It makes sense that the Pence amendment, which passed the House in February and which would bar Planned Parenthood from receiving federal funding, is backed by social conservatives, many of whom object to how the organization's services enable nonprocreative sex. But the amendment's support isn't limited to social conservatives—it includes even fiscal conservatives who don't typically take part in culture war shenanigans. With the campaign to defund Planned Parenthood now shifted to the Senate, Grover Norquist recently argued in the National Review that libertarian Republicans should get onboard: "If a new Congress elected on a pledge to halt skyrocketing spending and deficits can't cut the gold-plated panjandrums at Planned Parenthood, it can't cut anything." More than two dozen self-identified fiscal conservative groups, from the Koch brothers-backed Americans for Prosperity to the pro-gay group GOProud, have staked out a similar stance in a letter suggesting that, unless Planned Parenthood funding is cut, "there is little hope for fiscal restraint."
At first blush, these lines sound like fiscal conservatism; money not spent on Planned Parenthood is money not spent, right? But a closer look into the particulars of the Pence amendment demonstrates that the math doesn't add up: Eliminating funding for Planned Parenthood will likely cost the government more money in both the short and long run, adding to the deficit. Simply put, Planned Parenthood offers extremely cost-effective care compared to other government-funded providers, and each dollar spent on contraception saves taxpayers multiple dollars down the line.
To start with, Norquist and company are simply wrong to characterize the Pence amendment as a budget cut. It's in fact a budget prohibition barring Planned Parenthood and other clinics that offer abortions from either receiving Title X funding (which subsidizes reproductive health services for low-income women who aren't on Medicaid) or being reimbursed by Medicaid for reproductive health services. Under the Pence amendment, other clinics that provide reproductive health services to low-income men and women would still get Title X funding, as long as they didn't offer abortions, and the government would still pay for Medicaid recipients' reproductive health care. Even Rep. Mike Pence, R-Ind., himself is clear about the fact that the Pence amendment is not a budget cut. In a recent radio interview he praised Title X for providing "health services for women and children that might not otherwise have access to them." He just doesn't want any of its funds—or Medicaid's—to go to Planned Parenthood.
The Pence amendment would, rather than cut overall spending, shift patients from Planned Parenthood to other clinics—clinics that typically charge the government more for the same services. "These women are still going to be on Medicaid and still eligible for Title X," said Tanya Ehrmann, the National Director for Health Care Reform at Planned Parenthood, "and they will still, to the extent possible, go for services where they can. And in fact, may go to places that are more expensive, and may end up costing the government even more money."
The amount of money that could be lost by pushing Medicaid patients into other clinics is substantial. According to the Guttmacher Institute, in 2006, government spending on contraceptive services for 9.4 million patients-including Medicaid, Title X and state funding- totaled $1.85 billion. Of those patients, 2.6 million went through Planned Parenthood, at what Planned Parenthood estimates to be a cost of $385 million, and 6.8 million of them went through other providers, at a cost of $1.5 billion, according to Guttmacher numbers. Broken down, this means Planned Parenthood cost the government an average of $148 for a patient's contraceptive care in a year, while other clinics spent $215 a year per patient. Just pushing contraceptive care for these patients from Planned Parenthood to other clinics would thus cost the government an additional $174 million a year. *
How can Planned Parenthood offer services so much less expensively than other providers? In part, it's because there is a federal law that requires drug companies to provide deep discounts to organizations with an overt family planning mission. According to Ehrmann, the organization also saves money by keeping up with the latest standards of care. For instance, Planned Parenthood provides women full pelvic exams once every three years instead of every year, and unlike many providers, it doesn't require a full exam every time a patient comes in with a specific complaint. Also, like Wal-Mart, Planned Parenthood has an economy of scale advantage—it's the biggest reproductive health care provider in the country, with more than 800 clinics nationwide. "Because we're a large organization," said Planned Parenthood spokesman Tait Sye, "we're able to do national purchasing for medical supplies and other things at lower costs."
If the Pence amendment were to become law, the cost to Medicaid of paying more for contraception would be only the beginning. Planned Parenthood also provides STD testing and treatment and cancer screenings less expensively than most clinics that don't specialize in reproductive health care. It if passed into law, the Pence amendment would likely cause many Planned Parenthood affiliates and other clinics that offer abortion to close, forcing even their non-Medicaid patients to seek care from other clinics and hospitals that are geared to low-income patients. The Hartford Courant recently interviewed Connecticut health care providers on the likely consequences of pulling Planned Parenthood out of the health care system. The scenario that emerged? Clinics that already have three-month waiting lists would probably take on still more patients. More women would therefore resort to expensive emergency room care for gynecological conditions that could have been handled inexpensively through Planned Parenthood, and taxpayers would often end up footing the bill.
These are just the costs for women lucky enough to find alternate care. For many women in rural and isolated areas, Planned Parenthood is the only reliable source of contraception. If the Pence amendment terminates their access, more of these women–many of whom are either uninsured or on Medicaid—will face unintended pregnancies. Some will get abortions, but quite a few won't, which is where government costs could rise even more dramatically. The Guttmacher Institute estimated in 2008 that every dollar spent on family planning saves taxpayers $3.74 in government spending on prenatal care, childbirth, and the first year of an infant's health care. But if more women who are financially stressed end up bearing children they don't want, the costs of pregnancy and infant care will quickly be dwarfed by government spending on public assistance, food stamps, and health care.
Republicans have a habit of comparing government budgeting to family budgeting in cases where the metaphor doesn't hold, but in this case, the parallel is perfect. Individuals use contraception because delaying childbearing until you can afford it translates into massive savings over a lifetime. The same rationale works for the federal government and Planned Parenthood. True fiscal conservatism would mean choosing the cheaper option of paying for Planned Parenthood now and avoiding a larger deficit down the road.
Correction, March 29, 2011: This paragraph originally included a series of calculations based upon an incorrect comparison of Guttmacher Institute data with Planned Parenthood data. The $385 million figure cited by Planned Parenthood reflects all of its affiliates' public funding for family planning (including Medicaid, Title X and state programs), rather than Medicaid funding alone, as originally indicated. The Guttmacher data has been updated accordingly: Instead of referring to $1.3 billion in Medicaid spending on family planning services, the article now cites $1.85 billion in total federal and state funding for family planning services. This revised sum includes funding for a total of 9.4 million patients, of whom 2.6 million were served by Planned Parenthood clinics, not 2.5 million, as originally stated.
Several other numbers in the paragraph have been recalculated accordingly: 6.8 million patients were served by other providers at a cost of $1.5 billion, not 4.5 million patients at a cost of $1.1 billion, as originally estimated. Non-Planned Parenthood providers spent an estimated $215 in public dollars per year per patient, not $244 per year, and moving publicly subsidized contraceptive care from Planned Parenthood to other providers would therefore increase government spending by an estimated $174 million a year, not $225 million a year. Return to the corrected paragraph.