“1950, here we come.”
That’s the bleak outlook of many New Jersey women — particularly Democrats — as they lament the double assault by Gov. Chris Christie and the U.S. Supreme Court on women’s reproductive rights.
Although there have been a few legislative victories for them over the past several days, many women feel any gains are overshadowed by two irreducible facts: Christie’s refusal to restore funding to family planning centers and the Supreme Court’s Hobby Lobby decision, which lets private companies opt out of the Affordable Care Act (ACA) provision requiring them to supply all federally approved forms of contraception in their employee health plans.
On Monday, the day the Supreme Court released its ruling, Christie passed a budget for fiscal 2015 — with a line-item veto to the Democratic majority’s $7.5 million proposal to fund the state’s “Title X” family-planning centers, which lost all of their appropriations from Trenton when he took office.
The governor did leave intact increased funding for rape and domestic violence programs and maintained last year’s levels for breast and gynecological cancer screenings and treatment.
Now, his veto has led some women to worry that he won’t sign a separate bill to expand Medicaid coverage for family planning.
The governor didn’t take on reproductive rights in his veto message or answer questions from reporters after signing the budget. But he’s said in the past that the state can’t afford to spend on the clinics. Though his administration has focused new attention on safeguarding women from violence, he’s received a zero rating from NARAL Pro-Choice America and has made speeches in support of anti-abortion activists. That, plus his spotty legislative record on women’s issues, have earned him poor marks from women in and out of his party.
Democrats are accusing Christie of playing politics with women’s access to healthcare in order to curry favor with conservatives who are essential to his possible run for the 2016 presidential nomination.
“The battles I thought we’d fought and won — apparently they’re not won in perpetuity,” said Sen. Loretta Weinberg, who issued the statement that today’s Republican agenda reminded her of the 1950s. “The fact that this is all still with us is very disheartening.”
Democrats didn’t expect Christie to leave family-planning funding in the budget, but his line-item veto troubled them nonetheless. During every budget cycle for the past five years they’ve included $7.5 million to help support the free and low-cost Title X clinics that provide birth control, STD counseling, pap smears, and mammograms to uninsured and low-income women, men, and teens. And every year since the governor first defunded the centers, which operate with private and federal grants and donations, he’s vetoed Democrats’ attempts to restore the money.
The adverse effects, says Planned Parenthood Action Fund of New Jersey Executive Director Ed Remsen, still reverberate throughout the state.
“The pain hasn’t gone away,” he said, before noting that the elimination of state funding forced seven Title X clinics to close and others to drastically reduce their hours and staff.
Those who support the governor’s actions argue that patients of the closed facilities can simply patronize another one or seek services from either a family-planning center (similar name, different type of facility) or a community health center, both of which receive primary funding from the federal government.
But Remsen says it’s not that easy. In 2009, New Jersey’s Title X clinics (approximately 30 of which belong to Planned Parenthood) served more than 136,000 patients, 60 percent of whom used them for primary care. By 2012, roughly 35,000 of those patients had vanished from the system.
“We don’t know where they went,” he said.
But he can speculate why they left. In just three of myriad examples, a clinic in Hamilton switched to a fee-for-service model; Paterson’s clinic no longer offers prenatal care; and the Family Planning Center of Ocean County has increased its wait times for new patients from two to three days to two weeks.
What’s more, Assemblywoman Pamela Lampitt, who chairs the Committee on Women and Children, says low-income and elderly women now have a harder time physically accessing the more sparsely distributed clinics. She also notes that while every county has at least one federally supported community health center and one federally supported family-planning center that offer some of the same services, these facilities are often located in cities where suburban patients don’t feel comfortable.
“You’re not going to get a woman in Haddon Township to go into Camden to a federally qualified health center, but she would have gone to Planned Parenthood in Cherry Hill,” she said. The Cherry Hill office closed in September 2010.
According to the state’s Department of Health, six federal family-planning centers have also closed or merged since the end of 2010. Judging from the fact that the number of women seen at 105 community health centers increased by 51 percent between 2008 and 2013, it’s plausible that the majority of patients displaced by the closures are now receiving care at these facilities. But it’s equally likely that most remaining women are obtaining medical attention from emergency rooms or have dropped out of the healthcare system altogether.
Neither the family-planning centers nor the community health centers provide abortions. But 10 of Planned Parenthood’s 30-or-so clinics (of 58 total Title X clinics) do. And while, by law, federal money doesn’t fund abortion, pro-life advocates argue that dollars given to clinics that perform abortions enable them to redirect money that would have been used for other, less politically problematic, purposes.
Likely Impact of the Veto
The Guttmacher Institute think tank for reproductive rights reports that without Title X clinics, the number of unintended pregnancies in New Jersey would be 23 percent higher and the number of abortions would be 18 percent higher.
“By helping women avoid unintended pregnancies and the births that would follow, the services provided at Title X-supported centers in New Jersey saved $199.4 million in public funds in 2010,” read the institute’s State Center analysis.
Christie’s critics said the governor will make another financial sacrifice in exchange for political gain if he vetoes a bill that would expand Medicaid coverage to family-planning services for women who are not pregnant and who earn up to 200 percent of the federal poverty level. The ACA funds this coverage with a 9-to-1 match of federal to state funds.
“To me, it is unfathomable that Christie continues to put his political ambitions above the fiscal health of the state, leaving millions of dollars of healthcare funds on the table,” wrote Sen. Linda Greenstein in a statement. “We should be using all the resources at our disposal not just for the fiscal health of our state, but the health and wellbeing of all New Jersey’s women.”
Christie’s press office did not respond to a request for comment.
Rape and Domestic Violence
The governor did, however, safeguard two funding increases to rape and domestic violence programs. He boosted the allocation to the state’s lead domestic violence agencies and the New Jersey Coalition for Battered Women by $1.8 million and added $400,000 to the budgets of the New Jersey Coalition Against Sexual Assault and 21 county-based sexual violence organizations. He also maintained $9.7 million for 51 Family Success Centers that offer domestic violence prevention programs, among other services.
The backing represents the Christie administration’s continued concern with violence against women, as evidenced by the 2012 move of the Division on Women from the Department of Community Affairs to the Department of Children and Families. The Sexual Violence Primary Prevention and the Displaced Homemaker programs also moved, all with the purpose of making the DCF the primary agency for overseeing and administering antiviolence programs and, according to its website, to “better position the department to strengthen families and sharpen its focus on the occurrences of child abuse, domestic violence, and sexual assault.”
DCF oversees at least one lead domestic violence program — equipped with a shelter and a 24-hour hotline — in every county. There’s a state-wide hotline, as well. The DCF also administers free services to rape victims such as a hotline, crisis counseling, victim advocacy, follow-up support, and sensitivity training for professionals.
“I’ve been involved in the whole issue of domestic violence for more years than I care to remember, and yes, this increase is a good thing,” said Weinberg.
Women’s Healthcare – Is NJ Doing Enough?
The health department does house an Office on Women that works with various organizations to promote outreach for women’s health and, according to its website, “increase service accessibility to health professionals and consumers in the state.”
But it last issued its annual report almost a decade ago, and it lists areas of direct focus as cardiovascular disease, disability, sexual violence, bleeding disorders, and caregiving. A link to a purported list of all 21 county family-planning centers and information about other resources leads to some basic health information but no list and no additional resources.
The site does, however, provide detailed information about clinics that offer STD testing and treatment, along with a 24/7 hotline.
In signing the budget, Christie did generate a few news mentions for accepting an increase in funding for cancer research and for maintaining $12 million in state and federal dollars for The New Jersey Cancer Education and Early Detection Program. CEED provides outreach, screening, and follow-up to uninsured and low-income patients who have breast and gynecological cancers, among others.
The Task Force on Cancer Prevention, Early Detection and Treatment in New Jersey reported to Gov. Christie in 2012 that while white women contract breast cancer more frequently than African-Americans, it is black women who suffer higher rates of mortality.
The task force noted that, “These differences may result from genetic factors or the disparity observable by race in healthcare prevention and treatment services, which is reflective of access-to-care, prevention, education, and early-detection issues in New Jersey. The latter probable causes should be the focus of our efforts over the next several years.”
But with the closure and consolidation of women’s health clinics, can women access the screening and information they need?
Remsen says no. “Most of our services are about prevention and wellness. And now there are those 35,000 people we’re not able to serve,” he said.
In Atlantic County, the cuts kept Planned Parenthood from implementing colposcopies for women who have received abnormal pap-smear results.
“Restoring funding remains our top priority,” said Remsen. “Meantime, we’re going to continue to fight for the people we serve and those we could serve and those we’re no longer serving.”