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Has Trump Increased or Decreased Funding for Planned Parenthood?
Some pro-lifers are angry at President Trump for increasing Planned Parenthood's funding, while some pro-choicers are angry at President Trump for cutting that funding. They can't both be right, can they?
Here's what's going on. I'll explain as simply and as neutrally as I can.
Planned Parenthood gets government money from two sources:
Grants and such, like the Title X federal family planning program. The government hands Planned Parenthood a chunk of money and tells them to go do something with it, like provide condoms to low-income people.
Reimbursements, mainly through Medicaid. Planned Parenthood performs some service for a person insured by the government, and the government pays Planned Parenthood for services rendered.
If you want to understand how much of Planned Parenthood's clinic revenues come from doing abortions, you need to separate those two buckets of government cash. However, pro-lifers started using this data to argue that Planned Parenthood's principal revenue-generating activity was performing abortions (which did appear to be the case), and so they stopped providing it in 2010. It's difficult today to track exactly how much money Planned Parenthood gets from Door #1 vs. how much it gets from Door #2. However, we can see from comparing 2009's report to 2010's report (note footnote [c] on page 8) that, a decade ago, state and federal grants combined paid Planned Parenthood about $350 million, while Medicaid reimbursements appeared to account for about $100 million.
So these were both large revenue sources for Planned Parenthood, and presumably still are. Nearly half its 2010 budget came from state and federal taxpayers.
The Trump Administration has done everything in its power to reduce the flow of federal government grants to Planned Parenthood. Several measures are involved, but the most important one was their decision to implement the Title X Reagan Regulations.
Title X's text is actually pretty clear that Title X grant money shouldn't go to fund or even indirectly subsidize abortion. (42 USC § 300a–6 is surprisingly broadly worded.) In the 1980s, the Reagan Administration created regulations that upheld that text: programs where abortion was used as a method of family planning were excluded from funding, which obviously would include Planned Parenthood. Planned Parenthood and other abortion providers had the option to continue receiving Title X funds, but would have to either stop providing abortions or engage in much stricter separation of abortion-related and non-abortion-related funds.
However, the Reagan Regulations were tied up in court throughout the remainder of Reagan's term and nearly the entire George H.W. Bush presidency. They were finally upheld by the Supreme Court in Rust v. Sullivan (1991). But, because the federal regulatory engine moves slow, Bill Clinton was elected President before the Reagan Regulations could actually go into effect. Clinton killed the regs immediately and substituted his own, much more permissive, interpretation of Title X's abortion restrictions.
The G.W. Bush administration considered reinstating the Title X regulations, but decided to spend their political capital on restructuring Social Security instead. (And look where that got them.) So PP continued to pull in federal Title X money during the Bush and Obama administrations.
The Trump Administration finally heeded conservative calls to revive and implement the Reagan Regulations. And they went about it in a legally very effective manner. They spent years assembling the legal components, made sure to stay well within the boundaries described by Rust v. Sullivan, and finally rolled it out when it was ready. It was still challenged in lower courts, but what appellate court is going to let an injunction against it stand when there's a binding Supreme Court precedent from 1991 addressing the exact issue? The Reagan Regulations (now the Trump Regulations) went into effect in June 2019. Rather than comply, Planned Parenthood withdrew from Title X funding. (So did several blue states, which then continued to fund Planned Parenthood through their own state-level Title X-style programs.)
So Planned Parenthood has been deprived of federal Title X money for about 16 months.
Even if Trump loses this fall, President Biden may have a tough time rolling back these regulations. As I said, the Trump Administration did them in a very legally sound way, and they're already implemented. The text of the underlying law certainly reads to me like it supports the Trump Regulations more than the Clinton/Biden alternative, and our courts are increasingly wedded to legal text. Courts may be reluctant to allow a change, especially without substantial new material facts justifying said change. But we'll see what happens.
In any event, Planned Parenthood continues to get ample funding from other sources, including especially state grants. Yet Planned Parenthood is now locked out of the major federal grant program (unless they stop performing abortions, which is an option the Administration has offered them). Private donors have not made up the shortfall, and are notoriously flighty anyway. President Trump can now tout a very big win to his pro-life supporters, along the lines of, "Three Republican Presidents have made you wait thirty years for this, but I accomplished it" -- and Planned Parenthood can use this to motivate their base to get out and vote against Trump.
On the flip side, though, there's the reimbursement bucket.
As the abortion industry in the United States continues to face a variety of legal and social pressures, small abortion providers are collapsing. In 2012, there were 510 independent abortion clinics in the United States. That was right as the giant wave of state-level pro-life legislation (resulting from 2007's Gonzales v. Carhart decision and the 2010 wave election) began to hit. By November 2019, there were only 344 independent clinics left. Why? The abortion providers themselves are clear: independent clinics aren't able to sustain themselves in the face of Gonzales-compliant abortion regulations, state and federal insurance payment bans (including the Executive Order Bart Stupak insisted on for Obamacare), and growing social opprobrium. This is one of several factors contributing to long-term declines in the abortion rate. There are fewer abortions in the United States today than there were in 2010, and pro-life legislation plays a substantial role in that story. (That's another blog post, though.)
However, pro-lifers' success has also benefited Planned Parenthood. As small abortion clinics fail, Planned Parenthood is able to pick up some of their business. Thus, while total abortions are falling nationally, Planned Parenthood's abortion total is going up. This seems like a paradox, but isn't: it's exactly the same reason the pandemic has been good for big chain restaurants even while the overall economy is in freefall.
A significant percentage of people who get abortions are also on Medicaid, or otherwise have their medical paid by the federal government (for example, federal employees). In theory, the Hyde Amendment means one of these moms can only have her abortions reimbursed by the government if the abortion is necessary to save the mother's life or if the child was conceived in an act of rape. In practice, it's not clear how effectively this is enforced, or how it possibly could be enforced. Many states have Hyde Amendment workarounds in place using state funds (including my home state of Minnesota, which guaranteed a constitutional right to fully-taxpayer-funded abortion in 1995's Doe v. Gomez decision). The bottom line is, there appears to be an enormous gap between the number of abortions performed to save the life of the mother or to terminate offspring conceived in rape and the number of abortions paid for by state or federal Medicaid dollars.
The upshot of all this is: as independent clinics nationwide close, Planned Parenthood performs more abortions, which leads to Planned Parenthood taking in more government funding through reimbursement mechanisms.
Why hasn't Trump put a stop to that? Because he can't. Medicaid reimbursement rules for abortion are set by Congress. The President doesn't have wiggle room on this. There's nothing he can do. Congress tried passing a law to comprehensively remove Planned Parenthood from the government-funding trough when Republicans controlled all three branches in 2017, but the bill were stymied by Senate Democrats, who filibustered the bill in the Senate. Congress tried again to pass a similar measure through the budget reconciliation process (which would have required only 50 votes), but lacked the votes to overcome a surprising adverse ruling by the Senate parliamentarian.
So, yes, total government funding for Planned Parenthood has (probably) gone up during the Trump Administration. But this is largely due to consolidation in the abortion industry and statutory reimbursement rules. President Trump has done all in his power to close the grant-money spigots he has direct control over (plus a few he doesn't; there are parallel battles happening within red states right now that rely on the White House's regulatory backing, long story), and Trump has done a comprehensively thorough job of that. If Hillary Clinton, rather than Donald Trump, were president, it is almost certainly the case that Planned Parenthood would be drawing in tens of millions of dollars more from the government than it does today.
It seems to me that it is fair to say that Trump has reduced government funding to abortion providers, including Planned Parenthood. It further seems to me that it would be misleading to say that he has increased Planned Parenthood's funding -- at least, not without adding substantial context to the claim. Absolute dollar totals are not the full story there, and never have been. Whether you're one of the crowd that thinks that's a good thing, or part of the crowd that thinks it's a bad thing, is up to you. I've tried to deliver just the facts, ma'am.
UPDATE: This article originally stated that there were 544 independent abortion clinics in the United States in 2010. According to the cited article, there were 510. That was 100% me mixing up my numbers. I regret the error.