With implementation of the federal Affordable Care Act's major provisions gearing up in Arkansas, the potential involvement of Planned Parenthood is stirring controversy among Republican lawmakers.
The ACA will make subsidized health insurance available to hundreds of thousands of Arkansans starting in January, with enrollment beginning in October. As part of the law, 642 outreach workers, known as "guides," will work in every county in the state to inform people that they're eligible for coverage and help them navigate the process of enrollment.
The Arkansas Insurance Department (AID) is contracting with various entities in the state — ranging from state agencies to private companies to local community organizations — to hire the guides (at around $12 an hour). Thirty groups applied and were certified by the Office of State Procurement as qualified vendors to provide the guides, including Planned Parenthood.
Among the many health services that Planned Parenthood provides is abortion, and Sen. David Sanders (R-Little Rock) and Rep. John Burris (R-Harrison) — who have been working closely with state health officials on implementation of the "private option" for Medicaid expansion passed last April — objected to contracting with the non-profit as a vendor for the guides.
"Any honest person has to acknowledge the obvious controversy that comes with an organization like that," Sanders said. In practice, the guides — who will be trained and licensed by AID, the Department of Higher Education, and the Association of Two-Year Colleges — are restricted to the task of helping eligible people sign up for insurance. Guides would not be funded to offer Planned Parenthood's regular healthcare services, just as guides hired by the Central Arkansas Library (a vendor that was awarded a contract without controversy) will not be shelving books. Nevertheless, Sanders said, "I see their involvement as completely unnecessary. It's a needless injection of controversy."
Insurance Commissioner Jay Bradford decided to delay the contract for Planned Parenthood, even as he went forward with the other groups (of the 30 applicants, 23 have been awarded contracts; three have pending contracts; and three have dropped out). Bradford said that he wanted time to talk to Planned Parenthood and "make sure there was a clear scope of work," in the hopes of alleviating Republican concerns and establishing that the guide program had nothing to do with abortion.
In a phone interview last week, he said, "I don't foresee any problem ... I think we're going to get something worked out with them and we'll go through the process. It will be at a later time." Bradford acknowledged that the "emotion involved" explained the extra scrutiny for Planned Parenthood and the additional effort to "clearly define the scope of work."
Funding for 542 of the guides comes fully from a federal grant, while 100 will be funded through the Arkansas Department of Human Services, with the cost split between the state and the feds. The appropriation has already been approved, but it could theoretically be blocked by the Legislative Council in the interim between sessions.
"The issue is, do they have a population that needs to be served?" Bradford said of Planned Parenthood. "In my viewpoint they do. We need to have a clearer definition so we don't have any trouble from conservatives that they think it has anything whatsoever in any way to do with the abortion issue." Explaining the decision to hold off on a contract, Bradford said, "I'm worried that it will not be understood appropriately. Once it's made clear I can't imagine anybody having a problem with it."
However, in response to Bradford's comments — reported on the Times' Arkansas Blog — Republican lawmakers took to social media to object. Rep. David Meeks (R-Conway) tweeted that a contract with Planned Parenthood would be "unacceptable" and "I will continue to oppose ANY taxpayer funds going to Planned Parenthood." Others followed suit: Sen. Jim Hendren (R-Gravette) tweeted "Hiring 'navigators' and Planned Parenthood to help spend more of our Grandkid's money. #Obamacare #selfish" and Sen. Jason Rapert (R-Conway) tweeted, "I have advised Ins. Comm. Bradford that if he pushes for funding of Planned Parenthood as navigators — all momentum will stop" and "I am sick and tired of taxpayer dollars being funneled to the number one abortion provider in our nation. It is wrong."
Officials from Planned Parenthood of the Heartland, which has locations in Fayetteville and Little Rock, along with Iowa, Nebraska, and Oklahoma, told the Times that they wanted to participate because the guides program "will increase access to the ACA and reduce the number of uninsured Arkansans. Planned Parenthood plays a critical role in reaching the families who need affordable health care the most." Tens of thousands of people have contact with the organization both at clinics and at outreach programs in the community — half of them are at or below the federal poverty level, and another 14 percent are between 100 and 200 percent of FPL. Planned Parenthood spends around $300,000 a year in uncompensated care here in Arkansas.
"For the guide program to work, we need people who are trusted advisors of diverse populations," Exchange Director Cynthia Crone said. "We know that there is a group that goes to Planned Parenthood that is uninsured, that is there — they could connect with them and we could get them insured. Our objective is to get as many people enrolled as we can."
"[Planned Parenthood] has a population, a lot of young people that are going to need to understand how to get this coverage," Bradford said. "I didn't want to get bogged down on a political, emotional issue when it does not apply to that. It's too important. We need to reach that population, it's too important a process."
Sanders countered that "there are plenty of other organizations that are serving the purpose that was intended for the guides program. [Planned Parenthood] just doesn't fit. People get healthcare services from a myriad of places. We have a number of programs that cater to the uninsured and the underinsured. I don't think finding [other groups] is a problem."
In practice, however, attracting vendors to participate in the guides program has proven difficult. The AID reached out to 7,000 organizations in an attempt to find vendors, including churches, health clinics, not-for-profits, libraries, rotary clubs, businesses and chambers of commerce. They held information and recruitment sessions and advertised across the state. All of that produced 30 applications, three of which were withdrawn.
Bradford met with Planned Parenthood's Legal and Public Policy director last Friday to discuss the possibility of additional language in a potential contract to make it as explicit as possible that guide activities won't be connected to abortion in any way. Bradford said that Planned Parenthood will "submit some more specific wording on what their mission would be."
However, Sanders said that attempts to tighten a potential contract amounted to "engaging it — literally injecting controversy into something that shouldn't be controversial." He warned that lawmakers would object to Planned Parenthood's involvement no matter how explicit the rules. "The legislature has a clear role to play in this," he said. "It's just not going to happen."
"My hope is that Planned Parenthood will realize that and withdraw," Sanders continued. "They obviously know who they are and they also know the controversy that they carry. I would think that if they're thinking of the greater good ... their involvement is unnecessary."
Planned Parenthood has no plans to withdraw at this point, telling the Times, "We believe that Planned Parenthood of the Heartland is a qualified contractor in the state of Arkansas. ... We will continue to provide information as best we can to move this process forward."
If the state refuses to contract with Planned Parenthood, it would face the potential for a legal challenge. "It would appear to raise viewpoint discrimination problems under the First Amendment," said Teresa Biener, law professor at the University of Arkansas Little Rock.
Sanders said that even if there was a constitutional issue, he did not think that Planned Parenthood would bring a lawsuit. "Would they really do that?" he asked. "That seems kind of silly." Asked about the legal question, Planned Parenthood responded, "We cannot speculate about the legal ramifications of a decision that may or may not be made. We are working to the best of our ability to provide any and all information needed so that we will be approved as a vendor."
By Monday, Bradford was a bit more cautious in his outlook. He said it was unclear whether AID would go forward with a contract with Planned Parenthood or not. "We haven't made any agreement at this stage," he said. "We'll see what they submit."