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JACKI LYDEN, HOST:

It's WEEKENDS on ALL THINGS CONSIDERED from NPR News. I'm Jacki Lyden.

Coming up, protests in Brazil and a new film from director Pedro Almodovar. But first, a bill working its way through the Ohio state legislature has major implications for the way family planning services are provided. The Ohio budget contains language that puts family planning clinics at the bottom of the list to receive federal funds. Then...

MARY WYNNE-PEASPANEN: Local health departments have first priority for the funding.

LYDEN: Mary Wynne-Peaspanen is executive director of an organization that operates several independent family planning clinics in Northeast Ohio. They don't provide abortion, but they're still at the end of the line under a new tiered system. Ahead of them are places like emergency rooms and free clinics. And then if there's any money left over...

WYNNE-PEASPANEN: Which is not very likely, then they could consider applications from independent specialty clinics like my organization and like Planned Parenthood.

LYDEN: It is important to note that the Family Planning Association of Northeast Ohio has no affiliation with Planned Parenthood. While it does not provide abortions, it does offer referrals. And the budget bill from the Republican-controlled legislature could well put them out of business. Our cover story today: family planning services, scarce resources, bitter politics.

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LYDEN: We're talking to Mary Wynne-Peaspanen, the head of the Family Planning Association of Northeast Ohio. Since 1970, they've served primarily low-income women, but they're facing an anticipated 40 percent hit to their bottom line. Collateral damage in the abortion fight.

WYNNE-PEASPANEN: They've been very clear about the fact - at the general assembly - that their target is Planned Parenthood, but that doesn't change the fact that there are other organizations that will be impacted by this funding.

LYDEN: You're serving about 5,000 patients a year. Is it possible for your organization to survive a hit of perhaps 40 percent?

WYNNE-PEASPANEN: That's questionable for us. And with this funding comes benefits that we would also lose, which make it more cost-effective for us to operate. The main one being that we can participate in a program called the 340B Drug Pricing Program, which enables us to purchase our prescription drugs, primarily our contraceptives, at drastically reduced prices and make them available to our clients at a price that we can afford and a price that our clients can afford.

LYDEN: Would these health clinics - the people who get the first priority, would they be able to take over what you do?

WYNNE-PEASPANEN: The local health departments, it varies from county to county whether or not they could or would be willing even to take on those services. In the three counties that we serve, there has not been any interest up to this point to provide the services because we do it, and we do it well, and there's no point in duplicating services. I know that at least in two of our counties, the health departments would work with us if this were to come to pass and that they might apply for the funds and perhaps contract with us. But as the health departments are currently structured, they don't have the capacity to provide these services.

LYDEN: In Ohio and elsewhere, family planning clinics typically provide a range of women's health services.

JUDY WAXMAN: Cancer screenings, your weight, you get your blood pressure taken, you get your family planning, your contraceptive questions answered, and leave with a prescription.

LYDEN: That's Judy Waxman, the vice president for health and reproductive rights at the National Women's Law Center. She says by any measure, the vast majority of American women who are sexually active have used contraception at some point in their lives.

WAXMAN: It's really not a controversial issue for women, and yet you do see it coming up in the legislature sometimes where some of the legislators want to put some boundary or some rules on who can get contraceptives or family planning services.

LYDEN: Well, can you trace where this became a politically loaded concept, if it has, and has it changed?

WAXMAN: Well, 100 years ago, of course, it was a controversial issue and illegal for even married couples to buy contraceptives until 1965. But since that year, things have obviously changed dramatically. And now with the passage of the Affordable Care Act, all health plans have to cover contraceptives as a preventive service with no cost sharing for the individual woman.

So on one level, we as a nation have recognized that contraceptives are not only what everybody uses, but they also are very important for women's health. There is, however, a minority of politicians who try to use any issue that's related to, quote, "sex," unquote, to make some kind of political hay out of it.

LYDEN: So what states have laws or budgets that have revisited how these family planning services are to be provided?

WAXMAN: There's a handful of states who have started to look at the centers that are getting Medicaid funding or state money to provide the wide range of family planning services. And some states are just cutting their family planning budgets drastically.

LYDEN: Those states include Indiana, Arizona, Wisconsin and now Ohio.

Michael Gonidakis is the president of Ohio Right to Life, one of the groups that lobbied hard for the current legislative approach. He admits their ultimate objective is a straightforward one.

MICHAEL GONIDAKIS: Our goal is to find a way to end abortion, not make it illegal, but to end it. And we're big proponents of adoption reform and foster care reform, and we want to find ways to continue to help women who find themselves in unintended pregnancy to realize that they can have their baby, that there's support services there for them to keep their child.

LYDEN: The final language in the Ohio bill grants priority only to clinics that do not perform abortions or provide referrals for the procedure.

GONIDAKIS: We tried to craft it in a way, you know, the community action agencies came to us early on and said, hey, we might be getting caught in this net here. Can we help amend the language so that entities that are only providing those types of services, non-abortion services, are not caught in the crossfire? And we did. Even our pro-life representatives and state senators said, hey, we need to ensure that we're not leaving anyone behind.

LYDEN: He doesn't expect that women will have less access to family planning, not even those who are low income.

GONIDAKIS: There's nowhere - and I repeat nowhere - in the state of Ohio where there won't be other options in a very close walking proximity to where a clinic that may go out of business - Planned Parenthood or private or otherwise. It's just we're fortunate in Ohio we have approximately 130 community health centers, 45, 50 community action agencies, over 180 local departments of health. So, you know, we're doing some good things here in Ohio, and there's access to these types of services and care for low-income women across the state.

LYDEN: But it's something that uninsured Jess Locher, a 28-year-old cosmetologist in Chardon, Ohio, is worried about. She remembers going to the local branch of the Family Planning Association as a teenager.

JESS LOCHER: I had the same boyfriend throughout my whole high school. And I was sexually active. And I wasn't comfortable to ask my parents to get me protection and I wanted to be protected.

LYDEN: Ten years later, and now a mother of two, she still goes to the same clinic because she can't afford anything else.

LOCHER: If they took family planning away, I wouldn't be getting the female care that I need because my job doesn't offer me insurance, so I couldn't afford to go to a gynecologist.

LYDEN: Ohio is on the verge of making decisions that will alter the way family planning is funded there. Texas started down this road two years ago.

BECCA AARONSON: So when the Tea Party wave came through Texas in 2010, there was a big movement to oust Planned Parenthood from all of the state health programs.

LYDEN: That's journalist Becca Aaronson. She covers health care for The Texas Tribune. She explains how state lawmakers there took a three-pronged approach to cutting family planning funds.

AARONSON: First, they cut two-thirds of the family planning financing, then they set up a tiered financing system for their remaining funds so that federally qualified health centers and comprehensive health clinics would get money before the family planning clinics like Planned Parenthood. And, third, they set up a rule called the abortion affiliate rule, which prohibited anyone with trade associations with a provider that performed abortions such as Planned Parenthood from participating in the Medicaid Women's Health Program.

LYDEN: Over 50 clinics throughout Texas closed their doors. And as the dust settled, the consequences of this policy started to become apparent.

AARONSON: The state estimates that roughly 24,000 babies are going to be born as a result of these changes, and that's because women don't have as much access to birth control.

LYDEN: And that caused a big enough stir in Texas for state legislators to restore some of the funding to family planning.

AARONSON: They decided to put an extra $100 million towards primary care for women's health so that many uninsured women of all ages could get cancer screenings, diabetes treatment and family planning access.

WAXMAN: Well, I would say what happened in Texas was a failure for the women in the state.

LYDEN: Again, Judy Waxman of the National Women's Law Center.

WAXMAN: It's possible in some circumstances that women could go somewhere else, but many other health centers do not provide family planning services because they know Planned Parenthood is available to do that.

LYDEN: Where do you see this all headed? I mean, the National Women's Law Center has presumably been looking at this for a long time. Is it a snowball effect that more states are going to start to defund family planning?

WAXMAN: Well, I would say that this is an ideological issue. I can only hope that those people that are really outliers on this issue not continue to erode and really hurt the women in their states.

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LYDEN: Who's hurt and who's helped by laws that determine access to the full scope of family planning services is in part, of course, a matter of deeply held opinion and even religious faith. In Northeast Ohio, Mary Wynne-Peaspanen at the Family Planning Association is bracing herself.

WYNNE-PEASPANEN: I've been with the agency for 27 years. And funding cuts happen and, you know, funding increases happen, but this is, yes, I would say this is the most serious that has impacted us to date.

LYDEN: But Michael Gonidakis from Ohio Right to Life says he's confident things will be just fine.

GONIDAKIS: I don't foresee any situation whatsoever where a woman's going to be denied services because of the availability of so many other clinics in the state of Ohio.

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LYDEN: Ohio Governor John Kasich is expected to sign the state budget bill into law.

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