Jeb Bush offered a study in how not to talk about reproductive health on Tuesday. Attack Planned Parenthood? Smart politics for a Republican. Tell an audience, “I’m not sure we need half a billion dollars for women’s health issues”? Not such a great idea.
Unsurprisingly, Bush now says he misspoke, but his remarks raise several interesting questions.
First, what exactly does it mean to talk about “women’s health issues”? Women often bristle at men discussing reproductive issues—a particularly common issue in politics, where men dominate. Of course, women are slightly more than half the general American population, so the idea it’s a niche concern is misguided at best and condescending at worst. This is a problem that cuts across party lines: When Republican leaders attempted to pass a late-term abortion ban that set stringent conditions on rape exceptions, female GOP lawmakers revolted and scuttled the deal. Some of the issues considered “women’s health” really do concern mostly women, like mammograms. But others, such as family planning, sexually transmitted diseases, and birth control, affect the entire population. Even if social expectations have placed much of the burden for preventing pregnancy on women, that’s a socialized rather than inherent condition.
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Second, how much money is that half a billion, really? In short: not a great deal. In fact, dividing the $528.4 million Planned Parenthood received in the fiscal year ending in June 2014 by the female population of the United States, it comes out to just about $3.25 per woman per year—about the same as a grande Starbucks cold brew.
But what does that money do? About a quarter of Planned Parenthood’s government revenue comes from grants for Title X services, which comprises family-planning for low-income people, including:
contraceptions and counseling
breast-cancer and cervical-cancer screening
pregnancy tests and counseling
testing and treatment for sexually transmitted infections
By statute, federal funding can’t go to abortion services—at Planned Parenthood or anywhere else. (Planned Parenthood says only 3 percent of the services it renders annually are abortions.*) But anti-abortion advocates say that doesn’t mean at all what it seems, arguing that since money is fungible, and since providing abortions is clearly important to Planned Parenthood, every federal dollar that goes to the organization frees up another dollar from another source to pay for abortions.
The other three-quarters of the government money that Planned Parenthood receives comes from Medicaid, which also provides services to low-income people. As Politico reported, that complicates the defunding push. Generally patients have broad latitude to choose their provider, so state-level efforts to block funding to Planned Parenthood have tended to be blocked by courts that find the measures infringe on patient choice.
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What’s interesting about these services is pretty much everyone agrees they ought to be available. (Who’s against cervical-cancer screening?) The dispute is purely over who ought to provide it—and whether Planned Parenthood’s abortion services (and the recent sting videos) ought to disqualify it.
Planned Parenthood’s defenders argue that not only is defunding the organization potentially illegal, it’s dangerous. The rest of Bush’s quote, after the verbal misstep, offers an interesting argument. “Dollar for dollar, there are many extraordinary fine organizations, community health organizations, that exist, federally sponsored organizations, to provide quality care for women on a variety of health issues,” he said. Other social conservatives have advanced similar claims. Planned Parenthood’s critics say there are plenty of ready alternatives.
Democrats argue that isn’t true, that in the absence of Planned Parenthood, many people—including men, and not just women—would be left without providers for health care. It’s hard to predict how a national defunding would pay out, but the case of Texas offers a somewhat chastening story. The state successfully blocked Planned Parenthood from receiving funds, but lost federal Medicaid funding because it had fallen afoul of rules. As a result, women reported struggling to find the services they’d previously received. Even if Planned Parenthood’s medical services under Medicaid and Title X are replaceable, its size suggests it would be hard to immediately fill the gap.
But there will soon be another possible test. Louisiana Governor Bobby Jindal, one of Bush’s rivals for the Republican presidential nomination, announced Tuesday he would block state funding for Planned Parenthood. With the federal defunding push at least temporarily stalled, Louisiana may be the battleground to watch.
* This article originally stated that 3 percent of Planned Parenthood’s spending goes to abortion. We regret the error.
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This article was originally published on The Atlantic.