By Rebekah Sager for the Pennsylvania Independent.
Broadcast version by Danielle Smith for Keystone State News Connection reporting for the Pennsylvania Independent-Public News Service Collaboration

On Jan. 23, Sen. Rand Paul of Kentucky introduced a bill called the Defund Planned Parenthood Act, which states, "Notwithstanding any other provision of law, no Federal funds may be made available to Planned Parenthood Federation of America, or to any of its affiliates."

A press release on Paul's Senate website links the bill to the "March for Life" event staged by abortion opponents every year in Washington, D.C., and says, "The Defund Planned Parenthood Act would ensure federal tax dollars aren't going to organizations, like Planned Parenthood, to perform abortions."

But the reality is that federal funding for abortion has been prohibited by the Hyde Amendment, a restriction included in annual federal spending bills since 1976, except in cases of medical emergencies in which a pregnant woman's life is at stake.

Instead, what prohibiting federal funding of Planned Parenthood would do is put an end to Medicaid reimbursement to providers of the costs of an array of reproductive health care services for those who wouldn't otherwise be able to afford them.

Fadia Halma, 55, was just 12 when she found her way to a Planned Parenthood clinic in Bethlehem, Pennsylvania. She told the Pennsylvania Independent that she'd gotten her period at school; her family hadn't discussed anything related to sex education with her, and not knowing what was happening to her, she believed she was dying.

"I had no idea what was going on," Halma said. "I just knew I was in a lot of pain, and there was blood, and I was being sent to the nurse's office."

She said that after a few hours during which the school tried unsuccessfully to reach her mother, who worked in a factory, a teacher gave her a piece of paper with an address on it and told her to go there for help. Halma said she walked five miles to what turned out to be a Planned Parenthood clinic, where she was given menstrual pads and told what was happening with her body.

"I told them that we didn't have health insurance. We were very poor and didn't know how I was going to be able to buy pads. So they gave me, like, six months' worth of pads and had somebody drive me home because I was so shaken up over it," Halma said. "It literally had such an impact on my view of the world and helping others that I didn't want what happened to me to happen to others."

The health care services offered by Planned Parenthood include screenings for cervical and breast cancer and sexually transmitted infections, prenatal and postpartum care, and education on contraception. The organization reported that its clinics had seen 2.05 million patients in 2022-2023.

Halma said she used Planned Parenthood clinics for her reproductive health care through college and into her late 20s, for everything from birth control to help with recurring urinary tract infections.

Planned Parenthood funding comes from private donations, Medicaid, and federal grants that reimburse clinics for providing services to patients who are unable to pay, the latter through the federal Title X program, established in 1970 to make family planning and reproductive health care accessible.

In addition to Sen. Rand Paul's bill, which has seven Republican cosponsors, two pending lawsuits pose a threat to the organization.

The U.S. Supreme Court is currently considering Kerr v. Planned Parenthood South Atlantic (now called Medina v. Planned Parenthood), a case on whether South Carolina can end all Medicaid funding to Planned Parenthood. The case was brought by by the Alliance Defending Freedom, an anti-abortion legal group.

"The Kerr case could hobble Planned Parenthood and dramatically reduce access to family planning services in lots of states," Elizabeth Sepper, a professor at the University of Texas School of Law and a scholar on religious liberty and health law, told Slate.

In a statement, Jenny Black, the president and CEO of Planned Parenthood South Atlantic, said, "This case is politics at its worst: anti-abortion politicians using their power to target Planned Parenthood and block people who use Medicaid as their primary form of insurance from getting essential health care like cancer screenings and birth control."

In 2023, U.S. District Judge Matthew Kacsmaryk ordered a jury trial for a lawsuit initially filed in 2021 against Planned Parenthood and its Texas affiliates with the claim that the clinics had defrauded the Medicaid system by continuing to bill the state after it made Planned Parenthood ineligible to participate in Medicaid. Texas officials are seeking $1.8 billion in repayment and civil penalties, an amount that could cripple the organization.

After years of fundraising, talking to people about the organization, and organizing volunteer escorts for patients, Halma recently became a Planned Parenthood board member.

Halma said she's been working to help people understand what rights they have and what legal challenges the organization may face, and making sure that people understand that those facilities are going to stay open for them.

"People don't realize that all people use Planned Parenthood. It's not just poor people. They think that we're offering this to just kids who are having early sex and getting pregnant. That's not what it's about at all," Halma said. "There's all different age groups that come to Planned Parenthood, all different types of constituencies, white, Black, brown, Asian - there's many different constituents that actually come to Planned Parenthood and use it. ... A woman has the right to have health care. It's just a basic human right, and they should not have the ability to dictate where we get that health care."


Rebekah Sager wrote this article for the Pennsylvania Independent.


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Patient's rights advocates are working to restrict huge fees some Washington patients must pay in order to access their complete medical records.

Holly Brauchli, managing partner at Sears Injury Law in Seattle, said navigating the medical system is complex and often requires support from lawyers or other advocates. But Brauchli noted once patients secure an advocate they can face huge fees for their records. One client was charged $28,000 by health data firm Datavant.

Brauchli pointed out the fees can prevent sick or injured patients from quickly accessing the records they need for legal claims and other urgent matters.

"To navigate things like whether a protective order should be issued to someone who has suffered from domestic violence, or whether a breast cancer battler should be able to get FMLA leave," Brauchli outlined.

Legislation to limit fees was introduced in Olympia this session but did not pass. Advocates plan to reintroduce it next session. While federal law supports patients, Brauchli argued companies like Datavant exploit loopholes in state regulations to impose high fees.

Brauchli noted Datavant contended getting complete medical records can be complicated because they have to dig through microfiche. She countered it is a poor excuse, adding records starting in 2016 are all digital and people rarely need records before then. There are large providers in the state, like University of Washington, added Brauchli, who charge much less.

"When they issue tens of thousands of pages of patient bills, they charge something reasonable, like 20 bucks," Brauchli stressed.

Providers like Datavant, Brauchli explained, charge patients about $1 per page of a PDF. She said a one-week hospital stay could easily create 15,000 pages of records.


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Some Kentucky lawmakers want to make it mandatory for some Medicaid participants in Kentucky to work, but experts say that would disproportionately affect people with mental health or substance use disorders.

House Bill 695 would require able-bodied adults with no dependents to work - and prove it - to receive health care.

Kentucky currently has a voluntary program, with job training and opportunities for community engagement, but Emily Beauregard - executive director of Kentucky Voices for Health - explained it isn't required for Medicaid eligibility.

"The majority of Kentuckians with Medicaid coverage are already working," said Beauregard. "They're working full time, part time. They're students, they're caregivers, taking care of children or older family members, people with disabilities."

Supports of work requirements argue the current system incentivizes people not to work, and argue the change will help alleviate staffing shortages.

Meanwhile, Congress is considering deep cuts to Medicaid, around $880 million over the next decade.

Groups like the Kentucky Center for Economic Policy say that would disproportionately affect Kentucky, which is one of the top ten states for the share of its population covered by Medicaid.

Valerie Lebanion teaches local parenting classes in Whitley County. She said most of her clients rely on Medicaid for health coverage.

She said she believes increased red tape around the program would end up hurting families.

"When moms and dads are sick, they can't take care of their children," said Lebanion. "They can't take their children to school, get their children off to where they need to be, or even to take care of their children."

Beauregard said the state would also end up paying more for the administrative work needed to track and document mandatory work requirements.

"It doesn't make sense economically," said Beauregard, "and it puts an additional burden on hard-working Kentucky families who are doing everything right and end up falling through paperwork cracks."

A recent poll from the health policy and research organization KFF found 96% of participants said Medicaid is either important or very important to their community - and 82% said lawmakers should leave Medicaid spending unchanged or increase funding.

Tensions are rising in Ohio between doulas and the state Board of Nursing, as only a small number of doulas have been able to be certified for Medicaid reimbursement - despite a statewide push to reduce infant mortality.

More than 60,000 births in Ohio each year are covered by Medicaid. Research shows having a doula can lower risks for both moms and babies.

But only 132 doulas statewide are certified to receive Medicaid payments.

Dr. Marie McCausland, who chairs the state's Doula Advisory Group, said to meet the demand, about 3,000 need to be certified.

But she contended the certification process has been anything but collaborative - and called it "top-down and exclusionary."

"Day one, the first meeting, they already had almost all the rules written," said McCausland. "They sent it to us and we were supposed to start there, versus any sort of collaborative writing of the rules."

She said she recently discovered she's being removed as chair after a quiet legislative change that stripped doulas of their ability to lead the advisory group, effective April 9.

The Ohio Board of Nursing said in a statement the leadership change was made for consistency with other professions.

But McCausland said even doulas serving non-Medicaid families are sometimes being turned away, because they don't hold the new certification.

Guillermo Bervejillo, research manager with Children's Defense Fund Ohio, said the governor made doula access a priority, but the Board of Nursing may be undermining that effort.

"Gov. DeWine made it a priority to reduce infant mortality, especially amongst Black children," said Bervejillo. "He created a doula advisory group. The doula advisory group has faced obstacle after obstacle. It's been kind of wild. It feels like the governor doesn't even know what's going on."

McCausland said there also are concerns about racial bias and representation.

She said Black voices on the advisory group have been ignored, even scrubbed from official meeting records - prompting the group to hire a court reporter.

"Doulas are happy to come into hospital systems and work with doctors and nurses," said McCausland. "We want to be able to work as a team for our client success."

The Board of Nursing says it values the input of doulas and that the advisory group includes health professionals from a range of backgrounds.

The board says it is committed to improving maternal health outcomes and continuing to refine the certification process.