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What are state governments doing to prevent a repeat of a public health crisis like the one that’s hobbled Scott County, Indiana?
On the campaign trail, defunding Planned Parenthood was a prominent red-meat topic of discussion and a rallying call for core conservatives, just like repealing Obamacare was.
But repealing as something as complex as the Affordable Care Act isn’t a simple action, nor is replacing it. So it’s not necessarily surprising that some Republican leaders on Capitol Hill and in the states, like Arizona Gov. Doug Ducey, have been urging caution about rushing an Obamacare repeal through Congress. (The U.S. Senate approved a measure on Thursday that takes the first step in the direction of a repeal.)
Republicans should also be careful when addressing the sweeping calls from conservatives to defund Planned Parenthood in order to punish the organization for providing abortion services.
During Tuesday’s Condition of the State Address in Des Moines, Iowa Gov. Terry Branstad told his fellow Republicans, who now control both the Hawkeye State’s legislative chambers, that he’s aiming to defund organizations that perform abortions while redirecting “family planning money to organizations that focus on providing health care for women and eliminates taxpayer funding for organizations that perform abortions.”
Important points to remember: While some Planned Parenthood clinics perform abortions, the portfolio of health care services provided by the organization is far more expansive than just reproductive health and that no federal funds go toward abortion services.
In response to Branstad’s address, The Des Moines Register editorial board asked regarding his call to shift family planning funding to other health care organizations in the state:
The governor should specify exactly which organizations those would be. He should sit down and write the names of the entities that can provide comprehensive family planning services in Iowa. Then he should scratch those no longer in business, like Central Iowa Family Planning.
As The Register rightfully points out, rural access to health services and adequate funding for those services remains a huge challenge for Iowa, as it is for other states.
Just look at Scott County, Indiana, which has become a national poster child for what can go wrong when you mix rampant opioid abuse in a rural community with unsafe needle-sharing practices, an HIV epidemic and a struggling public health response.
Within a few months of the start of the Scott County’s HIV outbreak in December 2014, around 200 people had been diagnosed. (This week, Route Fifty examined the Scott County situation, the success of needle exchanges and how a local public health director in West Virginia is trying to prevent a repeat of the Scott County “nightmare” in his community.)
Up until 2013, Planned Parenthood had operated a rural health care clinic in Scott County, which provided HIV testing but didn’t perform abortions. Federal and state funding cuts for the organization, championed by Vice President-elect Mike Pence when he served in Congress and as a Indiana’s governor, prompted that Planned Parenthood clinic in Scott County, along with four others in rural Indiana communities, to close.
As The Indianapolis Star reported in 2015:
Patti Stauffer, vice president of public policy for Planned Parenthood of Indiana and Kentucky, said she can't make a direct link between the closure of the Scottsburg clinic — which served 1,500 patients in the last full year before it closed—and the HIV outbreak.
"But that health center was providing HIV tests in Scott County, and any positive tests would have been reported to the state," she said.
Low public health funding affects a state's ability to detect problems such as an HIV outbreak and to address them quickly, said Jeff Levi, executive director of Trust for America's Health and an HIV expert. "But some of the issues associated with this have less to do with money and more to do with policy and appropriate policy response."
Unfortunately for Hoosiers, Indiana ranks low among U.S. states when it comes to the strength of public health infrastructure, as The Star reported.
And even without a firm connection between the Planned Parenthood clinic closure and Scott County’s HIV epidemic, the public health crisis shows the high stakes when it comes to having inadequate funding and access to health care services, especially in rural communities.
The Register’s editorial continues about Planned Parenthood’s important footprint in Iowa:
Planned Parenthood has been providing birth control, pregnancy testing, health care, disease treatment, teen pregnancy prevention programs and other services to Iowans for decades. It has the infrastructure in place to reach thousands of people, including those in rural and low-income areas.
If the governor rejects this particular organization, he should specify exactly who has the statewide ability to take its place. And he should remember school nurses and optometrists do not provide pap smears.
Inadequate public health access can have life changing impacts on communities. Fiscal conservatives should remember that ineffective management of a public health crisis can lead to unintended consequences and costs—beyond the human cost, of course.
The estimated price tag on the lifetime treatment for the HIV and hepatitis C outbreak in Scott County, Indiana, is around $100 million, which Iowa lawmakers should note is about equal to the size of the $110 million budget hole that Branstad currently is trying to fix.
It should be noted that repealing the Affordable Care Act would make it far more difficult for states and localities to treat mental illness and the substance abuse, especially states that have had high numbers of opioid-related deaths.
Could Scott County, Iowa, or for that matter, Scott County, Missouri, or Scott County, Tennessee, be the next Scott County, Indiana? If policymakers in those states and the nation’s capital aren’t careful, they very well could.
Michael Grass is Executive Editor of Government Executive’s Route Fifty and is based in Seattle.
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