On Tuesday, Republican members of the House Oversight and Government Reform Committee lambasted Cecile Richards, the president of the Planned Parenthood Federation of America, for five hours. From watching the hearing, I learned three things. One, Richards makes more than $500,000 a year. Two, it’s not enough. For taking that kind of abuse, she should be paid more. Three, the GOP’s arguments for defunding Planned Parenthood are incoherent. They cancel each other out. Pick them apart, and you’ll see what the party really thinks: that no organization involved in abortions should get public funds for anything it does. Republicans are mounting a boycott, using your tax money and the threat of a government shutdown, to force medical providers to stop offering abortions.
To understand what’s fishy about the GOP’s arguments, you have to understand two things about Planned Parenthood. First, most of what it does isn’t abortion. Its affiliates provide about 10 million services a year: 4.4 million tests and treatments related to sexually transmitted diseases, 3.5 million birth-control services, 1 million pregnancy tests, 500,000 breast exams, 378,000 pap tests, and 327,000 abortions. That makes abortions about 3 percent of Planned Parenthood’s work (though a bigger share of its revenue, since abortions are relatively expensive).
Second, more than 80 percent of the money Planned Parenthood gets from the federal government is Medicaid reimbursement. It isn’t assigned to Planned Parenthood up front. It’s paid as compensation to clinics for services they’ve delivered to people covered by Medicaid. If those people choose other doctors or clinics, Planned Parenthood doesn’t get paid.
Throughout the hearing, Republicans complained that Planned Parenthood gets too much of its revenue from the federal government. Several members of the committee—Jeff Duncan of South Carolina, Cynthia Lummis of Wyoming, and John Mica of Florida—protested that taxpayers were supplying more than 40 percent of Planned Parenthood’s income. Duncan fumed that the Boys and Girls Club gets only a fraction of what Planned Parenthood receives. Mica explained the GOP’s underlying beef: Many Americans, including some who are pro-choice, don’t want their tax money used for abortions.
As an argument for defunding Planned Parenthood, this complaint makes no sense. Richards explained to the committee that under U.S. law, federal funds can’t be used for abortions unless the pregnancy threatens the woman’s life or was caused by rape or incest. So if Planned Parenthood is getting a high percentage of its income from the government, that means much of the work it’s being paid for isn’t abortion.
Even after hours of interrogation and explanation, the Republicans couldn’t get this through their heads. While railing against federal “subsidies” for Planned Parenthood (which pay for non-abortion services), they simultaneously protested that the organization drew too much of its income from abortion. Rep. Mark Meadows of North Carolina used a projector slide to show that at one Planned Parenthood affiliate, abortions brought in 28 percent of revenue. Rep. Steve Russell of Oklahoma, using wildly inflated numbers (he calculated each abortion at $1,500), suggested that abortion might represent 42 percent of Planned Parenthood’s revenue. Several members of the committee, including the chairman, Jason Chaffetz of Utah, noted with disapproval that Planned Parenthood’s non-abortion services—pap tests, breast exams, prenatal care—had declined in recent years.
Richards tried to explain the declines. Pap tests, she said, were down because new federal guidelines say they’re not necessary every year. At some clinics, birth control visits declined because women can now get six-month prescriptions or long-acting reversible contraceptives. Several members of the committee chastised Planned Parenthood for not offering mammograms. Richards replied that her clinics, like general practitioners, do preliminary breast exams but refer women to specialists for mammograms.
At no point did the Republicans recognize that excluding Planned Parenthood from Medicaid eligibility, as they’ve proposed in a bill that just passed the House, would exacerbate these trends. If Medicaid doesn’t reimburse Planned Parenthood for Pap tests and breast exams, Planned Parenthood is that much less likely to offer them. At the hearing, Lummis challenged Richards to explain why abortions comprised “over 86 percent of your nongovernment revenue.” Richards patiently explained that the statistic was a truism: If Medicaid covers almost every health service except abortion, then almost all of Planned Parenthood’s “nongovernment revenue” will come from abortions. And if you cut off all the government revenue, as Republicans are proposing, you leave Planned Parenthood with only one procedure that can pay the bills.
One of the day’s angriest speeches came from Rep. Paul Gosar of Arizona, who recently boycotted Pope Francis’ speech to Congress on the grounds that the pope is too liberal. Gosar, a former dentist, agreed with Richards that as a health care provider, “you're lucky if you get reimbursed your costs” under Medicaid. He criticized the declines in Planned Parenthood’s preventive services, described abortion as the organization’s “profit center,” and accused Richards of “narrowing” Planned Parenthood’s work “so that you're profiting off death.” But if you really believe that’s what Richards has done, how would excluding Planned Parenthood from Medicaid make things better? Wouldn’t the more logical response be to raise the reimbursement level for non-abortion services?
The committee’s Republicans repeated this fallacy as they made their case for federally approved “community health centers.” They said CHCs are better than Planned Parenthood clinics because these centers are more numerous and offer more services. Rep. Diane Black of Tennessee, the sponsor of House-passed legislation to defund Planned Parenthood, proudly told Richards that her bill “redirects those federal dollars to clinics that offer more preventative health care than Planned Parenthood.” But if CHCs really are better than Planned Parenthood, you don’t need Big Brother to redirect federal money. Women will choose the best providers, and Medicaid reimbursements will follow.
Why don’t Republicans recognize the tradeoff between Planned Parenthood’s reliance on federal funding, which pays for non-abortion services, and Planned Parenthood’s reliance on abortion income? To some extent, it’s because they don’t believe the restrictions on federal money will be honored. They worry that, as Lummis put it to Richards, “taxpayer dollars are being used to free up services that you provide that are abhorrent.” The more money Planned Parenthood receives from the government for non-abortion services, the more money it can allot from its private fundraising to abortions. Another committee member, Rep. Blake Farenthold of Texas, expressed the same worry about federal funds: “Even though not directly spent, they help facilitate [abortion], and that's one of the reasons I support defunding.”
That’s a legitimate concern. But if you defund Planned Parenthood on this basis, then what you’re really saying is that no organization that performs abortions can receive public funds. In theory, every dollar is fungible. No matter how carefully you separate the accounting, aid to Israel can help it build settlements in the West Bank, and tax breaks for churches can free up their other funds to support antigay conversion therapy. To prevent that kind of shuffling, you’d have to bar the government from paying for anything.
But that’s where the GOP is taking us. At the hearing, Russell said Planned Parenthood should be defunded because every abortion kills a child. Black, the sponsor of the House defunding bill, declared that “abortion is not health care” and urged Richards to “temporarily discontinue your abortion services”—all abortions, not just late-term abortions or fetal tissue donations—in order to appease Congress. If Republicans win, the new federal policy will be that you can offer abortions, or you can do business with the government, but you can’t do both.