http://www.seattlepi.com/local/politics/article/Future-of-Washington-women-s-health-murky-in-the-10935174.php
Future of Washington women's health murky in the age of Trump
Updated 11:54 am, Thursday, February 16, 2017
Sharon Thielman spent last Saturday morning with her family -- on the picket lines in Kent.
She and her aunt, daughter and daughter-in-law went to the Kent offices of Planned Parenthood to join hundreds who gathered in support of the clinic at a time when the organization's federal funding is under attack by Republicans in Congress.
"We're here to protect our daughters' and granddaughters' rights," Thielman said.
Both daughter Lynnsey Thielman and daughter-in-law Lauren Thielman had used Planned Parenthood before -- and, in Lynnsey's case, discovered and treated a lump in her breast.
"It's just about healthcare," Lynnsey Thielman said of Planned Parenthood, decrying the political football it's become.
The future of women's healthcare remains unclear as the new presidential administration brings promises of eliminating the Affordable Care Act and "defunding" Planned Parenthood, but without many concrete steps toward those ends so far.
Though Washington state has shown a commitment to reproductive health access -- even successfully defending its requirement that pharmacies dispense the "morning-after pill" in a case that ultimately was denied review by the U.S. Supreme Court -- it remains vulnerable to any healthcare cuts proposed by President Donald Trump and congressional Republicans.
"We should be working toward filling the gap in access today," said Jennifer Allen, policy director of Planned Parenthood Votes Northwest and Hawaii. "Instead, what we're talking about is going absolutely backwards in our health care."
Pro-Choice demonstrators counter Pro-Life rally at Planned Parenthood in Kent, Wash on Saturday, Feb. 11, 2017.
Media: MediaOS VideoWHAT'S AT STAKE
It remains unclear what may come of Republicans' promises to repeal -- or, as the line goes these days, "repeal and replace" -- the ACA, passed in 2010.
However, "we are certainly taking Trump and his administration at their word that they are going to go after the Affordable Care Act," said Tiffany Hankins, executive director at NARAL Pro-Choice Washington. It's not a matter of if they'll attack it, but when and how, she said.
In addition to repealing the ACA, Congressional Republicans have also advocated revoking federal support for Planned Parenthood. Though there's no line-item in the federal budget for Planned Parenthood, 60 percent of the patients at the low-income health clinic rely on public programs such as Medicaid and Title X to receive care.
Most Medicaid funding goes to preventive health care, Planned Parenthood says. As it stands, federal money does not go toward abortions, due to the Hyde Amendment, which passed Congress in 1976. However, abortion remains intertwined in the political dialogue about reproductive healthcare and could become harder to access should Republicans follow through on their promises.
Abortion makes up 3 percent of Planned Parenthood's services.
However, neither an ACA repeal nor a defunding of Planned Parenthood need to happen for the federal government to make changes to women's healthcare. Health and Human Services Secretary Tom Price can change the rules that govern the enforcement of the ACA and change the federal requirement that companies cover contraceptives without cost sharing, Hankins points out.
Furthermore, a decimation of Planned Parenthood could cut off care for the 98,000 low-income people in Washington who access the clinic with federal assistance.
"There isn't any other organization that can just step in and pick up the slack for 98,000 people losing their care," Allen said. "We face a provider shortage as it is."
That would leave patients grasping for another clinic that accepts Medicare-assisted patients, which is already a tough task, particularly in rural communities, Allen added.
A recent article in Rewire indicated that Washington is one of the most vulnerable states in the face of a Planned Parenthood slashing -- it is the sixth-most reliant state on federal money as a percentage of revenue, behind other progressive states such as California and Oregon.
And if the ACA is indeed repealed, what could be lost is the standard of medical coverage that federal law set, said Michael Marchand, a spokesman at the Washington Health Benefit Exchange.
One of the benefits of the ACA, Marchand explained, was the setting of a benchmark for essential health benefits, including requirements to cover commonly used services for women, such as maternity care and contraception. An ACA repeal could eliminate those requirements and send women back to a time when they were charged more for health insurance because of the possibility of expensive events such as pregnancy, Marchand said.
"The idea that a baseline level of insurance wouldn't cover maternity could pose problems because that's a pretty expensive bill," he said.
In addition to losing care for contraceptives and other services that would help them prevent getting pregnant, women who do become pregnant may not be able to afford prenatal care or maternity care, which could lead to larger medical issues and a larger price tag for all consumers, Marchand said.
Currently, about 1.8 million Washington residents use the state insurance exchange to receive healthcare coverage.
"We don't want to take a step back in services that have been brought forward through the ACA," Marchand said. "It's important that we are able to level out the playing field for women."
EXISTING STRAIN
Even with the existence of Planned Parenthood and the expansion of health insurance coverage with the ACA, women -- disproportionately those of color or who are low-income or rural -- still face several barriers to reproductive health care.
Trina Stout works on the front lines of this issue as president of the CAIR Project, which issues grants to women who can't afford an abortion. They primarily serve women in Washington, Oregon, Idaho and Alaska, but nearly half of their grants go to Idaho women because of the anti-choice policies enacted by legislators there. Additionally, they have fewer clinics than neighboring Washington and Oregon, so they often need money to travel to Spokane or Yakima.
If the ACA were to be taken away, Stout believes the United States will see an increase in unintended pregnancy and a greater demand for abortion care. Furthermore, she fears state legislators will continue to pursue greater obstacles to abortion -- an Idaho lawmaker introduced a bill last month that would classify abortion as murder.
"The new administration is emboldening conservative lawmakers to try to put more and more barriers to abortion care in place," Stout said.
The CAIR Project can resolve a lot of women's difficulties by referring them to sign up for Medicaid coverage, which pays for abortion care in Washington, Oregon and Alaska.
But even under private plans, high insurance deductibles can make abortions cost-prohibitive for women. Additionally, about 4,000 women in Seattle alone work for the federal government, which does not provide insurance that covers abortion thanks to the Hyde Amendment, Stout added. Tribal health policies also leave out that benefit.
Moreover, Washington's abortion providers hug the I-5 corridor, with outposts in Yakima, Spokane, Tri-Cities and Walla Walla. The volunteer-run CAIR Project helps pay for bus tickets and hotel fare for women who live in more remote areas.
But the CAIR Project itself has limits to how much money it can give away. Each week it has a set number of grants it can give out, but typically runs out by Tuesday or Wednesday. Anyone who calls its hotline after that must be rescheduled for the next week.
"That is the most awful part of serving the hotline, because we have to tell someone she has to be pregnant longer than she wants to be," Stout said.
Though donations have surged since the election, so has demand for care, she added.
And unintended pregnancies prove to be riskier ones, Allen says. They lead to a greater risk of homelessness and family hunger, as well.
"This isn't about abortion," Allen said of the squabble over Planned Parenthood. "This is about access to basic healthcare for low-income people in Washington and across the country."
WHAT'S BEING DONE
Kent's pro-Planned Parenthood rally was held in response to an anti-choice, anti-Planned Parenthood rally scheduled for the same time and place. Hundreds of participants marched nearly two miles through the city and uphill to the clinic to show support for reproductive care.
"I do think that protests can make a difference in people's opinions on these issues," said Leela Yellesetty, a co-organizer of the rally on behalf of Seattle Clinic Defense.
"We needed to make it known that (Trump and Congress) were not going to go unchallenged," she said.
People of all ages and their dogs attended the rally, holding signs that read "Trust women" and "Catholics for Planned Parenthood" while chanting phrases such as, "My body, my choice."
Nick Farwell of Beacon Hill carpooled from Seattle with Green Lake resident Jeff McClard to show their support for women's health care. They both have daughters whose rights they want to protect.
Farwell, who has a 4½-year-old daughter, said, "I'm afraid for her rights."
"If the so-called pro-life people were serious about preventing abortions, they'd raise money for Planned Parenthood in their churches," he said.
McClard has a 24-year-old daughter who has used Planned Parenthood herself.
"I'd like to see her future as secure as possible," he said. "... Now is the time to make a stand."
A few bills have been introduced in the state Legislature in an effort to protect women's healthcare. One would allow women to receive up to 12 months' worth of contraceptives -- as opposed to the current standard of one or three months at time -- and another would make current ACA insurance standards state law.
The latter, Rep. June Robinson, D-Everett, said, was a response to the threats by the federal government. That bill would protect access to preventive care services with no out-of-pocket costs, including pap smears, breast exams and immunizations.
"I think the threat isn't real yet, but certainly looking ahead it's still a possibility that those things might be threatened," Robinson said.
The 12-month contraceptive supply bill, she said, would make obtaining birth control more convenient for women and reduce unintended pregnancies.
"It's just a good women's health bill," she said.
Another bill supported by NARAL is one that would prevent pregnant women from facing workplace discrimination.
Washington has served as an epicenter for activism supporting reproductive care, Hankins said.
"So far in Washington state we've been floored with the energy of our pro-choice community," she said.
"Here in Washington state we're not going to go back in time."
Lynsi Burton can be reached at lynsiburton@seattlepi.com. Follow her on Twitter at @LynsiBurton_PI.
