Nationwide abortion politics threatens the survival of well-liked clinics in Maine : Pictures

[ad_1] <img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4498x3000+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F58%2Fbb%2Fbddc7df54c9a957fcc7d67276949%2Fgrybus-npr-ruralhealthcare-hr-21-8261.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4498x3000+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F58%2Fbb%2Fbddc7df54c9a957fcc7d67276949%2Fgrybus-npr-ruralhealthcare-hr-21-8261.jpg" class="img" alt="Ashley Smith, a young woman with long red hair, sits in a rustic cabin. Pine trees are visible out two high windows. " loading="lazy"/> Ashley Smith, who's uninsured, has relied on Maine Household Planning for her well being take care of years. She's pictured on the women' summer season camp close to her residence the place she works, along with different jobs. Greta Rybus for NPR disguise caption

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Greta Rybus for NPR When Ashley Smith arrived to testify earlier than the Maine Legislature throughout a committee listening to final spring, she was terrified. "I used to be shaking like a leaf within the wind," she says.

She instructed lawmakers that she was there in assist of Maine Household Planning, a 50-year-old community of reproductive well being clinics the place Smith is a affected person.

State lawmakers had been contemplating how one can make up a funding shortfall from Washington, D.C. the place Republicans in Congress aimed to chop off federal funding to clinics that present abortion.

Smith instructed the committee that she would not have medical insurance and that Maine Household Planning's nonprofit clinics had been her solely supply of well being care.

"Within the final 4 years I've acquired care there, not as soon as did I've an abortion," Smith testified. "I did, nonetheless, have entry to STD and STI (sexually transmitted illness and an infection) testing, referrals for thyroid testing and blood panels, pap smears, breast examinations, referrals for mammograms, and a premenstrual dysphoric dysfunction analysis. The final two I listed saved my life," she mentioned.

Smith, who's 36, says she was impressed to testify and write an op-ed, as a result of she's fearful about what would occur if Maine Household Planning needed to shut within the face of deep federal funding cuts. "I am unable to think about what would occur to our communities if we misplaced such a keystone — that is what actually fueled my hearth," she says.

Maine Household Planning did get a yr of further funding from the state, nevertheless it additionally misplaced Medicaid income for one yr with the passage of President Trump's tax and spending invoice — a 20% hit to the group's funding.

The "defund" effort past Deliberate Parenthood In Maine, abortion is authorized and broadly supported by the voters. In a ballot launched by the Pew Analysis Middle this summer season, 72% of Mainers say abortion needs to be authorized in all or most instances. The state legislature has moved to develop entry to abortion care because the Supreme Court docket overturned Roe v. Wade three years in the past.

Now, the Trump administration and congressional Republicans are utilizing federal funding as a lever to limit abortion entry in states, like Maine, the place it's authorized and guarded by state legislation.

Republicans and anti-abortion rights activists have lengthy sought to finish Medicaid {dollars} flowing to Deliberate Parenthood for any cause, arguing that federal reimbursement even for unrelated providers not directly helps abortion in clinics specializing in reproductive well being. In July, they had been lastly capable of accomplish that purpose.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4498x3000+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F49%2Fcd%2Fe8c2dcab4f0594125ded0f59f88c%2Fgrybus-npr-ruralhealthcare-hr-39-8379.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4498x3000+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F49%2Fcd%2Fe8c2dcab4f0594125ded0f59f88c%2Fgrybus-npr-ruralhealthcare-hr-39-8379.jpg" class="img" alt="An open door in an otherwise dark room inside the Maine Family Planning clinic in Augusta is shown." loading="lazy"/> Maine Household Planning operates 18 clinics across the state, together with this one in Augusta, Maine. It offers major care along with a full vary of reproductive well being care. Greta Rybus for NPR disguise caption

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Greta Rybus for NPR The availability within the legislation blocks federal Medicaid funds from being paid to reproductive well being nonprofits that obtain greater than $800,000 in Medicaid funds in a yr. It took impact when the invoice was signed by President Trump on July 4. (Republican senators modified the timeline from a decade to a single yr of defunding to adjust to Senate guidelines.)

Only a few organizations match the $800,000+ description. Deliberate Parenthood is considered one of them, one other is Well being Imperatives in Massachusetts, and so is Maine Household Planning.

"The place am I going to go?" About half of Maine Household Planning's sufferers are on Medicaid. The group is not reimbursed for his or her visits.

That is about $2 million gone, says George Hill, Maine Household Planning's president and CEO.

"That is troublesome. You need to make some troublesome selections," he says. "Both you generate extra income, otherwise you minimize prices."

On Oct. 1, the group let sufferers know they'd be ending major care providers on the finish of the month at three clinics within the far reaches of the state: Houlton, Presque Isle and Ellsworth. That change affected practically 1,000 sufferers, together with sufferers on Medicaid and people with personal insurance coverage.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2160x1728+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F32%2Fa0%2Fc384fc264c9ab5baca02b1325507%2Fselena-outside-clinic.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2160x1728+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F32%2Fa0%2Fc384fc264c9ab5baca02b1325507%2Fselena-outside-clinic.jpg" class="img" alt="George Hill, Maine Family Planning’s President and CEO, stands outside one of the clinics. " loading="lazy"/> George Hill, Maine Household Planning's president and CEO has labored in well being care for nearly 40 years. "We now have a mission," explains Hill, "to make it possible for the total vary of sexual and reproductive well being care is obtainable to as many sufferers as doable." Selena Simmons-Duffin/NPR disguise caption

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Selena Simmons-Duffin/NPR "The day that our portal message went out [to patients], the telephones simply began ringing off the hook," says medical providers director Melissa Grey. "It was the identical message time and again: 'The place am I going to go? You of us have helped me with issues that no one else had helped me with, I by no means felt such as you had been judging me. I do not need a completely different supplier, I wish to maintain seeing you.'

"It was actually heartbreaking and a tough couple of days for employees," she says.

Grey and her group spent all of October attempting to attach these sufferers to new medical doctors, and ensuring they had been arrange with sufficient refills of medicines to final them when there have been lengthy waits earlier than they may very well be seen by the brand new follow. Maine has a well being care supplier scarcity, which made that job more durable, she says. "There already weren't sufficient suppliers — we had been getting new affected person requests on a regular basis," she says. "Now there's much less."

The purpose of scaling again major care was to attempt to protect household planning for longer. All 18 of their household planning clinics across the state are nonetheless open. "We now have a mission," explains Hill. "And our mission is to make it possible for the total vary of sexual and reproductive well being care is obtainable to as many sufferers as doable."

They're nonetheless seeing Medicaid sufferers for sexual and reproductive well being with out getting paid for it.

A stack of billing sheets, simply in case Considered one of their clinics is in Thomaston, Maine, a small city alongside the coast. Vanessa Shields-Haas is the nurse practitioner there. The clinic is vivid and pleasant, with colourful "condom artwork" on a bulletin board within the ready room.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2097x1677+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F1a%2F22%2F570f08f84b20aa080cdc52ded601%2Fselena-condomart.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2097x1677+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F1a%2F22%2F570f08f84b20aa080cdc52ded601%2Fselena-condomart.jpg" class="img" alt="The fall scene decorating the wall at the Maine Family Planning clinic in Thomaston is crafted from colored condoms." loading="lazy"/> The rotating seasonal scenes within the ready room on the Maine Household Planning clinic in Thomaston are crafted from coloured condoms. "I believe they're enjoyable," nurse practitioner Vanessa Shields-Haas says. "Sufferers love them." Selena Simmons-Duffin/NPR disguise caption

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Selena Simmons-Duffin/NPR Shields-Haas is infuriated by the funding cuts to Maine Household Planning and what they imply for her sufferers.

"Numerous my sufferers — perhaps they're working at a lodge or they're ready tables, they're serving lobster rolls to hungry vacationers, beginning oyster farms," she says. "These are individuals which can be working actually arduous."

She does so much for them: fertility remedies, biopsies, prescription refills, even vasectomies. And he or she's continued to do all these issues for her sufferers coated by Medicaid with out getting reimbursed.

"We have not been turning them away," she says. "I fill out the billing sheets and we stack them up within the occasion that we may very well be reimbursed presumably sooner or later."

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2112x1690+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fd7%2F3b%2F680faa474ac48346367f871a8ea7%2Fselena-nurse-practitioner-portrait.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/2112x1690+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fd7%2F3b%2F680faa474ac48346367f871a8ea7%2Fselena-nurse-practitioner-portrait.jpg" class="img" alt="Vanessa Shields-Haas, a nurse practitioner, is pictured in Maine Family Planning's clinic in Thomaston, Maine." loading="lazy"/> Vanessa Shields-Haas has been offering medical take care of sufferers coated by Medicaid with out getting reimbursed. "We have not been turning them away," she says. Selena Simmons-Duffin/NPR disguise caption

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Selena Simmons-Duffin/NPR She says sufferers are confused by what's taking place, and plenty of have despatched her messages asking if they will nonetheless go to her for care. She assures them that they will, though she worries in regards to the future.

"Sadly, decision-makers in Washington are having such a profound impression on what we are able to and might't do," she says. "Not with the ability to be reimbursed for the visits is actually crippling, financially."

A authorized problem For George Hill, political interference in sexual and reproductive well being care is nothing new. "I have been within the discipline since 1987, so near 40 years, [through] a number of completely different presidential administrations which were hostile to the care that we now present," he says. "That is — by quantity and velocity — most likely the worst that we have now seen."

Simply weeks after the One Large Stunning Invoice Act was signed into legislation, Maine Household Planning filed a lawsuit to problem the supply that blocks them from getting Medicaid funding.

"The lawsuit was filed primarily as a result of Maine Household Planning says that is unfair and it is unsuitable and it is unconstitutional to be singling out and focusing on sure suppliers based mostly on this animus in opposition to abortion," says Autumn Katz, interim director of litigation on the Middle for Reproductive Rights, which represents the group in its lawsuit.

The federal authorities defended the supply in a courtroom submitting, arguing that it promotes Congress' "purpose of decreasing abortion" and suggesting Maine Household Planning might get its funding again if it stopped offering abortion.

(Deliberate Parenthood filed a separate lawsuit and was capable of safe an injunction. In Maine, the injunction request was denied and so the supply is in impact whereas the lawsuit works its approach via the courts.)

One other risk looms Anti-abortion efforts on the federal stage could not cease with the Medicaid legislation.

One other 20% of Maine Household Planning's funds comes from the federal authorities via Title X — a decades-old grant program that allows the clinics to see uninsured sufferers. In October, the Trump administration fired the entire group that works on that program. These firings had been reversed in mid-November as a part of the deal to finish the shutdown, however the administration might attempt to finish this system in one other approach.

Hill says he is not positive what is going on to occur subsequent with the lawsuit and Medicaid, or Title X, however he says they don't seem to be giving up. The state legislation that affected person Ashley Smith advocated for offers brief time period funding from the state to assist fill the funds hole. Hill says they're exploring new potential partnerships and new methods to boost income they have not tried earlier than.

He quotes Rep. Pat Schroeder, the late Democratic lawmaker from Colorado: "You possibly can't roll up your sleeves and get to work should you're wringing your palms," he says. "We will proceed to do the work. We're not going to cease."