The One Big Beautiful Bill Threatens to Defund Planned Parenthood

The One Big Beautiful Bill is a reconciliation bill which passed the House and has moved on to the Senate. Included in this bill are provisions that would defund Planned Parenthood, threaten health insurance access, undermine access to abortion and gender-affirming-care nationwide, and raise costs on working families. Ianthe Metzger, Senior Director, Advocacy Communications at Planned Parenthood, sits down to talk with us about this insidious bill and how it, among other things, threatens the care Planned Parenthood provides.

Defunding Planned Parenthood, which refers to cutting the provider out of the Medicaid program, would threaten access to cancer screenings, STI testing and treatment, prescription services, abortion care, and more across the country. In fact, a new analysis shows that, if the bill passes, nearly 200 health centers across the country would have to close, and 1.1 million people who depend on Planned Parenthood for a spectrum of care would be forced to look elsewhere.

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One Big Beautiful Bill Act Is a Repeal of the Affordable Care Act by Another Name
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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hi rePROs, how's everybody doing? I'm your host... y'all my brain is struggling today... I'm your host Jennie Wetter and my pronouns are she/ her. Happy Pride, y'all! I hope everybody's Pride is off to a wonderful start and that you're able to find joy celebrating in your community I know there is a lot happening right now and it's really heavy with so many attacks on LGBTQ rights particularly on trans rights right now and there's so much that we need to be keeping an eye on and fighting back against but I hope you were able to find the joy in celebrating with your community and able to continue joyfully into the fight. You know, they want us to lose hope and be frustrated and be hopeless and celebrating and finding joy is something that they don't want us to have. So, I hope everybody is able to be joyful warriors to continue to go forward and fight so hard for the LGBTQ+ community and to continue to fight to ensure that they are able to exercise all of their rights. Yeah. So, just thinking of that this month and hoping people find the peace and joy they need and celebrating with their community and that we are all energized to keep up the fight against all of the many ways that LGBTQ rights are under attack right now. Let's see. Also, I wanted to give a huge, huge thank you to some of the people who reached out to me about suggestions for films with abortion storylines that I asked for last week. So, I really appreciate it, y'all. Thank you. Thank you. Thank you. Thank you. If you didn't reach out and you have some ideas, please feel free. I'm still open to suggestions. You can email me at jennie@reprosfightback.com. Feel free to reach out on social. I'll see it there too. Somebody also commented on the YouTube video. I also see that, so... Please feel free to reach out in any way you would like. I always love to hear from y'all. If you have an episode topic you would like us to cover, I would also love to hear that as well. I want to make sure that we are giving you the information that you want and need. So, if there's something in particular that I haven't talked about or something I haven't talked about in a while, please, please, please shoot me a note anytime. I want to make sure that I am giving you the tools you need to continue fighting. There's a lot going on right now and so much to keep an eye on. We're keeping an eye on Congress and the reconciliation package. We're going to be talking about that in the episode today. There are so many terrible things in that bill. We're not going to be able to talk about all of them, but we're going to talk about some of them. It is also, as Boom! Lawyered says, sweaty SCOTUS season. It's that time of year because it's June where all eyes turn to the Supreme Court, where we are waiting for them to hand down decisions in a number of cases that we are keeping an eye on. We will have episodes up as soon as possible after decisions on ones we have been keeping an eye on. I know particularly this Pride Month, I'm really worried about this Skrmetti decision and what that would mean for gender affirming care. Yeah, just... would really hate to see them attack trans rights at any time, but also particularly during Pride. So, this is just a lot to keep an eye on at the moment. Also keeping an eye on what it's going to mean, the Biden administration's clarifications on EMTALA, the Emergency Medical Treatment and Active Labor Act, which says that if you, among other things, if you show up and an emergency room and you need care and you're pregnant and the care you need to save your life and health is an abortion that the hospital has to provide it for you. The Trump administration is trying to say that that is not true, that if states have banned abortion, they don't need to provide that care. Let's just be clear. That means people will die. That is unacceptable. So, we need to be keeping an eye on how what is going to happen with that. I'm sure we'll talk about it on the podcast sometime in the near future. I know we've talked about him a lot. There's been a lot happening on it. This year, so, you know, we will maybe put it in like a grab bag episode so we're not just doing an all EMTALA episode again because, yeah, there has just been a lot around EMTALA happening. But it is important because, again, it's basically saying that you should let people die rather than getting life-saving abortion, which is... horrifying. It is horrifying and should never be the case. Let's see. I think those are most of the big things I wanted to talk about. I guess the other thing, just because I always try to be open and talk about when it's happening, my anxiety is a little high right now. And in particular, it is manifesting where... my inner voice, I always talk about my inner Statler and Waldorf who are sitting there and always constantly critiquing me are particularly loud right now. And part of being better about dealing with it is acknowledging it's happening and that I don't need to listen to them. They are not right. They are not right about me. They're just noise in the background. And so, I'm trying really hard to push them to the background right now, but as I'm recording this today, they are very, very loud. So just acknowledging it and saying it out loud does actually help me a little bit because it's just making it very clear that that's all that is. It's just noise. It is not true. My anxiety is lying to me. So just, I always try to be open about it here because I know a lot of people struggle with it. So, it is something I just want to make clear that there are harder days and today is one of those days. I'm fine. Nothing is wrong. It's not a big problem, but they're just particularly loud and I need them to recede back into the background a little bit instead of being in the foreground where they are at the moment. So yeah, I think those are all the big things I had to talk about today. I am very excited for this week's episode. Like I said earlier, we are going to be talking a bit about the reconciliation bill. In particular, we're going to be talking about defunding Planned Parenthood and what that would mean. And I am very excited to have with me today Ianthe Metzger with Planned Parenthood to talk about the reconciliation bill and what it would mean to defund Planned Parenthood. So, with that, let's go to my interview with Ianthe.

Jennie: Ianthe, thank you so much for being here today.

Ianthe: Thank you, Jennie. I'm really happy to be here.

Jennie: Before we get started, do you want to take a second and introduce yourself and include your pronouns?

Ianthe: Sure. So, my name is Ianthe Metzger. I am the Senior Director of Advocacy Communications at Planned Parenthood. I use she/her pronouns, and I've been with the org for about four years.

Jennie: Great. I'm so excited to have you back. There is a lot going on, but I feel like a lot of it is centered around this big bill that is working through in the Senate right now. And, like, I always feel like I am dumber when I, like, say the name. But, like, it's called the Big Beautiful Bill. It, like, hurts my soul to say it.

Ianthe: Yes.

Jennie: But can you tell us a little bit, like, what is this bill?

Ianthe: Yes. So, the Big Beautiful Bill, per Trump's naming, passed the House last month. And it's now with the Senate, as you said. And it is a reconciliation bill that they are trying to pass online. with a simple majority in both chambers, and it is jam-packed with a bunch of cruel provisions in it. It is more than 100 pages of text. There are provisions that would defund Planned Parenthood, and we can talk more about what that means. Also, just to rip away people's health insurance, to undermine access to abortion and gender-affirming care nationwide. And it also includes a raft of provisions that would raise costs on working families, undermine the rule of law, and so much more. So, it really is an awful bill, and we are sounding the alarm, so people know what's in it and what's at stake.

Jennie: Yeah, there's so much terrible in it that it feels like it's hard to focus on any one thing because there are just so many parts that are bad and are going to have real impacts on people's lives. But we're going to focus today on the Planned Parenthood part. And I think really important to note when we talk about it is: I think a lot of people think when they say that, that there's like this big bucket of money that says Planned Parenthood. What does it actually mean to defund Planned Parenthood?

Ianthe: Yes. So Planned Parenthood is not a line item in the budget. We basically have hundreds of health centers across the country that provide basic reproductive health services like cancer screenings, birth control, STI testing and treatment. And we have many patients that are on Medicaid, and we are reimbursed for their services through the government Medicaid program. So, defunding Planned Parenthood would mean cutting us out of that program, which would mean us not being able to provide those services to our patients, and in many cases, being forced to shut down. If this bill passes, we did a new analysis that found nearly 200 of our health clinics across the country would have to close or 1.1 million people would come to us and be forced to find somewhere else for care. So, it would be really, really devastating.

Jennie: Yeah, I think it's so important for people to understand what an important role Planned Parenthood plays, particularly for people on Medicaid, for accessing reproductive healthcare. Often, their only point of contact with the healthcare system. Could you maybe explain that a little bit? Because I think people maybe don’t have quite the full picture on what that means.

Ianthe: Planned Parenthood health centers are- like 64% of them are in areas that are medically underserved or rural and just don't have another medical provider. So, if we are kicked out of Medicaid, if we are forced to shut down, people would have literally nowhere to go. And to your point, it is the first point of entry for many people, you know, like to get birth control and then they get a wellness exam at the same time. So, it's the first time they're seeing a doctor or the only time they're seeing a doctor. So, it would be really, really detrimental to communities across the country. But another thing that we are really trying to make a really salient point here is that, you know, if these health centers are forced to shut down, that doesn't mean that only like STI testing, cancer screenings and all those important things are being taken away. That also means that that's less clinics that can provide abortion. So, they're also eliminating abortion with this bill. And we've been calling it a backdoor abortion ban. We've been also sounding the alarm that in areas where we would be forced to close, most of them, 90% of those clinics would be in states where abortion is already protected. So, it really would cut access across the board for all services, including abortion. And that is the goal. That is the intent of the bill. And it's really dangerous.

Jennie: So, I think it's really also important to note the important role Planned Parenthood plays in that they would create a big gap in the system if they were not able to see Medicaid patients. One, not all providers see patients with Medicaid. There are often low reimbursement rates, so not all doctors take Medicaid patients. And that's a really important role that Planned Parenthood fills because they do see patients with Medicaid. And Planned Parenthood is an expert in sexual and reproductive health services. This is what they do. They are able to see more patients and have more family planning appointments. They provide a complete range of family planning options that not all local doctors may have; they may not have the expertise in IUD insertion or other things that Planned Parenthood has because this is what they do all day, every day. So, if Planned Parenthood is no longer able to see Medicaid patients, there is going to be a really big gap that may not be able to be absorbed, right? Because the doctor first may not offer a full range of family planning services. They may only have certain methods. They may not have expertise in all of the methods, but also, they may not accept Medicaid. So, that will leave these patients without somewhere to turn to for care.

Ianthe: Yes, it'll be harder. Wait times will be longer because yes, I mean, Planned Parenthood, more than half of our patients are Medicaid patients or recipients of Title X, which is another federal family planning program that is under attack right now. And Guttmacher Institute just did a report that really showed that the providers that exist are not able to fill the gap if Planned Parenthood health centers shut down. There's a lot of proof of this in states where we've been defunded at the state level, like in Texas. There's a lot of evidence that shows that when Planned Parenthood is kicked out of these communities, patients suffer. We know that STI go untreated, cancer screenings go undetected. There is real evidence to that. So, it's really, really critical that we do everything we can to stop this bill.

Jennie: Okay. And so, you started to mention how this would impact abortion access, but maybe we want to focus a little bit on that as well. Because in theory, this bill doesn't have anything to do with abortion. It doesn't call out abortion or add any restrictions. But as you said, it's going to impact clinics that are open in states where abortion is legal, and those clinics may be providing abortion.

Ianthe: Yeah, exactly. I mean, this bill is a backdoor abortion ban. Rather than try to make abortion illegal nationwide, because we know that's incredibly unpopular, they're doing everything they can to make it impossible to access. So Planned Parenthood is being targeted for so-called defunding because our health centers provide abortion, and we're proud to do so. And we're being punished for it. And in the process, they're punishing millions of people across the country. And I think that that is a really important aspect of the bill that is not being talked about enough. So, beyond the defunding provision in the bill, there's also a measure that aims to eliminate health insurance coverage for abortion under the Affordable Care Act. So, they're coming from it at all angles. And as you said, you know, abortion is not specifically what it's targeting, but that is the intent. And that is the impact that we're going to see if this bill is passed and signed into law.

Jennie: Yeah. And I always think it's always important to note that none of this is happening in a vacuum, right? You already mentioned the attacks on Title X that we're seeing that are also going to are impacting Planned Parenthood affiliates. There's the Supreme Court case that y'all are waiting to hear the decision on. There's restrictions on mife that could be happening. There are so many ways that there are threats to accessing care in the atmosphere right now that any one of them could cause really detrimental impacts for access to sexual and reproductive health care.

Ianthe: Yes. And in the past week alone, there's been a lot of news on the abortion access front. We have this bill as we're talking about, but I mean, you mentioned the mifepristone thing where the FDA commissioner has said how they are going to review the safety and efficacy of Mifepristone, which is insane because this is a drug that has been studied and peer reviewed and been taken by 7.5 million people across the country for safe termination of pregnancies. And this week, the Trump administration also rescinded guidance on the Emergency Medical Treatment and Active Labor Act, EMTALA, which has been known for 30 years to mean that if a pregnant people is experiencing a medical emergency and the cure for that is an abortion, they have a right to an abortion. The Trump administration says that's not true and that in states where abortion is banned, you are out of luck if you are pregnant and you are bleeding. So, a lot of really awful news happened this week that we are tracking, but you're right. This is not happening in a vacuum. This is the goal. It's a long, coordinated effort to come for our rights on all fronts from all angles.

Jennie: So, the bill has the part about defunding Planned Parenthood, but that's not the only attack on healthcare that we're seeing in that bill. There are huge attacks on Medicaid. Do you want to maybe tell us a little bit about the overall attack on Medicaid?

Ianthe: Yes. So, this bill guts Medicaid and Obamacare health plans, and that will lead to roughly 60 million people, low or moderate incomes, losing their health insurance. I mentioned the piece about how it eliminates health insurance coverage for abortion care. It also adds a lot of bureaucratic red tape to Medicaid. So, there's things like work requirements and eligibility checks that will all make it harder for people to get coverage and keep it. It charges people with Medicaid more out of pocket money to see a doctor or pick up a prescription. And it also ends the incentives for states to expand Medicaid and blows up state budgets by limiting the state’s ability to use provider taxes to fund their portions of Medicaid care. So, it's just across the board, very awful, which is why, you know, of course we want the defund provision to be taken out. But, you know, we want the bill to be dead like that because it's so harmful. And as I've also already said so many of our patients are on Medicaid and this is going to really, really impact their ability to get care from us or from any provider.

Jennie: I think there's like one of those things that is so insidious about some of these things is there are things that on their face may sound reasonable if you like don't go below like the inch of the surface, like, where you hear about the work requirements, right? Like, you're like, oh yeah, that makes sense. Like, people need to work to get health insurance. Like, of course, like you can't just be lazy, whatever's like back to like the racist, like 'welfare queen' like stuff. So, I think that people have a lot of that image but when you actually look at work requirements and what they do, it is so much more harmful than that.

Ianthe: Yeah. There's this idea that people who support this bill are trying to push about a 30-year-old living in his parents' basement, playing video games all day on Medicaid and how he needs to get a job. But you know, there's been research that shows that the people who are impacted is a single mother of two kids who is, like, you know, trying to get by like those are the people who are impacted when you add these restrictions. And so, we really need to do a lot of debunking of who the Medicaid patient is, because for some reason that really insidious wrong narrative has really persisted. And it's just not true.

Jennie: Yeah, there is something about the messaging with so many of these…like, we see it with abortion and all of these things or even with gender affirming care, where you get this top-level narrative where if you don’t question it, it feels like it makes sense, but when you dig in, you’re like no wait this is actually just trying to ban care or whatever instead of trying to help people.

Ianthe: Yeah, no, 100%. I feel like, and they don't want us to question it. They just want us to take everything at face value, to ignore our lived experiences, ignore the people that we know, and just assume that what they're doing is in our best interest. But we know that's not the case. We know that bills like this are really cutting health services for people with low incomes just to give tax cuts for the ultra-wealthy. And that is really who they're looking out for, not for the average person. And that's why average people; everyday people like us need to speak out and pay attention to what's happening.

Jennie: Is there anything else in the reconciliation bill that you're keeping an eye on?

Ianthe: Yes. So, we are also looking at the attacks on gender-affirming care in the bill. So it does target the health of trans people by stripping away their access to this medically necessary care. And it's for people across the board, minors, adults, anybody. So that is awful, of course, but we know that, you know, the trans community continues to see a spate of attacks across the board. And it also strips insurance coverage for children and families by punishing states that use Medicaid funds to cover immigrants, including folks that are in DACA that are participating in the ACA marketplace. So again, two groups that folks like to demonize, immigrants and transgender people, they are also going to bear the brunt of harm when it comes to this.

Jennie: Yeah, when I see the stuff on gender affirming care in this bill, it takes me back to abortion restrictions and seeing how [lawmakers] said, "oh, we just want to make sure that the young people are protected and aren't being taken advantage of." And so, you saw the parental consent laws and stuff with abortion, but it never stopped there, right? It wouldn't go to attack access for everybody. And have been seeing so many trans advocates and people trying to explain to people that it was never going to stop with bans on young people. It was always going to come after access for everybody. And so, this was a real clear sign to show that, yeah, they are coming to block everybody from getting gender-affirming care.

Ianthe: Yeah, for years, anti-trans folks have used the anti-abortion playbook to push their agenda, starting with targeting young people's ability to get care. And, you know, this provision in this bill that would ban plans from covering gender-affirming care, that is basically a Hyde Amendment for gender-affirming care. And the Hyde Amendment, as I'm sure your audience knows, prohibits the use of federal funds for abortion, except in very extreme circumstances. And they're doing the same thing with gender-affirming care. So, it's the same playbook, the same lies, and... this is the point. They've been successful and they're going to keep trying to push it, but we have to push back.

Jennie: Yeah, I feel like that's one of the provisions that unless you're following like really specific reporters, particularly trans reporters, I feel like that bit has really gotten lost in the coverage.

Ianthe: Yeah, 100%. And it's so disturbing because I feel like attacks on trans people are continuing to blow up, but when we see these tangible policy changes, they're not getting enough attention. But at the same time, people have this warped sense of the transgender community. There's polling that showed that people think that 25% of people are transgender, which is not true. They just don't understand how this community works because it's been so demonized and been so talked about in a way that is negative. But when it comes to these actual policy issues, they're flying under the radar, as you said.

Jennie: Okay, so where are we at in the process right now? And I guess we should say we're recording this on Friday, June 6th, in case something weird happens before this comes out on Tuesday.

Ianthe: Yes, so around May 21st or 22nd is when the House passed their version of this bill. So, it is now with the Senate. We are hearing that the Senate is hoping to pass their own version or maybe this exact version before 4th of July. So, we have about three weeks to really dig in and, you know, talk to our senators, our lawmakers about why this bill is harmful. There's going to be a short recess during that time around Juneteenth where folks will be back in their districts. And hopefully that's a place where, you know, we can have constituents talk to them directly. But again, we have about three weeks if they stick to their 4th of July timeline. It seemed impossible for the House to pass before Memorial Day, given all the infighting, but they did it. So never underestimate these folks. But that is a timeline that we're working with at Planned Parenthood for sure.

Jennie: So, we saw there are really bad provisions that we would love to see come out, but I think the bigger ask is... that we want it to just kill this bill, right?

Ianthe: Yeah, we want, this bill is awful all around. And that is our goal. You know, we have, we of course, are a reproductive rights org and are focused on those issues, but you know, as I said, the impact on immigrants and LGBTQ communities is awful. So we're, you know, standing in lockstep with our partners to try to get this bill rejected. I don't know if people know or remember in 2017 when there was another reconciliation bill about to be passed, where they were going to defund Obamacare. There was a PPD fund provision in there. And it was John McCain's thumbs down that killed the bill. And he didn't kill it necessarily because he supported Planned Parenthood, but he killed the bill. And we're hoping for another hallelujah moment like that to come. But I think that we're doing everything we can to talk to the right people about the harm in many purple and red states. So there's a lot, I think, that we can hopefully find common ground on and work with the right people to get this bill rejected. But yeah, there's a lot that we can still do.

Jennie: Okay, so now that our audience is informed and knows what's in this bill and that it needs to go, like: how can the audience get involved in this fight?

Ianthe: Really, it really is about calling your elected officials, calling your senators, telling your story, making sure they understand what's at stake. You know, if you are a person who relies on Medicaid, if you're if you did at one point, if you have family members to do like talking about it, Medicaid is a huge program, you know, many Americans, millions of people will be impacted by this bill. And I'm sure many of your listeners are those people. So, it really is talking about it to your friends, getting educated, calling your senators, and showing up for events. Like I said, there's going to be a recess around Juneteenth. And I'm sure that many local organizations in key states will be having events. I know that our affiliates are hoping to do so. Showing up to those and holding your lawmakers' feet to the fire. They were elected to represent us. And it's important that they know where their constituents stand on the issues.

Jennie: Thank you so much for being here. It was so great to talk to you about everything that is going on right now.

Ianthe: Yeah, this was a great conversation. Thank you for having me. And I hope that people get involved and stay engaged.

Jennie: Okay, y'all. I hope you enjoyed my conversation with Ianthe. It was so wonderful to get to talk to her about the attacks on Planned Parenthood, but also kind of the full grab bag of terrible things that are in this bill and why it needs to be killed. It needs to go away. Yeah, I hope everybody has a chance to reach out to their congressperson to let them know that they need to oppose this bill and that we can stop it from happening because, like I said, there is just a grab bag of terrible in there. And with that, I will see everybody next week for the next in our series on abortion later in pregnancy. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!