President Trump likes to describe himself as a big-time deal maker.
However, an offer the president made to Planned Parenthood has been flatly rejected by the nonprofit organization.
According to The New York Times, the White House has told Planned Parenthood it can keep the $500 million it receives annually in federal money if it stops providing abortion services.
That money accounts for about 40 percent of Planned Parenthood’s annual $1.3 billion budget.
In comparison, abortion services only make up about 3 percent of the more than 9 million medical services the organization provides every year.
On paper, that might seem like a good deal. In reality, Planned Parenthood officials, say it is not.
“The White House proposal that Planned Parenthood stop providing abortion is the same demand opponents of women’s health have been pushing for decades, as a part of their long-standing effort to end women’s access to safe, legal abortion,” Erica Sackin, the director of political communications for the Planned Parenthood Federation of America, told Healthline in an email. “Planned Parenthood has always stood strong against these attacks on our patients and their ability to access the full range of reproductive healthcare.”
Abortion opponents see the rejection as the organization revealing its true priorities.
“It helps to show how central abortion is to Planned Parenthood’s operations,” Eric Scheidler, executive director of the Pro-Life Action League, told Healthline.
The debate has galvanized both sides, with supporters of Planned Parenthood rallying to their cause.
“All women need Planned Parenthood reproductive health services,” Terry O’Neill, the president of the National Organization for Women (NOW), told Healthline.
It’s Medicaid money
So what is the $500 million at stake here?
It’s not a line item in the federal budget that is simply crossed out.
The vast majority of that money comes from Medicaid when Planned Parenthood is reimbursed by that federal program for services provided for people receiving Medicaid.
Other money comes from reimbursements under Title X, a federal family planning program.
The defunding proposal is part of the Republicans’ plan, unveiled a week ago, to replace the Affordable Care Act (ACA). It would take away those federal reimbursements for Planned Parenthood for one year.
Medicaid is funded jointly by the federal government and the states. Those states could decide to make up the difference.
However, several states had already begun processes to defund Planned Parenthood, even before Donald Trump took over the White House.
In Texas, legislators took action in December to take away Medicaid funding for Planned Parenthood. That prohibition was temporarily halted last month by a federal judge.
In Iowa, state senators voted in early February to block Planned Parenthood from receiving federal funds. That bill is now making its way through the Iowa House.
In Mississippi, a federal judge last October struck down a state law that would have barred medical providers that perform abortions from participating in the state’s Medicaid program.
Planned Parenthood supporters point out that federal law prohibits federal money from being used for abortion services. They say the reimbursements go for other health programs.
Opponents, like Scheidler, say the federal funds free up money for Planned Parenthood to provide those other services, so the reimbursements indirectly pay for abortions.
They say it’s time for the federal government to put an end to this.
“If Planned Parenthood gets out of the abortion business, it will be a net gain for America,” said Scheidler.
Supporters of the organization see across-the-board disaster if that happens.
“Defunding Planned Parenthood would block millions of people in this country from accessing birth control, cancer screenings, and preventive care,” said Sackin.
What would be the effect?
According to Planned Parenthood, about three-fourths of the organization’s patients have incomes at or below 150 percent of the poverty level.
About 60 percent of the organization’s patients receive services for free through Medicaid or Title X, a federal family planning program.
If Planned Parenthood didn’t receive those federal reimbursements, that would mean it would either have to deny services to people with low incomes, or perform those services for free.
Either way, supporters say, the defunding would force the organization to close some of its 650 clinics across the country.
“For many patients, Planned Parenthood is the only healthcare provider they see,” said Sackin. “Blocking access to care at Planned Parenthood hurts communities that are struggling to get by the most, especially those with low incomes, those living in areas with no other quality health care providers, and communities of color who face systemic barriers to care.”
Scheidler said Planned Parenthood’s position is “a form of extortion” because they are telling federal officials they will yank all services if they can’t perform abortions.
Sackin did not respond to Scheidler’s claim, but O’Neill did.
She said that organizations like Pro-Life Action League have engaged in their own form of extortion by threatening women seeking abortions as well as the facilities where they’re performed.
She added that wanting to provide a full range of services is not extortion.
If Planned Parenthood clinics did close, abortion opponents say women could find those health services at other facilities that receive federal funding.
“The goal is to preserve the health services that women get,” said Scheidler.
However, Planned Parenthood supporters say it’s not that simple.
They say some women trust only Planned Parenthood to provide them with health services. This is especially true of teenage girls who might not want their parents to know they went to the doctor.
In addition, in many underserved communities, Planned Parenthood is the only facility near enough for women to visit. This is particularly true in rural areas.
“In a lot of these communities, women use Planned Parenthood as their primary care physician,” said O’Neill. “Places like rural areas would be badly hurt.”
Even Scheidler admits the adjustment would take time.
“It might take some effort to make up that gap,” he said.
There has been a preview of sorts of this ripple effect in Texas.
In 2011, state lawmakers introduced a series of budget cuts for family planning services. Those reductions caused the closure of 82 clinics, one-third of which were affiliated with Planned Parenthood, according to a study in the New England Journal of Medicine.
Planned Parenthood supporters say this magnitude of closures would drastically reduce health services to women.
They note the birth control and family planning services they provide actually save taxpayers money. They say their programs help prevent 2 million unintended pregnancies a year. Overall, those programs along with cancer screenings and other services save taxpayers more than $13 billion a year.
Therefore, they say, opponents should accept the fact Planned Parenthood performs abortions because of all the other services that it provides.
Scheidler can’t agree to that compromise.
“I can’t accept that bargain,” he said.
Planned Parenthood officials say it’s a matter of weighing the benefits their organization provides.
“For the vast majority of people in this country, Planned Parenthood is the solution, not the problem,” said Sackin.