Planned Parenthood, a major provider of contraception and other preventive health care to poor women in Pennsylvania, is betting that congressional efforts to pull federal funding for those services will backfire.
Planned Parenthood is targeting moderate Republicans in the House – including several representing competitive districts in the Philadelphia region – in hopes of stopping a proposal it says could force half of its 2.5 million patients nationwide to go elsewhere for birth control. The agency received about $500 million in federal money last year.
A section in the GOP bill to repeal the Affordable Care Act would prohibit the federal government from reimbursing Planned Parenthood for treatment of low-income clients using the Medicaid or Title X family-planning programs. That's because some of its clinics also offer abortions, although the law already prohibits taxpayer funding for those procedures.
"What they're doing here is saying to the women of America you can no longer go to the health-care provider of your choice," Planned Parenthood president Cecile Richards said in an interview. "That's contrary to everything Republicans and Speaker (Paul) Ryan have said they want."
In its analysis of the repeal bill, the Congressional Budget Office projected March 13 that the Planned Parenthood clause would cause at least 15 percent of low-income women living in rural areas to lose access to family planning options, because they live in counties without other health clinics or practitioners offering those services to Medicaid patients.
Republicans have made stripping federal money from Planned Parenthood a campaign issue for several election cycles but had until now been blocked by former President Barack Obama's opposition and, for a time, a Democratic Senate majority. Now the GOP controls both houses of Congress, and President Trump has promised to support the defunding despite personal ambivalence.
"I would defund it because I am pro-life, but millions of women are helped by Planned Parenthood," Trump said during the campaign. In several GOP primary debates, he praised the agency for saving lives with its screenings for cervical and breast cancer.
Last week the group launched a $1 million campaign of TV and digital advertising featuring women whose lives were saved by early detection of cancer at Planned Parenthood clinics. The buy included spots on shows that Trump is known to watch: MSNBC's Morning Joe and Fox and Friends on the Fox News network.
Although the use of federal dollars for abortion has been illegal since the 1976 Hyde Amendment, and Planned Parenthood does not accept federal reimbursements for them, many conservatives argue that taxpayers are, in effect, subsidizing abortion because money is "fungible."
Meanwhile, with a vote of the full House on repeal set for as early as Thursday, the bill is in political trouble from both ends of the GOP political spectrum. Conservatives believe its tax subsidies for individuals to purchase health insurance are too generous, and they want to roll back Obamacare's expansion of Medicaid sooner than the bill would allow. Moderates, including several in Southeastern Pennsylvania and New Jersey, are pushing for the opposite.
More than 1 million people in the two states have received health coverage in the Medicaid expansion.
Some Philadelphia area members of Congress are resisting the Planned Parenthood defunding.
"I have said repeatedly that I would like to separate the Planned Parenthood issue from the health-care bill," Rep. Charlie Dent (R., Pa.) said last week. "I suspect they're not going to do that — that's my suspicion — but I think it should be, because that's one of those issues that may not survive," in the Senate, he said.
Already GOP Sens. Lisa Murkowski of Alaska and Susan Collins of Maine have said they would not vote for repeal if the bill passes the House with the Planned Parenthood provision in it.
With one more Republican defection in the Senate, the legislation would fail.
Dent, of Allentown, and Rep. Tom MacArthur, who represents parts of Burlington and Ocean Counties in South Jersey, are working against the plan to speed up Medicaid cuts.
Rep. Ryan Costello (R., Pa.), who represents a Chester County district, has expressed concerns about those proposed cutbacks — and he is one of the few Republican representatives in the region to openly support the Obamacare repeal bill. Republican Rep. Patrick Meehan from Delaware County also has raised concerns about Medicaid cuts.
Democrat Hillary Clinton defeated Trump in both their congressional districts.
Richards said that Planned Parenthood supporters are bombarding all three Pennsylvania congressmen with calls and emails. She hopes that their concerns about cutting Medicaid will extend to support for the group's non-abortion health services, arguing that reducing access to family planning could reverse recent reductions in unwanted pregnancies and teen pregnancies.
"To me, it's unthinkable to say, 'Let's go backward,'" Richards said.