However shortsighted, expensive and harmful the resulting policies may be, Iowa Republicans remain obsessed with abortion.
Last legislative session, they chose to scrap the Iowa Family Planning Network waiver, primarily funded by the federal government, and replace it with a new program funded solely by the state. That initiative, now known as the Family Planning Program, took effect July 1.
Both programs provide men and women of childbearing age who do not qualify for Medicaid a cost-effective way of accessing reproductive health services including contraception, exams, screenings and testing.
The Iowa switch wasn’t proposed because the original program was riddled with fraud or otherwise ineffective. In May 2016, the University of Iowa Public Policy Center concluded that more than 80,000 women had used the Iowa Family Planning Network waiver since it was established in 2006. Because of its popularity, the state’s Medicaid costs associated with childbirth were reduced by $345 million, and overall savings were $265 million.
The program and its network brought positive national attention to the state in the form of private grants for pilot programs intended to further decrease rates of unintended pregnancy. The culmination of these efforts was fewer unplanned pregnancies and an abortion rate that declined nearly 25 percent.
That last statistic is particularly irksome because Iowa Republicans ended a successful and effective program as part of their quest against abortion — despite the fact that no money from the original program could be used to fund abortion services.
The new Family Planning Program established by the Legislature specifically and purposefully excludes health care providers who perform abortions, or who are part of a medical network that does.
The bill purposefully was crafted to exclude Planned Parenthood, but several lesser-known providers that primarily serviced rural areas were harmed, too. In addition, the massive UnityPoint medical network was cast aside because some of its hospitals provide abortions in limited circumstances such as fetal anomaly.
The background is important because while Iowa Republicans were upfront about the true intent of their bill, they also promised Iowans would continue to have widespread access to family planning services.
What we know now, six months into the new Family Planning Program, is that access to women’s health services was not a priority. Throughout debate of the bill, its passage and subsequent rule-making, the only GOP priority was to exclude abortion providers at any cost.
The initial list of statewide family planning providers circulated by GOP elected officials in May contained nearly 2,500 entries.
Political opponents and the media scrutinized that list, noting it included several health providers, like dentists, who would have no interest in providing pelvic exams, sexually transmitted infection testing or contraception.
The official list maintained by the Iowa Department of Human Services now is half that size, but still similarly flawed. Many providers are duplicated, inflating the number.
Health care professionals who offer no family planning services are listed, as are service providers such as laboratories that don’t work directly with patients.
In Linn County, for example, the GOP list contained 193 family planning providers. Six months later, Human Services has narrowed the list to 48.
Attempting to schedule an appointment while using that list is another story.
One provider offers therapy services for abused children, others provide radiology to cancer patients. An assistant in a neurologist’s office laughed when I asked if I could make an appointment for a Pap smear. Clinics at Cornell and Coe colleges are closed. One of the listed phone numbers is a direct line to an operating room at St. Luke’s Hospital.
When duplicates, other service providers and shuttered clinics are removed, Linn County is left with four providers, all in Cedar Rapids.
It’s a similar story across the seven-county region that makes up the Creative Corridor. Of the 382 providers highlighted by the Iowa GOP, Human Services has winnowed the list to 82. Out of those, 21 are actual providers of family planning services. If clinics open limited hours, not accepting new patients, or scheduling appointments weeks into the future are taken into consideration, the number of available providers shrinks more.
According to Human Services officials, the state’s Family Planning Program list of providers was built according to guidelines set by lawmakers. Those guidelines, unlike earlier federal requirements, didn’t specify who should be included based on services provided. Instead, the guidelines specify who should be excluded based on abortion services. Providers without an anti-abortion oath were not welcome. Those who did sign the anti-abortion form were placed on the list, regardless of whether they work with patients to provide family planning services.
In early November, Human Services officials said they were aware of some problems and working to correct them.
It’s all rather humorous, unless you’re an Iowan trying to access health care.
This column by Lynda Waddington originally published in The Gazette on Jan. 14, 2018. Photo credit: Rebecca F. Miller/The Gazette