Ashley Smith, who’s uninsured, has relied on Maine Household Planning for her well being look after years. She’s pictured on the ladies’ summer time camp close to her residence the place she works, along with different jobs.
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Greta Rybus for NPR
When Ashley Smith arrived to testify earlier than the Maine Legislature throughout a committee listening to final spring, she was terrified. “I used to be shaking like a leaf within the wind,” she says.
She instructed lawmakers that she was there in assist of Maine Household Planning, a 50-year-old community of reproductive well being clinics the place Smith is a affected person.
State lawmakers have been contemplating the right way to make up a funding shortfall from Washington, D.C. the place Republicans in Congress aimed to chop off federal funding to clinics that present abortion.
Smith instructed the committee that she does not have medical health insurance and that Maine Household Planning’s nonprofit clinics have been her solely supply of well being care.
“Within the final 4 years I’ve obtained care there, not as soon as did I’ve an abortion,” Smith testified. “I did, nevertheless, have entry to STD and STI (sexually transmitted illness and an infection) testing, referrals for thyroid testing and blood panels, pap smears, breast examinations, referrals for mammograms, and a premenstrual dysphoric dysfunction prognosis. The final two I listed saved my life,” she stated.
Smith, who’s 36, says she was impressed to testify and write an op-ed, as a result of she’s frightened about what would occur if Maine Household Planning needed to shut within the face of deep federal funding cuts. “I can not think about what would occur to our communities if we misplaced such a keystone — that is what actually fueled my fireplace,” she says.
Maine Household Planning did get a 12 months of further funding from the state, however it additionally misplaced Medicaid income for one 12 months with the passage of President Trump’s tax and spending invoice — a 20% hit to the group’s funding.
The “defund” effort past Deliberate Parenthood
In Maine, abortion is authorized and extensively supported by the voters. In a ballot launched by the Pew Analysis Middle this summer time, 72% of Mainers say abortion ought to be authorized in all or most circumstances. The state legislature has moved to increase entry to abortion care because the Supreme Courtroom overturned Roe v. Wade three years in the past.
Now, the Trump administration and congressional Republicans are utilizing federal funding as a lever to limit abortion entry in states, like Maine, the place it’s authorized and guarded by state legislation.
Republicans and anti-abortion rights activists have lengthy sought to finish Medicaid {dollars} flowing to Deliberate Parenthood for any cause, arguing that federal reimbursement even for unrelated companies not directly helps abortion in clinics focusing on reproductive well being. In July, they have been lastly in a position to accomplish that objective.
Maine Household Planning operates 18 clinics across the state, together with this one in Augusta, Maine. It supplies major care along with a full vary of reproductive well being care.
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The provision within the legislation blocks federal Medicaid funds from being paid to reproductive well being nonprofits that obtain greater than $800,000 in Medicaid funds in a 12 months. It took impact when the invoice was signed by President Trump on July 4. (Republican senators modified the timeline from a decade to a single 12 months of defunding to adjust to Senate guidelines.)
Only a few organizations match the $800,000+ description. Deliberate Parenthood is one in every of them, one other is Well being Imperatives in Massachusetts, and so is Maine Household Planning.
“The place am I going to go?”
About half of Maine Household Planning’s sufferers are on Medicaid. The group is not reimbursed for his or her visits.
That is about $2 million gone, says George Hill, Maine Household Planning’s president and CEO.
“That is tough. You need to make some tough choices,” he says. “Both you generate extra income, otherwise you minimize prices.”
On Oct. 1, the group let sufferers know they might be ending major care companies on the finish of the month at three clinics within the far reaches of the state: Houlton, Presque Isle and Ellsworth. That change affected almost 1,000 sufferers, together with sufferers on Medicaid and people with personal insurance coverage.
George Hill, Maine Household Planning’s president and CEO has labored in well being care for nearly 40 years. “Now we have a mission,” explains Hill, “to ensure that the total vary of sexual and reproductive well being care is offered to as many sufferers as attainable.”
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“The day that our portal message went out [to patients], the telephones simply began ringing off the hook,” says scientific companies director Melissa Grey. “It was the identical message over and over: ‘The place am I going to go? You of us have helped me with issues that no one else had helped me with, I by no means felt such as you have been judging me. I do not desire a totally different supplier, I need to hold seeing you.’
“It was actually heartbreaking and a tough couple of days for workers,” she says.
Grey and her group spent all of October attempting to attach these sufferers to new docs, and ensuring they have been arrange with sufficient refills of medicines to final them when there have been lengthy waits earlier than they may very well be seen by the brand new follow. Maine has a well being care supplier scarcity, which made that job more durable, she says. “There already weren’t sufficient suppliers — we have been getting new affected person requests on a regular basis,” she says. “Now there’s much less.”
The objective of scaling again major care was to attempt to protect household planning for longer. All 18 of their household planning clinics across the state are nonetheless open. “Now we have a mission,” explains Hill. “And our mission is to ensure that the total vary of sexual and reproductive well being care is offered to as many sufferers as attainable.”
They’re nonetheless seeing Medicaid sufferers for sexual and reproductive well being with out getting paid for it.
A stack of billing sheets, simply in case
One among their clinics is in Thomaston, Maine, a small city alongside the coast. Vanessa Shields-Haas is the nurse practitioner there. The clinic is brilliant and pleasant, with colourful “condom artwork” on a bulletin board within the ready room.
The rotating seasonal scenes within the ready room on the Maine Household Planning clinic in Thomaston are crafted from coloured condoms. Â “I feel they’re enjoyable,” nurse practitioner Vanessa Shields-Haas says. “Sufferers love them.”
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Shields-Haas is infuriated by the funding cuts to Maine Household Planning and what they imply for her sufferers.
“A whole lot of my sufferers — perhaps they’re working at a lodge or they’re ready tables, they’re serving lobster rolls to hungry vacationers, beginning oyster farms,” she says. “These are folks which are working actually arduous.”
She does so much for them: fertility remedies, biopsies, prescription refills, even vasectomies. And he or she’s continued to do all these issues for her sufferers lined by Medicaid with out getting reimbursed.
“We’ve not been turning them away,” she says. “I fill out the billing sheets and we stack them up within the occasion that we may very well be reimbursed presumably sooner or later.”
Vanessa Shields-Haas has been offering medical look after sufferers lined by Medicaid with out getting reimbursed. “We’ve not been turning them away,” she says.
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She says sufferers are confused by what’s taking place, and plenty of have despatched her messages asking if they’ll nonetheless go to her for care. She assures them that they’ll, though she worries concerning the future.
“Sadly, decision-makers in Washington are having such a profound impression on what we will and might’t do,” she says. “Not with the ability to be reimbursed for the visits is basically crippling, financially.”
A authorized problem
For George Hill, political interference in sexual and reproductive well being care is nothing new. “I have been within the area since 1987, so near 40 years, [through] a number of totally different presidential administrations which have been hostile to the care that we now present,” he says. “That is — by quantity and velocity — in all probability the worst that we’ve got seen.”
Simply weeks after the One Massive Stunning Invoice Act was signed into legislation, Maine Household Planning filed a lawsuit to problem the supply that blocks them from getting Medicaid funding.
“The lawsuit was filed basically as a result of Maine Household Planning says that is unfair and it is improper and it is unconstitutional to be singling out and focusing on sure suppliers based mostly on this animus in opposition to abortion,” says Autumn Katz, interim director of litigation on the Middle for Reproductive Rights, which represents the group in its lawsuit.
The federal authorities defended the supply in a courtroom submitting, arguing that it promotes Congress’ “objective of decreasing abortion” and suggesting Maine Household Planning may get its funding again if it stopped offering abortion.
(Deliberate Parenthood filed a separate lawsuit and initially was in a position to safe an injunction. That was overturned on enchantment, and Deliberate Parenthood misplaced its Medicaid funding in September. In Maine, the preliminary injunction request was denied. The Medicaid provision is in impact as each lawsuits work their method by the courts.)
One other menace looms
Anti-abortion efforts on the federal stage could not cease with the Medicaid legislation.
One other 20% of Maine Household Planning’s price range comes from the federal authorities by Title X — a decades-old grant program that permits the clinics to see uninsured sufferers. In October, the Trump administration fired the entire group that works on that program. These firings have been reversed in mid-November as a part of the deal to finish the shutdown, however the administration may attempt to finish this system in one other method.
Hill says he is not certain what is going on to occur subsequent with the lawsuit and Medicaid, or Title X, however he says they don’t seem to be giving up. The state legislation that affected person Ashley Smith advocated for supplies brief time period funding from the state to assist fill the price range hole. Hill says they’re exploring new potential partnerships and new methods to lift income they have not tried earlier than.
He quotes Rep. Pat Schroeder, the late Democratic lawmaker from Colorado: “You possibly can’t roll up your sleeves and get to work if you happen to’re wringing your palms,” he says. “We will proceed to do the work. We’re not going to cease.”
