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There's a provision in the Republican proposal to repeal and replace the Affordable Care Act that blocks Planned Parenthood from receiving Medicaid dollars for at least a year. Opponents of abortion rights say public funds for services like cancer screenings and contraception should instead go to health clinics that don't do abortions.
NPR's Sarah McCammon looks at what that would mean for public health centers and patients.
SARAH MCCAMMON, BYLINE: There are lots of reasons why women want to avoid getting pregnant. For Dawn States, two spinal surgeries as a teenager make pregnancy a bad idea.
DAWN STATES: My spine is fused, and I have two rods. And so it's just not really a setup for carrying around an infant.
MCCAMMON: Now 26 and living in Lancaster, Pa., States recently came to a Planned Parenthood clinic in York, about 25 miles away, to get a long-acting IUD.
STATES: Because I wasn't sure what was going to happen in the next foreseeable future. And I actually physically can't have kids. So it was - it's very important for me to never ever have that.
MCCAMMON: She worries about what will happen to women like her, who receive Medicaid and depend on Planned Parenthood for this kind of care. Planned Parenthood does provide about a third of the nation's abortions but can't use federal money for the procedure. For other services, like screening for sexually transmitted diseases, the organization gets more than $500 million a year in public funds, much of it from Medicaid. Eric Scheidler is with the Pro-Life Action League.
ERIC SCHEIDLER: Whether this funding goes directly for abortion or indirectly allows them to have access to a large population of potential abortion clients and to keep the lights on and man their call centers and do all their political activity, they should not be receiving taxpayer dollars.
MCCAMMON: Instead, he says, those patients should go to community health centers that specialize in treating low-income patients.
UNIDENTIFIED WOMAN: I'm OK. How about you?
MCCAMMON: In York, Pa., there is a federally qualified health center less than a mile from Planned Parenthood. Jenny Englerth is CEO of Family First Health, which offers primary medical and dental care at this clinic and several others in the area.
JENNY ENGLERTH: There are more patients who seek our care than we're able to provide care for.
MCCAMMON: More than half of the patients receive Medicaid, and the doctors stay busy.
ENGLERTH: Sometimes, in the height of the cold and flu season, there just isn't enough capacity to go around.
MCCAMMON: What's more, Englerth says, doctors here can decline to provide birth control if it violates their religious beliefs and instead refer patients to a colleague. Heavy patient loads are common at public health clinics, says Sara Rosenbaum, a health policy professor at George Washington University. And some patients may not go to a clinic that, by design, serves the whole family.
SARA ROSENBAUM: There may be people who were younger users of family planning clinics who were uncomfortable about going to a health center where they might run into their aunt sitting in the waiting room.
MCCAMMON: Rosenbaum points to Texas, where state lawmakers in 2011 reduced Planned Parenthood's funding. Dozens of family planning clinics closed and the birth rate for low-income women went up.
Sally Gambill, a certified nurse midwife at the Planned Parenthood in York says reduced access to contraception would mean more unwanted pregnancies.
SALLY GAMBILL: The sperm and egg really, really want to meet. They just do. That's why we're all here.
MCCAMMON: If Planned Parenthood were no longer an option for some patients, Jenny Englerth says her health clinics would try to serve them.
ENGLERTH: But I also understand the reality of what we try to do every day and the pressures that we feel every day with our existing demand. So there are going to be gaps and shortfalls.
MCCAMMON: Englerth says, if there are big changes to the funding for low-income women's health services, she hopes they don't happen too quickly so centers like hers have time to try to close those gaps.
Sarah McCammon, NPR News, York, Pa.
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