The multimillion-dollar cost of excluding Planned Parenthood as a provider in Iowa’s new family planning program will come directly out of the health and human services budget, Iowa Senate Appropriations Committee Chair Charles Schneider has confirmed to Bleeding Heartland. Republican lawmakers and Governor Terry Branstad have committed to creating a fully state-run program because federal rules do not allow states to disqualify Planned Parenthood from the Medicaid Family Planning Waiver. Under that waiver, federal funds have covered 90 percent of the Iowa Family Planning Network’s costs for many years.

In contrast, the state will be on the hook for every dollar spent on the new family planning services program. According to a fiscal note prepared by non-partisan legislative staff, that program is estimated to “increase General Fund expenditures by $2.1 million in FY 2018 and $3.1 million when implemented for a full year in FY 2019.”

The governor proposed using part of Iowa’s federal Social Services Block Grant funding to cover that cost, which is consistent with spending bills House Republicans approved during the 2015 and 2016 legislative sessions.

Instead, “a general fund appropriation in the health and human services budget” will pay for the new family planning program, Schneider said during an interview following the April 8 legislative forum in Waukee. After reviewing the proposal from the governor’s office, he explained, he chose to file “our own [bill] that didn’t take the money from the Social Services Block Grant.”

It’s understandable that Republican appropriators rejected Branstad’s idea. As Bleeding Heartland discussed here, the Social Services Block Grant is not a reliable funding stream. The U.S. House Ways and Means Committee leader has called for eliminating the grant, and House Republicans voted to do so last year.

But Republican plans to give up millions of federal family planning dollars look even more foolish now than they did a few months ago, when one considers Iowa’s worsening state revenue picture and the huge spending cuts already inflicted on human services.

Statehouse Republicans just announced their “global” budget targets on April 5 and have not revealed spending levels for individual line items. Nor have they specified which programs will be cut to make room for an additional $2.1 million to cover family planning costs next year and $3.1 million the following year.

One thing’s for sure: neither the Department of Human Services nor the Department of Public Health (which administers the current Iowa Family Planning Network) have any extra money lying around.

The DHS had to absorb a $25.5 million spending reduction during the last five months of the current fiscal year. Mid-year cuts to the public health department totaled nearly $2.3 million (see here and here).

Comparing revised spending during FY 2017 with actual spending during FY 2016 shows that the DHS budget is down by about 5.7 percent, and the DPH budget is down by 4.4 percent.

Branstad’s initial FY 2018 draft budget included further cuts to both departments, bringing planned spending below 2016 levels (see pages 95 through 97 here). After revenue estimators predicted in March that Iowa would take in $191 million less next year than anticipated, Branstad released a revised 2018 draft, calling for $173 million less in total spending. This document spells out the additional cuts throughout the budget. Here are the pages covering health and human services line items.

The Department of Human Services alone stands to lose about $85.7 million. In other words, nearly half of the extra spending cuts Branstad proposed following last month’s lowered revenue forecast will come out of DHS. Some notable line item cuts:

· $1.3 million from the Adoption Subsidy
· more than $2.5 million from Child Support Recoveries (according to Democratic gubernatorial candidate Jon Neiderbach, who used to work for the DHS, child support enforcement “brings in more than it costs”)
· More than $2.8 million from Child and Family Services
· $3 million from the Family Investment Program, which provides cash assistance under the federal Temporary Assistance to Needy Families block grant created by the 1996 welfare reform law
· nearly $5 million from Child Care Services
· $69 million from the main line item for Medicaid (even though the private companies now managing that program keep asking the state for more money)

Branstad’s latest budget draft doesn’t recommend such eye-popping cuts to public health, but every DPH line item was trimmed to reduce planned spending by more than $340,000 during the coming year.

The figures House and Senate GOP leaders released last week call for spending $38.6 million less overall and $10 million less on health and human services than the governor’s latest draft for FY 2018. We should find out later this week which line items will receive less funding than what Branstad now proposes.

Rod Boshart reported for the Cedar Rapids Gazette on April 5, “Schneider said GOP budget-makers were looking to leave a larger year-end cushion in case revenues failed again to keep up with projections.” Sounds sensible: Jon Muller, who used to be an Iowa revenue estimator, predicts further downward revisions to projected FY 2018 revenues later this year.

What makes no sense is Republicans committing to spend an extra $2 million to $3 million a year on costs the federal government could cover, when our health and human services programs are already underfunded.

On the Senate floor and at many legislative forums, Republicans have claimed Senate File 2 is designed to increase access for residents of small towns and rural areas. But researchers who study the issue doubt other Iowa health care providers can meet demand for the full range of services available at Planned Parenthood clinics, Erin Murphy reported in January.

A state-run family planning program won’t be more efficient. The policy won’t improve access to care in communities large or small. It won’t even be popular. The latest statewide poll on the subject found 77 percent of respondents (including 62 percent of Republicans) think the state “should continue to fund Planned Parenthood for non-abortion-related health services.”

Making Planned Parenthood services inaccessible to thousands of Iowans can achieve only one goal: scoring political points with the most hard-core “pro-life” activists. A bill banning most abortions after 20 weeks–amended to remove exceptions for severe fetal abnormalities and impose a 72-hour waiting period for abortions at any point in pregnancy–is likely to reach the governor’s desk soon. Yet some social conservatives are frustrated that even with large Republican majorities, the House and Senate haven’t advanced more ambitious bills to declare “life begins at conception” or ban abortions after a fetal heartbeat can be detected.

Speaking at a rally at the Capitol on March 30, House Speaker Linda Upmeyer said “House Republicans have always been a pro-life caucus” and “have a real opportunity this year with a new Senate to do even more.” She has long promised to take state funding away from Planned Parenthood, as has Senate Majority Leader Bill Dix. The base demands that they deliver.

Upmeyer hasn’t explained why the bill defunding Planned Parenthood is still sitting in the House Human Resources Committee, more than two months after it cleared the Iowa Senate, nor did anyone at the March 30 event press her on that point. I expected the legislation to move through the lower chamber quickly and have been unable to ascertain the reason for the delay.

Conservative activists will declare victory when Branstad signs an appropriations bill outlining a new family planning program funded wholly by the state.

The losers will not only be Iowans facing longer wait times or no way to obtain reliable contraception services, well-woman care, or testing and treatment for sexually transmitted diseases. They will also include children and families living in poverty, many of whom were underserved even at previous funding levels for Iowa’s health and human services programs. Those vulnerable people are mostly invisible in the halls of power, especially this year.

UPDATE: Linley Sanders reported for the Associated Press on April 10,

“We know we have to make a lot of tough decisions on the budget,” said House Appropriations Committee Chair Pat Grassley, R-New Hartford. “But that’s something that has consistently been a priority of our caucus. Making sure we can fund it is a part of that.” […]

“It’s just fiscally a backward concept. It’s at odds with the Republicans’ own budgeting principles,” said Rep. Chris Hall, a Sioux City Democrat and member of the House Appropriations Committee. […]

Senate Appropriations Committee Chair Charles Schneider, R-West Des Moines, said lawmakers didn’t want to fund the family planning program by cutting money to important federally funded programs and that the Department of Human Resources could manage the reduction.

“Every department has a tight budget this year,” Schneider said. “DHS is no different.”

Erin Davison-Rippey, a representative for Planned Parenthood of the Heartland, criticized the Legislature’s decision.

“When you look at Iowa’s budget overall, there is no extra money,” she said. “It’s really unfortunate that they would be considering taking money from so many important services that our state is already committed to, in order to pursue this political agenda.”