereas HB 298 was recommended for passage by the House Health and Aging Committee, it was never brought to the floor of the House for a vote, primarily because former Senate President Tom Niehaus (R-New Richmond) signaled the bill’s demise during last year’s lame duck session.
4) One week after the introduction of HB 298, Senator Kris Jordan (R-Ostrander) introduced its companion bill, SB 201, with only one co-sponsor (Sen. Peggy Lehner; R-Kettering).
On the ground intelligence from within the Senate Republican leadership indicated that there was little support for defunding legislation in that chamber. The intelligence proved accurate when SB 201 only received a single obligatory hearing and Sen. Niehaus announced that HB 298 would have been dead on arrival had it been passed by the House.
5) After HB 298 received two hearings, the Mid-Biennium Review budget bill (HB 487*) was amended to include similar language. It also proposed to disqualify Planned Parenthood from being eligible to receive funding through Title V, the Violence Against Women Act, the Breast and Cervical Cancer Mortality Prevention Act, the Infertility Prevention Project, and the Minority HIV/AIDS Initiative.
With the help of moderate Republicans on the House Finance and Appropriations Committee, this language was stricken from the bill the following week.
6) The latest attempt to divert family planning funds from those that have historically demonstrated an ability to deliver the highest quality services to the most people in the most cost-effective manner is the current biennial budget bill, HB 59*. This bill includes language very similar to HB 298, but also elevates the state’s 30 community action agencies to the second highest of the four-tiered formula.
Of course, HB 59 has been passed by the House and includes the language to change the eligibility mechanism for the distribution of family planning funds. However, having been term limited, Sen. Niehaus no longer leads the Senate. Will the new Senate President, the more conservative Sen. Keith Faber (R-Celina), follow the lead of his predecessor or allow the language to remain?
During the nine hearings held last session on legislation designed to change the mechanism for distributing family planning funds, expert testimony recruited from and delivered by physicians, public health providers, community allies of Planned Parenthood, other family planning providers, and advocates from throughout the state effectively made the case against the redistribution scheme. Only Ohio Right to Life and their supporters argued in favor of the change.
Selected testimony from last session:
- “In our last fiscal year, we provided over 9,000 family planning visits to almost 5,000 women and men in our service area. For many of our clients, we are the only source of healthcare.
“…dollars likely to be available are not sufficient to start up new clinic services, buy equipment, etc… In those counties where a (local health department) elects not to apply for funding, services may be lost entirely.” (emphasis added)
Executive Director, Family Planning Association of Northeast Ohio, Inc.
- “I believe that approval of HB 298 would result in a significant decline in the number of patients that could be served; would disrupt patterns of patient care that have long been established; and would result in a decline in the quality, depth and breadth of services currently available. My almost 40 years of experience in public health tell me that HB 298 would be a negative move for the public health of Ohioans.” (emphasis added)
C. William Keck, MD, MPH, FAMPM
(former Director of the Akron Health Department)
- “We oppose efforts that seek to re-direct federal family planning funds administered through the Ohio Department of Health and the Ohio Department of Job and Family Services to prioritized entities and which minimize the role of local family planning providers such as Planned Parenthood. In Summit County, the health district has long and purposefully supported Title X funding of our local Planned Parenthood as the principle and appropriate local provider of trusted family planning services. (emphasis added)
“In SummitCounty, Planned Parenthood is recognized, accessed, utilized and appreciated by an important at-risk population of low-income women in our community. Efforts to disrupt the successful continuum of safety net services will put many of these women unnecessarily at risk.”
Health Commissioner, SummitCounty Public Health
- “In this day of significant economic concern, defunding Planned Parenthood clinics and other popular reproductive health care clinics, does not make sense. It has been estimated that for every public dollar spent to provide family planning services we save approximately $3 in Medicaid costs for pregnancy-related care and medical care of newborns. When comparing contraceptive cost to the cost of unintended pregnancy when no contraception was used, a study estimates a savings to the health care system between $9-14,000 per woman over five years of contraceptive use.”
Kimberly Shepherd, MD
- “Currently, among the more than 120 local health departments (LHD) in Ohio, less than 25 percent provide any type of direct care health services. For a variety of reasons, many LHDs in our state have neither the infrastructure nor the capacity to provide direct care health services, focusing instead on important community-based, preventive health programs. These LHDs rely on local agencies as referral resources for uninsured and underinsured individuals seeking direct care health services. Thus, HB 298’s scheme ignores the current realities of health care needs and capacities for health services within Ohio.” (emphasis added)
Susan Misner PhD, RN
Let’s hope that the Senate Finance Committee will exhibit the necessary leadership to quash this ideologically-driven proposal and that they benefit from hearing similar expert testimony from the medical community, family planning providers, and allies who can explain why this reprioritization plan is not only unnecessary, but counter-productive.