Even the most pro-choice Americans who insist that women should have unfettered control over their bodies might be willing to concede that it is not incumbent on the government to actually pay for their abortions. So is it really so terrible that President Trump is trying to prevent Planned Parenthood from using federal dollars to perform abortions?
Yes—because he wants to control the organization, not just defund its abortion services.
Planned Parenthood has been in the crosshairs of pro-life conservatives because it is the nation's largest abortion provider—although that's only a part of what it does. In fact, it is a full-service family planning nonprofit that offers a range of health-care services to women that include prenatal care, cancer detection, screening for sexually transmitted diseases, and contraception. But its large abortion business—it performs about 330,000, or 40 percent of total abortions, each year—has invited constant attacks from conservatives. These attacks reached a fevered pitch a few years ago after the "expose" by the Center for Medical Progress, an anti-abortion outfit, which tried to cast Planned Parenthood as a soulless organization that eagerly and actively harvested fetal organs for sale. President Trump campaigned on a promise to defund Planned Parenthood and, true to his word, last week he announced a plan to do just that.
Planned Parenthood has two sources of federal funding that add up to about 40 percent of its $1.3 billion budget: Medicaid and Title X, a 1970s federal program that subsidizes family planning services for low-income women. It gets roughly $430 million from Medicaid and about $70 million from Title X. Federal law already bars the organization from diverting any of its government money toward abortion. And to satisfy that requirement, it has maintained entirely separate bank accounts, separate tax ID numbers, separate articles of incorporation, separate insurance policies—separate everything—for its abortion services. But pro-life conservatives have long argued that this is not enough because money is fungible, so every federal dollar to Planned Parenthood for one purpose simply ends up freeing its other dollars for abortion activity.
That is a misplaced concern for the simple reason that Planned Parenthood raises more than enough private funds to cover its abortion services. Indeed, if each abortion costs $1,500—a rather steep price—that would add up to $450 million, which is well below the $780 million it gets from private donations through corporations and individual donors.
But that is not stopping President Trump from attacking Planned Parenthood's federal funding. He can't do much about its Medicaid money because that requires congressional action. But Title X funding is under his control, and he wants to reinstate a discarded Reagan-era rule and make this money conditional not on "mere bookkeeping separation" but a physical separation of abortion and other services. This means that Planned Parenthood would have to construct entirely separate facilities for its abortion and non-abortion services. It wouldn't be able to house them in the same clinic.
Obviously, this would be tremendously expensive for Planned Parenthood. It will undermine the nonprofit's ability to perform abortions.
That's the point. After all, this will have no effect on the existing fungibility issue. It is not an effort to ensure that federal dollars don't go toward abortions—they already don't. Instead, it is an effort to hold federal dollars hostage in order to control how Planned Parenthood spends its private funds. It is an attempt to force a more expensive business model on the outfit and undermine it financially.
This won't hurt just Planned Parenthood. It would hurt untold numbers of Americans women, especially low-income ones given that there are many underserved counties where Planned Parenthood is the sole safety-net family planning center that offers emergency contraceptives and other services.
All of this will save taxpayers not one single dime, because President Trump didn't cut overall Title X spending, despite threatening to do so. Instead, his plan is to divert any potential savings from Planned Parenthood to more abstinence preaching as part of family planning, regardless of whether that is effective or not.
The solution for Planned Parenthood may be to voluntarily eschew Title X grants. At $70 million, they constitute a relatively small part of its overall $1.3 billion budget, but open it up to government control. Planned Parenthood would likely be able to make up for this funding loss with increased private donations (an increase of about 9 percent would do it)—and save itself from a world of political attacks. In fact, it can turn Trump's political attack on it as a rallying cry to raise more private funds.
President Trump is acting in bad faith to appease his faith-based constituency. But his attempt isn't the first and it won't be the last—until Planned Parenthood simply walks away.
This column originally appeared in The Week