Retroactivity, and how not to de-fund an abortion provider

Part 2 of 2. For part 1, with news of a planned “retroactive” grant of public funds to Planned Parenthood of Northern New England, click here

Since part 1 of this post, New Hampshire’s budget has been passed by the House and Senate. The extra half-million dollars for family planning added by the governor on top of DHHS’s $344,000 request went through without a hitch.Regarding the extra $500,000, Councilor Colin Van Ostern said “it doesn’t seem like one of the hot spots and that’s good.” PPNNE for once kept a low profile as the budget was crafted. That will apparently pay off. PPNNE’s status as the principal provider of abortion in New Hampshire is not a problem as far as the current Governor and Council are concerned.

Recall that PPNNE’s Title X contract was rejected by the then-Executive Council in 2011, while contracts with ten other agencies were approved. Since then, PPNNE has been covering about 57% of Title X-eligible family planning clients with funds it has received directly from the federal government. Last week, with the Executive Council looking very different since the last election, the newest round of Title X contracts was approved. The proceedings of that meeting revealed that while PPNNE had no contract in the mix, they would be getting Title X money soon.

The ten more-or-less non-controversial Title X agencies are listed in this letter.  Combined, these agencies serve the other 43% of Title X-eligible clients in the state.

At last week’s Executive Council meeting, described in part 1,  Commissioner Nick Toumpas of the Department of Health and Human Services assured Councilor Chris Pappas (D-Manchester) that Planned Parenthood of Northern New England will be reintegrated into New Hampshire’s Title X program at some future date, with payments retroactive to July 1 of this year. The terms of the current financial arrangement between PPNNE and the federal government for family planning work were not entered into the public record at last week’s meeting; in Commissioner Toumpas’s words, “It’s not appropriate for me to know what they did.” The end date for that arrangement is thus unknown to me at this point. Will “retroactive” payments from the state overlap with payments from the federal government?

That was evidently not on the minds of the Executive Councilors last week. The audio recording of the meeting is here; I made the transcript used below. Comments in brackets are my own, and I have emphasized in bold print certain statements from the meeting.

Pappas praises “statewide approach”

Commissioner Toumpas correctly calls the current arrangement a “bifurcated” family planning program, with some agencies getting state-administered funds and one getting direct federal funds. He confirms that no one has gone without family planning services despite the 2011 “hiccup” in state-level funding (using Councilor Pappas’s word).

Pappas: Many of us want to see a statewide approach once again. I think it treats everyone fairly equally. I’m concerned with my area being underserved with contracts, and [I’m] just kind of wondering what’s coming up. … There’s no need to hold this thing up, you know, anticipation of those dollars. I do hope we get to the day once again where family planning money is treated on a statewide basis.

Toumpas: [These are] vital organizations for the delivery of these particular [family planning] services. It was a challenging, uh, time, uh, a couple of years ago as we went through that particular process [the rejection of the 2011 PPNNE contract], because of the people that are being served by this, we didn’t want to have any interruption in services. To the credit of Planned Parenthood, when the contract was not passed, they continued to provide those services. They didn’t have to do that but they did. And I’m very appreciative of the fact that they did that. But again we still have good working relationships with them and we’ve been working with them on a different benefit that’s going to go into place on July 1, a limited Medicaid benefit that is outside of anything that is called Medicaid expansion.

I recall that in the immediate aftermath of the 2011 vote, there was a graphic on a PP web site – I can’t remember if it was PPNNE or PP Action Fund – counting the number of people “denied” family planning services after the Executive Council’s action. Commissioner Toumpas seems to think no one was turned away. No one on the Council last week disputed his assertion that PPNNE “continued to provide those services” after the 2011 vote.

Councilor Van Ostern chimes in

Councilor Colin Van Ostern (D-Concord) was elected to his District 2 seat last November. He ran as an unapologetic supporter of Planned Parenthood, and benefited from a gerrymandered district with new boundaries drawn after the 2010 census. He sailed in with 58% of the vote, which was not hard for a Democrat to do, with Concord and Durham and Keene to work with.

Executive Council district 2, outlined in red
Executive Council district 2, outlined in red. NHDOT map; district outline added by Ellen Kolb.

He was careful at the June 19 meeting to confirm the numbers involved in Title X work in the state, although neither he nor Councilor Pappas asked any follow-up questions about the Medicaid arrangement with PPNNE to which Commissioner Toumpas referred. Van Ostern took time from running the numbers to take a swipe at his predecessor.

Van Ostern: …I probably would say it a little less politely than Councilor Pappas did, but I think the Council botched this two years ago, and frankly I’m frustrated that it’s gonna take us until 2016 to get back to a system that worked well I think for decades. Frankly, I don’t think it’s a coincidence that the three Councilors who aren’t here with us now are the ones who voted to complicate it a couple of years ago…. [unclear] make sure I understand [unclear], just because we had discussions about it yesterday. So your intention is that at some point in the future, a few months from now, we will have awarded all of the funds that are available from the state for family planning, and at that point, whatever that total bucket of dollars is [over $800,000 with the now-passed budget], that bucket will be equally distributed across the state based on number of patients?

Toumpas: It will reflect the intent of what the legislation is, how that, what that equivalent and proportional piece of it means. There’s, uh, there’s one part of it that says equivalent, which is sort of across the board for everybody, and then there’s the proportional that I think is based on the number of clients.

Van Ostern: Once the budget passes we can have a check-in on this.

Toumpas: …My sense is that we would move on that relatively quickly.

Neither Toumpas nor the Councilors clarified what legislation they were referring to when they talked about “equitable and proportionate” family planning funding.

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Epilogue: factors affecting public funding of New Hampshire abortion providers

Elections matter. The June 19 Executive Council meeting showed clearly that there simply is no advocate in the executive branch for pro-life New Hampshire taxpayers who would like to be rid of an enforced investment in New Hampshire’s biggest abortion provider. On the legislative side, HB 228, an attempt to keep state funds away from abortion providers, was considered for 16 months until it died on the Senate table in April 2012. On the bright side, five of the six sponsors of the bill ran for re-election last year, and four of them won.

Appointments matter, too. Title X is handled for the most part by people appointed by the Governor and Council. Bureaucrats, in other words. They answer to the Council, not the voters.

Relationships matter. Developing constructive relationships and trust with policymakers takes time. When a rep hears information about abortion funding from someone she likes and trusts, she’ll listen.

Party affiliation is not very helpful in determining how someone will vote in a funding case. Democratic lawmakers and executive-branch officeholders in New Hampshire are nearly unanimous in their objections to cutting off state funds to abortion providers. That doesn’t mean Republicans can be counted on to support de-funding efforts. Republican Executive Councilors Ray Burton and Chris Sununu supported PPNNE’s contract bid in 2011 and again last week.  With nearly 300 Republican House members at the time HB 228 was considered, only 207 voted to pass the bill. Once it got to the Senate, Republican Majority Leader Jeb Bradley made the successful tabling motion.

Years of allowing abortion providers to mix the words “health care” and “abortion” are bearing ugly fruit.  When the senior policy director for PPNNE introduces herself before giving testimony in Concord, she doesn’t lead off with “we do more abortions than any other business in New Hampshire.” Instead, she calls her employer “a trusted health care provider.”

Mandatory collection of abortion statistics will force reconsideration of the distinction between abortion and health care. That’s one reason why abortion advocates fight stats bills and why New Hampshire doesn’t have a stats law. DHHS’s Division of Public Health knows what abortion providers choose to tell it, and that passes for “data.” Abortion advocacy is preventing the collection of public health information. 

Do I think a de-funding bill can pass and work? Sure – under the right conditions, with the right relationships and allies, with the right information in the right hands, led by the right sponsors. Not an overnight project, but then neither was the partial-birth law or parental notification.

In the meantime, the Executive Council is in control.

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