With the possible loss of federal dollars hanging over it, Planned Parenthood of Montana and the thousands of patients it serves annually are in the midst of an uncertain time.
“The level of anxiety we’ve been hearing from our patients, it’s upsetting,” PPM President and CEO Martha Stahl said Tuesday. “They have a question about whether or not our doors are going to remain open.”
On Monday U.S. Sen. Steve Daines, R-Mont., co-introduced bills with Sen. Joni Ernst, R-Iowa, to redirect federal funding from Planned Parenthood and toward other women’s health care providers, and undo rule-making by former President Barack Obama that protected Planned Parenthood funding.
Planned Parenthood of Montana operates five clinics in four cities — two in Billings, and one each in Helena, Great Falls and Missoula. The clinics serve between 13,000 and 14,000 patients a year, the majority ages 18-34, and about 10 percent men.
About 60 percent of the patients have insurance, Stahl said, and another 25 percent rely on Medicaid. The other 15 percent pay on a sliding-fee scale, depending on income level. That's made possible by Title X grant money, a federal family planning grant, Stahl said.
That grant money is part of what would be affected by the bills proposed by Daines and Ernst. The other, larger percentage of money that could be directed away from Planned Parenthood are the Medicaid dollars that cover direct medical services to low-income patients.
About 95 percent of what the five Montana clinics provide are prevention care services, such as annual exams, cancer screenings and birth control, as well as testing and treatment for sexually transmitted diseases and HIV testing.
Abortions account for the other 5 percent, Stahl said. The number of abortions, which are performed at all of the clinics except for Missoula, has remained relatively steady over the past 10 years.
“None of the federal funds we get go to abortion services,” Stahl said.
The uncertainty over federal funding isn’t the only factor that’s unnerving patients, she said. With President Donald Trump and a Republican Congress seemingly working to undo the Affordable Care Act, Planned Parenthood has seen a swell in the number of patients seeking birth control while they still have coverage.
Comparing December 2016 to the year before, the five Montana clinics did twice as many insertions of long-acting reversible contraceptives, including intrauterine devices and implants.
“Our patients are clearly worried about this, and when they come in they ask about it,” Stahl said. “They’re wanting to make sure they can get their birth control as soon as possible.”
She calls implants the most effective form of birth control, other than abstinence. They are good for a long period of time, she said, “and we have seen a lot of growth in that for patients of all ages.”
Keeping at it
Even if federal funding is cut, Planned Parenthood of Montana will keep its doors open, Stahl said. So far it has been able to maintain its level of staffing.
“Should we be defunded, we’ll be looking at all of our expenses and making sure we can maximize resources so we can continue to serve patients,” she said. “We’re trying to plan ahead as much as possible, but like so many things, there’s not a lot of clarity on what’s going to happen.”
Presently, the organization has about 60 employees between its five clinics and administration. In addition to the health care services Planned Parenthood of Montana provides, staff members also do a lot of community outreach, including evidence-based sex education. That might be cut if funding dries up, Stahl said.
She maintains that Planned Parenthood does more than any other organization to prevent unintended pregnancies in the United States.
In a paper published in January, Kinsey Hasstedt, senior policy manager with the Guttmacher Institute, a research and policy organization focused on advancing sexual and reproductive health, called Planned Parenthood critical in providing the nation's family planning safety net.
"Planned Parenthood health centers consistently perform better than other types of publicly funded family planning providers on key indicators of accessibility and quality of contraceptive care," Hasstedt wrote.
It's difficult to predict how a cut in finding might play out, she added, but "it is highly doubtful that other providers could step up in a timely way to serve the millions of women suddenly left without their preferred, and sometimes only, source of care."
And providing that care has a real effect in each community, Stahl said. The key to preventing the number of abortions from rising is making sure people have access to education and birth control, she said.
“If folks want to reduce the number of abortions, logic dictates continuing to fund organizations that have a proven track record of reducing intended pregnancy,” she said.