Five Years After Christie’s Family-Planning Funding Cuts, Debate Continues

Andrew Kitchenman | April 15, 2015 | Health Care
Onset of Affordable Care Act makes it even more complicated to assess impact on low-income women

State Health Commissioner Mary O'Dowd
Gov. Chris Christie’s decision to eliminate $7.5 million in state funding for family-planning centers five years ago continues to be debated, even as it becomes more difficult to judge exactly how those cuts have affected women in need of subsidized healthcare.

It’s difficult to compare the family-planning services available to women before Christie made the cut with those available today, in part because the Affordable Care Act has greatly expanded access to healthcare for low-income residents.

Still, the cut remains one of Christie’s most controversial healthcare decisions, and it led to the closing of six of the 58 women’s health clinics in the state. Others cut back their hours.

Although it was a relatively small amount of money, the funds were to be matched nine to one by the federal government. At the time, Christie said the cut was due to the state’s financial difficulties. In February, Christie said at the Conservative Political Action Conference that his five vetoes of attempts to restore the funds were part of his pro-life credentials.

Sen. Linda R. Greenstein (D-Mercer and Middlesex) expressed concern yesterday that the remaining clinics in the state are serving fewer patients than they were before the cut, potentially leaving some people without access to care. She noted that the number of residents using family-planning services at clinics fell by 33,000 from 2009 to 2012.

The state Department of Health “hasn’t really been able to demonstrate that FQHCs (federally qualified health centers) have adequately served these women who lost care in the women’s health centers,” Greenstein said, adding that the presence of FQHCs has been an “excuse” for Christie vetoing the funding.

State Health Commissioner Mary E. O’Dowd said she views both family-planning clinics and FQHCs that serve many low-income communities are part of the same “collective” group of providers.

But O’Dowd also said that FQHCs provide a more comprehensive set of services than family-planning clinics. “I wouldn’t ever say that the FQHCs have been framed as an excuse,” she said.

O’Dowd noted that the increase in the number of women served by FQHCs has more than offset the reduction at the family-planning clinics. The former climbed from 193,566 to 241,993 (between 2009 and 2015), while the latter dropped from 126,903 to 84,648 over the same period, for a total increase of 6,172.

Other factors further complicate efforts to analyze the numbers.

[related]For example, looking at the raw numbers from family-planning centers and FQHCs doesn’t indicate how many women actually received services related to reproductive health, or even how many of them are of reproductive age.

In addition, the state didn’t track what happened to the women who were served by the family-planning centers that closed or cut back their services. So even if the overall number of women receiving healthcare at both clinics and FQHCs grew, some women may have lost access. In previous years, critics of the funding cuts have said that former family-planning patients were struggling with longer travelling times to get to FQHCs.

Also complicating any analysis is the fact that three FQHCs receive some federal family-planning funding and have some patients included in both categories: Horizon Health Center in Jersey City; North Hudson Community Action Corp., with locations in Bergen, Hudson, and Passaic counties; and Zufall Community Health Centers, with locations in Morris, Somerset and Warren counties.

The healthcare landscape, especially for low-income residents, has changed dramatically since 2009, which further complicates comparing the number of women currently being served and the number served then.

In particular, the expansion of Medicaid and the addition of the federal health insurance marketplace under the Affordable Care Act have allowed many more women to choose their own doctors, meaning that some may be receiving healthcare that isn’t captured by either the family-planning center or the FQHC totals. The ACA mandates that insurers cover reproductive healthcare as an essential service.

O’Dowd noted that all of the centers that closed had to develop plans to transfer their patients to other centers. It’s not clear how many of these patients followed up with the new providers.

The commissioner added that she shares Greenstein’s concern that women, particularly young women, can access healthcare. She said that the Department of Health has been focusing on the pregnancy rate among teenagers as “a final outcome to all of this.”

“And what we have seen is that New Jersey has the fourth-lowest teen pregnancy rate in the country and in particular in the ages 15 to 17, we do have disparities — in particular in our Hispanic and African-American communities — but the trends are going down in every ethnic and racial group,” O’Dowd said.

Greenstein said after the Senate Budget and Appropriations Committee hearing yesterday at which the issue was discussed that she still has questions. One is whether the reproductive health services offered at FQHCs are as comprehensive as those offered at the shuttered family-planning centers. Another is whether those residents who relied on the family-planning centers to meet their primary-care needs are currently receiving healthcare. And the third is how much federal funding the state has foregone by not seeking federal-matching funds.

But Greenstein added, the ACA may prove to be a saving grace in expanding coverage to low-income women.