Clinics that provide abortion in Maine face an onslaught : NPR

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Currently, a network of medical clinics that provide abortions in Maine face deep funding shortfalls because of a new federal law that excludes them from Medicaid. We’re in a state where, according to a recent Pew Research Center report, nearly 3 in 4 residents believe access to abortion should be legal in all or most circumstances. NPR’s Selena Simmons-Duffin has this report from Maine.

SELENA SIMMONS-DUFFIN, BYLINE: It was the winter of 2020 – the first COVID winter – in Oxford, Maine. Ashley Smith received a phone call from an ex-partner.

ASHLEY SMITH: Someone I haven’t spoken to in a few months says, oh, hey. I’m sorry to contact you and tell you this, but…

SIMMONS-DUFFIN: They had tested positive for a sexually transmitted infection called chlamydia.

SMITH: I just did a quick Google search to see who was going to be in the area and I could just schedule an STI test, and that Google search led me to Planned Parenthood of Maine in Norway.

SIMMONS-DUFFIN: Which was very close, and they got him in quickly. Smith works in restaurants as a waiter. She doesn’t have health insurance, so she’s willing to pay cash. But the test was free.

SMITH: They made this process so simple and so painless.

SIMMONS-DUFFIN: From then on, that’s where Smith went when she needed a doctor. Planned Parenthood in Maine has been around for a long time – 50 years. They have 18 clinics throughout the rural state, so there was still one nearby when she moved. She went there for Pap tests, breast exams. Once she went to get a medical exam at a summer camp.

SMITH: I was like, I know you do primary care. Can you just take my weight and tell them my blood pressure is fine?

SIMMONS-DUFFIN: She says, more importantly, they diagnosed her with a chronic illness: premenstrual dysphoric disorder. She says receiving this treatment has significantly improved her quality of life.

SMITH: It’s day and night who I am.

SIMMONS-DUFFIN: Obviously, she’s a fan of Planned Parenthood Maine. So much so that the 36-year-old has transformed into a defender. In March, she fought through her nerves to testify before the state Legislature during a committee hearing.

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SMITH: I’m here because these nonprofit clinics are my only source of health care.

SIMMONS-DUFFIN: The need for advocacy is due to recent actions by the federal government and the fact that in addition to cancer and STI screenings and everything else, Maine Family Planning offers abortion care. After the Supreme Court overturned Roe v. Wade three years ago, 12 states banned abortion outright and others passed severe restrictions. States like Maine have moved in the opposite direction: to expand access. Now, the Republican-led federal government is moving to restrict access to abortion in states where it is legal and protected, using federal funding as leverage.

(soundbite of creaking door)

VANESSA SHIELDS-HAAS: Hey.

SIMMONS-DUFFIN: Hi.

SHIELDS-HAAS: Come in.

SIMMONS-DUFFIN: To be more specific, Medicaid funding is now no longer available to Planned Parenthood clinics in Maine for any services. Vanessa Shields-Haas is a nurse practitioner at the clinic in Thomaston, Maine, a small town along the coast.

SHIELDS-HAAS: This is our largest exam room.

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SHIELDS-HAAS: This is where we do most of our annual wellness visits. We also perform vulvar biopsies, vasectomies and intrauterine inseminations for people…

SIMMONS-DUFFIN: Just like Ashley Smith, who needed a basic physical for her job at a summer camp, many of her reproductive health patients also need primary care. Seventy percent of Maine Family Planning patients only see them as their doctor.

SHIELDS-HAAS: I can treat your tick bite or bronchitis. I tell people if you cut your finger or have a heart attack, I’m going to send you to the emergency room, but there are a lot of other things that can be treated here. And because…

SIMMONS-DUFFIN: Clinics like this were already barred from getting Medicaid reimbursement for abortion because of the Hyde Amendment passed in the 1970s. What’s new now is a provision of the One Big Beautiful Bill Act that congressional Republicans passed this summer that blocks several health care organizations, including Planned Parenthood and Maine Family Planning, from receiving Medicaid funding for services for a year.

SHIELDS-HAAS: So since July 4, since the bill passed, we have not been reimbursed for visits from patients who use Medicaid for insurance. And we saw all these patients for free. We did not turn them away.

SIMMONS-DUFFIN: Many of his patients have seasonal jobs. Half of Maine Family Planning’s patients are on Medicaid.

SHIELDS-HAAS: Maybe they work in a hotel or wait tables, serve lobster rolls to hungry tourists and start oyster farms. They are entrepreneurs. These are people who work very hard.

SIMMONS-DUFFIN: Shields-Haas tries to be there for them for whatever they need. She is acutely aware that there aren’t enough doctors in this rural state. She calls the new law infuriating.

SHIELDS-HAAS: Unfortunately, policymakers in Washington have a very profound impact on what we can and cannot do. Not being able to get reimbursed for visits is really financially crippling.

SIMMONS-DUFFIN: The person charged with solving this problem is George Hill, president and CEO of Maine Family Planning. He works about an hour away at the organization’s headquarters in Augusta.

GEORGE HILL: I have been in the field since 1987, so almost 40 years.

SIMMONS-DUFFIN: Over the years, many presidential administrations have been hostile to their work, he says.

HILL: This is, in terms of volume and speed, probably the worst we’ve seen.

SIMMONS-DUFFIN: Maine Family Planning has filed a lawsuit challenging the law that prevents them from obtaining Medicaid funding. In its response to the complaint, the federal government said the provision furthered Congress’s “abortion reduction goal” and suggested that Planned Parenthood Maine could stop providing abortions to recoup its funding. For now, while this lawsuit works its way through the courts, Maine Family Planning cannot receive Medicaid funding. That’s $2 million – 20% of their budget – gone.

HILL: It’s difficult. You have to make tough decisions. You either generate more money, more revenue, or you reduce costs.

SIMMONS-DUFFIN: In the short term, they had to cut some services. On November 1, Maine Family Planning ended primary care services at three clinics in the far reaches of the state. Staff helped nearly a thousand patients find new doctors. Hill hopes this move will help preserve the rest of what they do.

HILL: We have a mission, and our mission is to ensure that access to sexual and reproductive health care – the full range of sexual and reproductive health care – is available to as many patients as possible.

SIMMONS-DUFFIN: They also received additional funding from the state to help close the deficit, and he says they’re exploring new ways to generate revenue. He quotes the late Democratic lawmaker Pat Schroeder.

HILL: You can’t roll up your sleeves and get to work if you’re wringing your hands. We’re going to continue doing what we’re doing. We’re not going to stop.

SIMMONS-DUFFIN: Selena Simmons-Duffin, NPR News, Augusta, Maine.

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