The bill would have prevented state funding from being given to “any entity that performs abortions or maintains or operates a facility where abortions are performed,” except licensed hospitals and ambulatory surgical centers. Thus, it targeted Planned Parenthood for its abortion services, even though they are a small share of its services (across Indiana’s Planned Parenthood clinics, less than 7 percent of patients received an abortion last year). The law would have unnecessarily cut off access to crucial preventative services unrelated to abortion for the other 93 percent of patients. It also could have unfairly reduced access to safe abortions for women who use their own funds for the service.
The 28 Planned Parenthood facilities in Indiana provide cancer screenings, birth control and sexually transmitted disease and infection (STD/STI) testing to approximately 80,000 women and men; disallowing their Medicaid reimbursement claims could have caused 22,000 patients to lose access to high-value preventative health care services. Governor Daniels insisted that women had enough clinical options available that the bill “wouldn’t change anything.” He continually referenced an internal study that showed at least five clinics were available in each county to substitute for the loss of Planned Parenthood as an approved Medicaid provider. Unfortunately, Governor Daniels failed to see the story behind the arbitrary number five. For example, the report did not consider whether those providers were accepting new patients, the potential loss in service quality, accessibility issues and the costs associated with the disruption of care for thousands of existing Planned Parenthood patients. It also completely ignored the impact on the wider health system, which may have not been equipped to absorb the influx of former Planned Parenthood patients on Medicaid.
Research synthesized by the Robert Wood Johnson Foundation points to high returns on investment for the types of preventative care that Planned Parenthood provides. In addition, the nonpartisan Institute of Medicine recommended that insurers provide the following “vital screenings and tests” without cost-sharing because of their value in maintaining lifelong health: well woman exams, FDA-approved contraceptives, contraceptive education and counseling and screening for HPV, HIV and STIs. In fact, every dollar spent to prevent unwanted pregnancies saves nearly $4 in Medicaid expenditures (according to the U.S. Department of Health and Human Services and a 2012 study by the Guttmacher Institute). It seems counterintuitive for an efficiency-focused governor to prevent an experienced and effective community-based medical provider from providing services that lower health care costs for the state and improve health outcomes for its most vulnerable populations.
Governor Daniels did not dispute the research on preventative spending for contraception and health screenings when asked about his decision to sign the legislation. He took no ownership of his signature at all, stating it was not his proposal and that it was buried within a large and complex bill. He went on to say that a governor’s veto in Indiana can be overridden with a simple majority vote by the legislature, a fight he did not feel was warranted by this case. While Governor Daniels does not verbally acknowledge it, remaining silent in the face of unsupported and inefficient cuts in women’s health funding was hypocritical and places him among the most conservative politicians.
Governor Daniels, we believe that policies limiting provider choice without consideration of cost and quality are wasteful; and we believe that the rights of women to access basic health care services are worth your veto.
Jennifer Browning is a second-year graduate student at the Wilson School from Washington, D.C. She can be reached at firstname.lastname@example.org. Kate Fritzsche is a first-year graduate student at the Wilson School from Kennebunk, Maine. She can be reached at email@example.com. Cara Stepanczuk is a second-year graduate student at the Wilson School from Munster, Ind. She can be reached at firstname.lastname@example.org.