Jul. 28—The Executive Council on Wednesday approved contracts with four clinics to provide birth control and screening for sexually transmitted diseases, but again rejected contracts for the three largest clinics, which also provide abortions.

The vote leaves those clinics without funding to cover services for patients without health insurance.

On Wednesday, councilors unanimously approved contracts with Amoskeag Health in Manchester, Lamprey Health with locations in Nashua and Rockingham County, Coos County Family Health Services, and the Community Action Program of Belknap and Merrimack Counties.

But for the fourth time in nine months, the Republican majority voted against approving contracts for Planned Parenthood, Equality Health Care in Concord and the Joan G. Lovering Health Center in Greenland because those clinics also provide abortion services.

The family-planning contracts do not pay for abortion, but the concern that the contracts could indirectly fund abortions led the 4-1 Republican majority on the council to vote against these contracts in September and December 2021, and again in January 2022. The council has gone against Gov. Chris Sununu, who has said he supports the contracts.

Sununu's office said he and Health and Human Services Commissioner Lori Shibinette have been trying to convince the council members to approve the contracts.

"Governor Sununu and Commissioner Shibinette have repeatedly communicated the importance of these contracts to members of the Executive Council in a number of settings, and DHHS has consistently worked to provide councilors with requested information and documents to address their stated concerns," read an email from Sununu's press office.

On Wednesday, Councilor Joseph Kenney, R-Wakefield, asked which clinics offered abortions. Shibinette said Planned Parenthood, Equality Health and the Joan G. Lovering Health Center provided abortion services, but underlined that DHHS audits have shown that no state funds are used for abortions — a point Kenney had raised in earlier debates.

Despite Shibinette's assurances and Sununu's support for the contracts, Kenney and the other three Republican councilors — David Wheeler, R-Milford, Ted Gatsas, R-Manchester, and Janet Stevens, R-Rye — all voted against the contracts.

The debate about these contracts meant uncertainty even at centers that were funded Wednesday, said Lamprey Health CEO Greg White.

As a "safety net provider" committed to serving patients without health insurance or the means to pay for care, White said Lamprey relies on these contracts, on the mix of federal and state funding, to make sure cancer screening, birth control, and testing and treatment for sexually transmitted infections can stay affordable for the state's poorest patients.

White said Lamprey would not raise its rates, so to make up for the jammed-up contract, Lamprey had to cut supplies and staff hours. With shortage of health care workers, White said, Lamprey did not want to lay off staff, because there would be no guarantee they would return to work.

So the family-planning programs ran at a loss, he said.

The uncertainty continues for the three clinics that had their contracts denied again Wednesday.

For the largest provider, Planned Parenthood, the contracts were a smaller slice of funding — though Planned Parenthood New Hampshire Action spokeswoman Kayla Montgomery said losing the contracts has been one of many difficulties that led to the closure of a clinic in Claremont earlier this year.

The loss of the funding has bigger impact on the smaller clinics like Lovering Health.

"These funds were foundational," making up about a quarter of the clinic's revenue, said Sandy Dinoncoeur of Lovering.

Already, the clinic has had to cut the job of an outreach worker whose job was to make sure low-income women knew about the clinic's services.

To make up the funding gap, Dinoncoeur said her staff has had to spend time and resources getting funds from donors and foundations. The coming budget year will be tough.

Still, she won't raise fees.

"We've refused to transfer that burden to pay to our patients, who are very low income."

Funding only the smaller clinics that do not provide abortion services will mean longer wait times for care, and longer journeys to receive a cancer screening, birth control or testing and treatment for a sexually-transmitted infection, she said.

The smaller clinics will not be able to absorb all the patients who get care through these contracts, Dinoncoeur said. During the meeting Wednesday, Patricia Tilley of the state Department of Health and Human Services said about 16,000 women get care through these family planning contracts.

Montgomery said she expected those numbers to rise after the Supreme Court overturned the Roe v. Wade decision last month. Already, she said, more women are coming to reproductive health clinics in search of long-acting, reversible birth control such as intrauterine devices.

jgrove@unionleader.com