Indiana Update

Turns out that when a state ignores reports that say "restricting freedom of choice with respect to providers of family planning services is prohibited (by federal law)" and passes a law anyway doing just that, the federal law will raise its eyebrows at the state and ask it "WTF are you doing?"

WASHINGTON — The Obama administration is raising serious objections to a new Indiana law that cuts off state and federal money for Planned Parenthood clinics providing health care to low-income women on Medicaid.

The changes in Indiana are subject to federal review and approval, and administration officials have made it clear they will not approve the changes in the form adopted by the state.

Federal officials have 90 days to act but may feel pressure to act sooner because Indiana is already enforcing its law, which took effect on May 10, and because legislators in other states are working on similar measures.

If a state Medicaid program is not in compliance with federal law and regulations, federal officials can take corrective action, including “the total or partial withholding” of federal Medicaid money. The mere threat of such a penalty is often enough to get states to comply. Actually imposing the penalty would, in many cases, hurt the very people whom Medicaid is intended to help.

Administration officials said the Indiana law imposed impermissible restrictions on the freedom of Medicaid recipients to choose health care providers.

[...]

Asked for comment on the Indiana law, the federal Centers for Medicare and Medicaid Services provided this statement, cleared by the White House: “Federal law prohibits federal Medicaid dollars from being spent on abortion services. Medicaid does not allow states to stop beneficiaries from getting care they need — like cancer screenings and preventive care — because their provider offers certain other services. We are reviewing this particular situation and situations in other states.”

Medicaid is financed jointly by the federal government and the states, which must comply with federal law as a condition of getting federal money.

[...]

Most of the money at stake is federal. The federal government pays about 66 percent of the cost of most services covered by Medicaid in Indiana, but for family planning the federal share is 90 percent — an indication of the importance historically attached to such services by Congress.

Just for reference, according to Guttmacher:

Title X–Supported Services in Indiana

•Title X–supported centers provided contraceptive care to 39,800 women in Indiana in 2008.(3)

•These centers served 11% of women in the state in need of publicly supported contraceptive services and supplies, compared with 27% served by such centers nationally.(3)

•Of the total contraceptive clients served by these centers, 77% had incomes at or below the federal poverty level, compared with 70% nationally.(8)

•In 2006, 40 family planning centers in Indiana received support from Title X.(9,10) They included:

Health department clinics: 4
Community health centers: 5
Planned Parenthood clinics: 13 (emphasis mine)
Hospital outpatient clinics: 9
Other independent clinics: 9

•These centers provided contraceptive care to the following numbers of clients:

Health department clinics: 1,960
Community health centers: 6,800
Planned Parenthood clinics: 25,780 (emphasis mine)
Hospital outpatient clinics: 9,960
Other independent clinics: 6,950

Impact of Services Provided by Title X–Supported Centers in Indiana

•In 2008, contraceptive services provided at Title X–supported centers in Indiana helped women avoid 8,300 unintended pregnancies, which would have resulted in 3,700 births and 3,500 abortions.(3)

•In the absence of these services, the level of abortion in Indiana would be 34% higher.(6,9)

•In 2006, contraceptive services provided at Title X–supported centers in Indiana helped women younger than age 20 avoid 2,929 unintended pregnancies.(11)

•In the absence of these services, the level of teen pregnancy in Indiana would be 21% higher.(7,11)

•By helping women avoid unintended pregnancies and the births that would follow, the services provided at Title X–supported centers in Indiana saved $32,013,000 in public funds in 2008.(12)

What the government ends up saying with regards to Indiana is important (though it is not party to court cases regarding the law) since besides being taken into consideration in any Indiana ruling, what the gov't says may affect similar legislation that's being considered in Wisconsin, Oklahoma, Texas, and Kansas. In fact:

Both houses of the Kansas Legislature have approved a 2012 budget bill that would redirect about $300,000 in federal family planning money from Planned Parenthood to state and local clinics. Gov. Sam Brownback, a Republican, is expected to sign it.

Of course he is.