Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696592757171.pdf (United States)
June 14, 2018 Investing in reproductive health isn’t just good for women and their families—it’s good for the economy.

As elected officials sworn to represent the best interests of our constituents, we know that economic opportunity and stability are keys to safe neighborhoods, healthy families, and a thriving city.

Good jobs and affordable health services together are crucial to fostering economic stability.
Yet after recent proposed changes by the Trump administration to the Title X Family Planning program, equal and affordable access to comprehensive health care services is once again under threat, including right here in Columbus where more than 10,000 of our citizens receive services under Title X.

For those 10,000 patients, many of whom have no backup insurance coverage like Medicaid, Title X has opened up access to high‐quality basic care regardless of their socioeconomic status.
The health benefits of that alone are important.

But the economic benefits of broad access to reproductive health care services should make the topic uncontroversial.

Investing in reproductive health isn’t just good for women and their families—it’s good for the economy by saving seven times its investment in public expenditures, preventing unintended pregnancies, increasing women’s labor force participation, and improving the financial picture for those families.
President Trump, Vice President Pence, and their administration should stop playing politics with health care access and family stability.

Let’s instead reaffirm the essential role that Title X and reproductive health care access play in communities like Columbus and the State of Ohio.

Join us in standing up for women’s access to comprehensive health care and its importance in Ohio’s economy.
Megan N. Kilgore Columbus City Auditor T (614) 645‐7616 E mnkilgore@columbus.gov Elizabeth C. Brown Member, Columbus City Council T (614) 645‐2151 E ecbrown@columbus.gov Investing in reproductive health isn’t just good for women and their families—it’s good for the economy.

Dismantling a program with proven benefits for the health of women and families is not only confounding, it is a threat to the economic security of many thousands of Ohio households.
Yet President Trump’s announcement in late May would do just that: block federal Title X funds from going to health centers that have a connection to abortion services, including hospitals, doctors, and community health centers across the country who educate their patients on abortion as an option or make abortion referrals.

Despite myopic and thinly veiled attempts to link the word “abortion” to Title X, the program, since its launch by President Nixon in 1970, has never paid for abortions.
Federal funding for abortions is already banned in the United States.

Health centers, including Planned Parenthood, must and do segregate funding sources in order to provide abortion services and family planning services in the same facility.

WHAT IS TITLE X?

The longtime purpose of the Title X program has been to expand access to contraceptive care and reproductive health care for low‐income, uninsured, and underinsured individuals.
Women and men across the nation rely on Title X for basic health care, including: a broad range of family planning and contraception services approved by the U.S. Food and Drug Administration; cervical and breast cancer screening; screening and treatment for STIs and testing and links to care for HIV/AIDS; infertility services; screening for high blood pressure, anemia, and diabetes; and referrals for other health services.
Per the 2016 U.S. Department of Health & Human Services’ Title X Family Planning Annual Report1: ‐ More than 4 million men and women were served in 2016 ‐ ‐ ‐ ‐ 89% of those served were female (self‐identified) 66% were under the age of 30 64% had family incomes at or below the poverty level ($24,300 for a family of four in Ohio) 88% of patients qualified for either subsidized or no‐charge services HOW OHIO BENEFITS FROM TITLE X In Ohio, 87 health facilities, serving nearly 94,000 patients, received $8.7 million in Title X funding last year.
There are only two direct grantees of Title X funding in the State of Ohio: Planned Parenthood and the Ohio Department of Health2.

Planned Parenthood serves the most Ohioans (a significant 63% of Ohio’s Title X patients) by providing care for approximately 59,000 patients via 17 health centers.

In fact, Ohio is one of fourteen states where Planned Parenthood serves more than 50% of the state’s Title X patients.
Unlike Planned Parenthood, the Ohio Department of Health does not directly provide health care services to patients.

Instead, it passes on funding to sub‐recipients across the state.

A total of 35,000 patients via 70 facilities receive services provided by Title X funding.
The April 2018 Title X Directory sub‐recipients included: numerous county health departments, including Gallia County, Lawrence County, Henry County, Ottawa County, Erie County, Allen County, and Meigs County; numerous city health departments, including Portsmouth, Cincinnati, Columbus, and Cleveland; and various other governmental combined health districts.

1 U.S. Department of Health & Human Services.

(2017).

Title X Family Planning Annual Report: 2016 National Summary.
Retrieved from https://www.hhs.gov/opa/sites/default/files/title‐x‐fpar‐2016‐national.pdf 2 U.S. Department of Health & Human Services.

(2018).

Title X Planning Directory.

Retrieved from https://www.hhs.gov/opa/sites/default/files/OPA_Title_X_Family_Planning_Directory_April2018_508.pdf ME GAN N .
KILGORE EE EEEEEE E LI ZABE T H C. BROWN 2 HOW THE PROPOSED RULE WILL AFFECT HEALTH CARE IN OHIO Due to its prominent role and to offer measurable context, we will focus our economic review on how the proposed Title X defunding will affect the populations of Ohio currently supported by Planned Parenthood.

Today, Planned Parenthood of Greater Ohio serves 59,000 Title X patients out of a total statewide patient population of 63,000.

More than 10,000 Title X patients live and work in Columbus.
Planned Parenthood’s patient demographics in Ohio are similar to Title X’s nationwide: o 77% of patients are between the ages of 18‐34 o 31% of patients are African American o 85% are female (self‐identified) o 15% are male (self‐identified) A major area of concern for us is the importance of Planned Parenthood’s health care services in certain counties.

Planned Parenthood is the sole Title X provider in nine Ohio counties (based on the latest data available).
Those counties include Athens, Lucas, Mahoning, Medina, Portage, Richland, Summit, Trumbull, and Wayne.

In these counties, Planned Parenthood is the only Title X family planning provider, serving an indispensable role in providing medically isolated communities with essential reproductive health care and education.

Exhibit 1.

Planned Parenthood is the sole Title X health care provider in nine Ohio counties ME GAN N .
KILGORE EE EEEEEE E LI ZABE T H C. BROWN 3 TITLE X, PLANNED PARENTHOOD, & SERVING OUR VULNERABLE POPULATIONS While all areas in the State of Ohio will be affected by Trump’s proposed Title X defunding, we are concerned that the more economically vulnerable populations—in the state’s more economically fragile counties—will suffer the most hardship.
These individuals are being hit with a double blow: they’re reliant upon Title X to fund their needed health care and, if Trump’s proposed rule goes into effect and Title X funding to Planned Parenthood is eliminated, these Ohioans may have zero local options for health care.

Below is a map from the Ohio Development Services Agency.
We’ve sought to visually depict the counties that are currently served by Planned Parenthood (silver rings) and highlight those counties where Planned Parenthood serves as the only source of Title X health care (purple rings).

Exhibit 2.

Poverty in Ohio by County3 Map from Ohio Development Services Agency: 2012‐2016 American Community Survey Planned Parenthood Health Center(s) The nine counties where Planned Parenthood is the sole Title X provider 3 Ohio Development Services Agency.

(2018).
(2018).

The Ohio Poverty Report.

Retrieved from https://www.development.ohio.gov/files/research/p7005.pdf ME GAN N .

KILGORE EE EEEEEE E LI ZABE T H C. BROW N 4 We are deeply concerned that of the top twenty‐five (25) counties, Planned Parenthood is currently the sole Title X provider in four (4) of those counties, including the county with the highest rate of poverty in the state (Athens).
To say that women in Southeastern Ohio will feel the most severe effects of the proposed Title X defunding at the Athens Health Center is an understatement; any change in Title X funding will eliminate not only critical health care services, but will significantly alter how individuals in Southeastern Ohio are able to obtain health care.

Exhibit 3.
High Risk: Counties Where Planned Parenthood is the Sole Title X Provider Ranking (Highest Poverty Rate to Lowest) Out of 88 Counties 1 County Athens Poverty Rate of County’s Population4 31.2% Number of Persons in Poverty5 17,301 9 22 25 Lucas Mahoning 20.7% 18.1% 87,717 40,823 Trumbull 17.5% 35,115 Health Center(s) Planned Parenthood of Greater Ohio (PPGOH) ‐ Athens Health Center PPGOH ‐ Toledo Health Center 1) PPGOH ‐ Youngstown Health Center; 2) PP of Northeast Ohio (NEO) 1) PPGOH ‐ Warren Health Center; 2) PP of NEO It should be noted that our analysis compares the delivery of Title X health care to one single economic factor: poverty.
As we all know, the full complexity of the effects of reductions in Title X funding are likely to result in numerous other social inequities.

For example, while dependence on governmental support (including Title X) will grow as economic conditions in Ohio worsen, such dependence is not evenly distributed across the state.
Some counties and populations within the state will suffer greater hardship because of their distance from other low‐cost health care providers or economic vulnerability due to high rates of poverty.

WHAT WILL HAPPEN TO OHIO’S ECONOMY?


In calling for the Title X defunding of the national reproductive health care providers here in Ohio—which would also wipe out the long list of basic health care that these organizations so importantly provide—the President is crippling the earning potential of Ohioans and holding back Ohio’s economy.

Nine out of every ten Title X‐supported patients are women.

Women in Ohio cannot be ready to earn or ready to learn without access to safe, affordable health care.
Publicly funded family planning is one of our government’s smartest, most economically efficient, and most cost‐ effective investments.

This is why, historically, funding comprehensive family planning has been a bipartisan and prioritized issue.

It’s easy to understand why: access to family planning and reproductive health care services naturally increases women’s participation in the labor force, allowing women and their families to generate more financial security.
This is critical to the overall economy because undoing a program with proven benefits for the 4 Ohio Development Services Agency.

(2018).

The Ohio Poverty Report.

Retrieved from https://www.development.ohio.gov/files/research/p7005.pdf 5 Ohio Development Services Agency.

(2018).

The Ohio Poverty Report.

Retrieved from https://www.development.ohio.gov/files/research/p7005.pdf ME GAN N .
KILGORE EE EEEEEE E LI ZABE T H C. BROWN 5 health of women and families is not only baffling, it is a direct threat to the economic security of many thousands of Ohio households.

Women make up nearly half of Ohio’s workforce (48%), and women are increasingly the sole or primary breadwinners in Ohio households.

To put a price tag on how much Trump’s proposal could cost citizens, take a look at the Guttmacher Institute’s research.
Using information from 2010, the most recently available analysis, family planning and health care services funded by Title X resulted in federal and state government savings of $13.6 billion6.

The economic benefit of Title X to taxpayers is clear.

What’s not clear is how the Trump administration expects citizens to pay for the health care services that it is proposing to take away.

The Federal Reserve Board’s Report on the Economic Well‐Being of U.S.
Households, released at the end of May, quantified the vulnerability of Americans.

The Report found that 41% of men and women could not cover a $400 emergency expense using cash in 20177.

President Trump’s plan to decimate Title X could cause thousands of Ohioans—including residents of Columbus— to go without access to affordable reproductive health care, cancer screenings, STI diagnoses, and more.
It would dwindle the family planning provider network and hamper the efforts of clinicians working in often underserved areas.

The Federal Reserve’s Report sums it up with debt: those who cannot afford the $400 unexpected expense simply turn to credit cards or borrowing from others.

Twenty‐two percent say they would expect to skip payments on some of their bills.
And nearly half of those who skip bills would let their credit cards go unpaid, resulting in snowballed, high interest rate charges and potential long‐term consequences to their personal credit.

Good public policies that support comprehensive reproductive health care help reduce poverty and improve our economy.

But the importance of these policies reaches far beyond those outcomes.
Public health infrastructure that prioritizes the needs of women helps women reach their full potential as citizens, employees, and parents— fostering multi‐generational security.

6 Guttmacher Institute.

(2014).

Beyond Preventing Unplanned Pregnancy: The Broader Benefits of Publicly Funded Family Planning Services.
Retrieved from https://www.guttmacher.org/gpr/2014/12/beyond‐preventing‐unplanned‐pregnancy‐broader‐benefits‐publicly‐funded‐family‐planning 7 Board of Governors of the Federal Reserve System.

(2018).

Survey of Household Economics and Decisionmaking.

Retrieved from https://www.federalreserve.gov/consumerscommunities/shed.htm ME GAN N .

KILGORE EE EEEEEE E LI ZABE T H C. BROWN 6