COLUMBIA — For the past 34 years, a federal law has prohibited the use of any federal money for abortions that aren't necessary to save the mother's life. A growing number of anti-abortion activists and state and federal legislators, however, are skeptical about how well the policy is being followed.
A bill, proposed by Rep. Stanley Cox, R-Sedalia, would require Missouri clinics that receive federal Family Planning, or Title X, funding to report to the state exactly how each federal dollar is spent. It comes on the heels of a proposal in Congress that would slash Title X funding and another that would make Planned Parenthood, specifically, ineligible for the funding stream.
The Title X Family Planning program, created in 1970, allows state and local health departments, nonprofit health centers and other agencies to provide family planning and preventive health care to uninsured and low-income women and men.
Last year, Planned Parenthood served more than a quarter of all Title X beneficiaries around the country.
In Missouri, however, Planned Parenthood also runs two of the state's three abortion clinics — and that, to Cox, is a problem.
"I think there is a question there about whether money is fungible," Cox said during a hearing on the bill before the Committee on Women and Children on Wednesday morning. "(Say) you give me $10, and I promise not to spend it at McDonald's, but then that might allow me to go to McDonald's."
Cox's bill, as written, would apply to any clinic that "encourages or counsels a woman to have an abortion not necessary to save her life." Since all Title X clinics are required to at least give pregnant women printed information about all of their legal options, including abortion, all of the 22 clinics in Missouri that currently receive Title X would fall under the bill's purview.
Mid-Missouri is home to four of the state's Title X-funded clinics: the Audrain County Health Department in Mexico, Mo.; the Columbia/Boone County Health Department in Columbia; and Planned Parenthood clinics in Jefferson City and Columbia.
Of those, Columbia's Planned Parenthood is the sole provider of abortion services.
Michelle Trupiano, a lobbyist and mid-Missouri spokeswoman for Planned Parenthood, said the agency goes to great lengths to prevent any "cross-contamination" between its Title X funding stream and any other money it receives from insurance companies, donors or individual patients seeking an abortion. It has completely separate accounting systems, staff, supplies and entrances for the days they provide abortions, she said. It also schedules any abortion-related appointments on separate days from preventive health programs.
Connie Cunningham, executive director of the Missouri Family Health Council, said Planned Parenthood clinics are among "the most highly monitored agencies in the country."
Cunningham's job includes distributing Title X funds and monitoring how they are used.
"If they buy disposable gloves for an abortion, they code that over to the abortion side, not the Title X side," she said.
Cunningham's seven-person staff works almost exclusively on monitoring and documenting the work of the state's 22 Title X-funded clinics.
"We sign the assurance with the federal government that no Title X dollars will be used for abortion, and we take that very seriously because, if anything ever happened, that would put our funding in jeopardy," she said.
As for Cox's concern that Title X money frees up funds for abortions to occur, Cunningham says the amount of money simply isn't enough for that to be a factor.
"Title X has been around for 40 years, and we are fortunate to have the funding we have, but the cost of health care has increased over and over, and the funding hasn't kept up," she said.
"The agencies we support are not getting even enough money to provide the high cost of the services they are required to provide under Title X," she said.
According to Missouri Family Health Council data from the past year, the Planned Parenthood clinic in Columbia used Title X funds to conduct 1,433 pap smears, 1,500 breast exams, 4,515 tests for sexually transmitted diseases and 385 HIV tests. It also provided 2,609 patients with free or discounted contraceptives.
Cunningham said her agency is neutral on the bill.
"We're already doing what they are asking for," she said in an interview later in the day. "All it would be is more work."
However, Cunningham said she doesn't see the bill as completely innocuous.
"I think there seems to be a really anti-Planned Parenthood initiative right now, and this is part of it," she said.
Three anti-abortion activists spoke in favor of the proposed legislation Wednesday, and no one spoke against it.
Samuel Lee, a lobbyist for the Campaign Life Missouri, said that though much Title X data is already compiled at the federal level and those reports are public information, the state has no part in monitoring or dispersing the funds, which he thinks is a problem.
This bill would create transparency at the state level and allow more Missourians to know how the federal government is spending their tax money, he said.
"And that is what this bill would do," Lee said to the committee. "It doesn't prohibit anyone from getting that money. It doesn't say you can't get any. There are certainly proposals in Congress that would prohibit certain agencies from getting Title X funds, but that is not what this bill does."
As currently written, the new data would cost the state a little more than $9,400 per year to process and store — which the reporting clinics would be responsible to cover, according to a legislative fiscal impact statement.