Since the late 1970s, states have attempted to impose abortion-related restrictions on the use of public funds for family planning services. Many of these attacks are rooted in the flawed assertion that funds allocated for family planning services are “fungible” and free up other funds that providers might use to pay for abortion services. In reality, publicly supported family planning providers are generally underfunded, and funding that supports or reimburses for other reproductive health services do not transfer to abortion services. Most early attempts to exclude abortion providers from receiving state funds were struck down by courts that specifically rejected the fungibility argument.
However, in the intervening decades, states have become more successful in enacting public funding restrictions. For example, states have made providers’ eligibility for state funding contingent on meeting certain conditions, such as not offering abortion services, even if such services are provided without the use of state funds. Increasingly, states are seeking to deny funds even to entities that do not provide abortions but offer counseling on or referral for abortion. And a number of states now allocate funds through a priority system that either disadvantages or wholly excludes safety-net health centers affiliated with clinics that provide abortion. These restrictions typically apply to state family planning funds or federal family planning funds that pass through the state treasury.
The latest wave of policy threats to family planning funding emerged in the summer of 2015 with the public release of a series of deceptive videos seeking to discredit Planned Parenthood. Since then, several states have attempted to prohibit abortion providers generally, or Planned Parenthood affiliates specifically, from receiving any public funds that pass through the state treasury, including federal grants such as Title X funding.
Some states have gone so far as to end their joint state-federal Medicaid family planning expansion programs in favor of entirely state-funded “spin-off” programs. These state-funded programs cover many of the same services as the Medicaid family planning expansions, but exclude providers that offer abortion services.
Other states are now seeking to prevent safety-net health centers from receiving other types of public funds intended to address a wide range of public health concerns, such as infant mortality, STIs, breast and cervical cancer, and domestic and sexual violence.