Oregon’s Planned Parenthood clinics anticipate 70% budget loss

As soon as President Trump signed his tax-cut and spending package into law on July 4, one of the ways it impacted Oregon was to immediately make all Planned Parenthood clinics ineligible to receive Medicaid reimbursement for one year. In Oregon, those reimbursements make up approximately 70% of budgets. That is, if they continued to perform abortions — even for the approximately 90% of health care services that are not abortion related. Planned Parenthood sued the Trump administration and got a temporary injunction — but that’s set to expire at the end of this week.

In Washington state, Gov. Bob Ferguson has committed to backfilling the loss for clinics in that state for one year. We talk with Sara Kennedy, President and CEO of Planned Parenthood Columbia Willamette, which runs nine clinics in the region, about the impact of the expected Medicaid cuts and what alternatives might be available.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. When President Trump signed his tax cut and spending package into law on July 4, Planned Parenthood clinics became ineligible to receive Medicaid reimbursement for one year. That is, if they continued to perform abortions, which only make up about 10% of the health care services they provide. But these Medicaid reimbursements make up a big percentage of Planned Parenthood’s overall funding, which has led to serious questions about the viability of the entire network. Some Planned Parenthood chapters sued the Trump administration and got a temporary injunction, but that is set to expire at the end of this week. In Washington, Governor Bob Ferguson has committed to backfilling the loss for clinics for one year.

Joining me to talk about all of this is Sara Kennedy. She is the president and CEO of Planned Parenthood Columbia Willamette, which runs eight clinics in Oregon and one in Washington. Sara, welcome back to Think Out Loud.

Sara Kennedy: Thank you, Dave. It’s a pleasure.

Miller: Can you explain what the “One Big Beautiful Bill” actually says about organizations like yours?

Kennedy: Sure. So this terrible bill has language that made organizations with the following criteria ineligible to receive Medicaid reimbursements: if you are a nonprofit community clinic or healthcare provider, and you provide reproductive healthcare, and you provide abortions, and you receive a minimum of $800,000 in Medicaid revenue annually. Then you are ineligible to receive Medicaid reimbursements for 12 months. So it turns out that the only organization in the country that meets all four of those criteria is Planned Parenthood.

Miller: Am I right that Congress couldn’t specify Planned Parenthood in a bill, that goes against laws, but they set up criteria that accomplish the same thing, and that’s basically what happened? This was a Planned Parenthood target without saying Planned Parenthood?

Kennedy: That’s exactly right. And we really viewed this as a backdoor abortion ban. They are trying to shutter Planned Parenthood health centers because they don’t like what we do, and they don’t like us providing basic health care.

Miller: Given that the majority of the services you provide do not include or don’t involve abortion, did you consider telling your clinics to stop offering abortion?

Kennedy: We never did this, Dave, here in the state of Oregon and in the state of Washington. We really believe that abortion is basic health care. It is intrinsically linked to just wellperson care and it is part of our identity. We believe that walking away from abortion is really turning our backs on patients who need us most and makes pregnancy more dangerous, which is completely in opposition to our mission.

Miller: How important is federal Medicaid reimbursement to your system?

Kennedy: Seventy percent of our patient visits annually are reimbursed via the Medicaid system. That represents about 65% of our total revenue. This is a debilitating attack against Planned Parenthood, given the number of patients that we serve. Our commitment is to serve low-income Oregonians and Washingtonians. Most of those folks are on Medicaid. And starting July 5, we were unable to receive Medicaid reimbursements for any of those patients that we saw.

Miller: Are Planned Parenthood chapters in states like Oregon – which were early adopters of Medicaid expansion under the Affordable Care Act, some red states followed later – more likely to lose more funding? Do you have a higher percentage of people who come to you using Medicaid?

Kennedy: That’s exactly right. I feel really proud to be an Oregonian because Oregon has invested in healthcare and has ensured that 97% of our current residents are covered through health insurance, most of those through the Medicaid system. So this bill specifically targets not only Planned Parenthood, but its biggest effects are on big blue states with strong Planned Parenthood chapters who have expanded their Medicaid population. So we are disproportionately hit here in the state of Oregon because we primarily take care of low-income Oregonians.

Miller: Is it fair to say though, as long as we’re talking in generalities, that those big blue states like Oregon are also states where it’s more likely that if women can’t get their services, get an abortion, say, at Planned Parenthood, there are other options? Not necessarily in all parts, not in rural parts, but more so than in red states?

Kennedy: It’s difficult to compare apples to apples between states. But I can tell you that if Planned Parenthood didn’t exist here in Oregon, a huge number of those patients – and tens of thousands of patients are the numbers we’re talking about – actually would have nowhere else to go. We have health care partners on record, major CCOs, major other healthcare providers, who are saying to us there is nowhere else for our members to go, for our patients to go. And if you didn’t exist, they just wouldn’t get care. And that is, of course, disproportionately impacted in rural communities, where we literally are the only health care provider for hundreds of miles, and many patients’ only health care provider that they see at any point over the course of the year.

But even here in Portland, there is no other health care system that can accommodate the volume of patients that we see or the scope of services that we deliver.

Miller: What is that scope of services? So again, the number that seems really important here is that if 10% of what you’re providing is abortions, what is the other 90%?

Kennedy: That’s right – 90% of what we do, which is somewhere in the ballpark of around 90,000 patient visits annually, are completely unrelated to abortion. There’s three big buckets of care that we deliver and then lots of other smaller services. Those three buckets, the first one is cancer screening. Because we are the only statewide health care provider across the state of Oregon, we serve every corner of Oregon, what we generally do more of than anyone else.

Miller: So like Pap smears and mammograms?

Kennedy: Pap smears, and breast and chest exams, exactly. Breast cancer screening and cervical cancer screening is a huge amount of what we do.

The second bucket is in contraception. We obviously provide a ton of contraception so that people have the choice of if and when they want to become pregnant. And the third is infection testing, and specifically STD testing and treatment. So again, we provide more STD screening and treatment than any other health care organization in the state. In many counties, we are the only health care provider who actually treats something like syphilis. We have in Oregon a syphilis spike in epidemic and we’re the only health care provider who actually carries penicillin to treat that disease, which is a communicable disease.

Miller: So you said that this happened on July 5, it was immediate, that the day after the signing that you were no longer eligible for Medicaid reimbursement. One of the themes that has gone through a lot of our conversations on this show, or just nationwide in recent weeks, is cash flow and the way reimbursements work. Did that mean that services you had already provided in the weeks earlier weren’t going to be paid for by the federal government? Or going forward, they can’t be reimbursed? I guess I’m wondering if you were in an immediate hole or if the hole is about to hit you?

Kennedy: Well, the bill took effect immediately, so that was Friday, July 4, when President Trump signed the bill. On Saturday morning, we had five health centers across the state that were open seeing patients at 8 am. We made the decision because this is part of who we are and our mission that we were committed to seeing those patients. Those Medicaid patients came, received full services and we are unable to receive reimbursement for those services via Medicaid. So that is an immediate act that, starting July 5, the day after the bill was signed, any patients that are seen after the bill is signed, we are ineligible to receive Medicaid reimbursements for.

Miller: How long can you do that for? If you’re talking about, as you said, 65% of your operating budget until July 4 has come through this federal reimbursement, and now you’re not getting that, how can you proceed?

Kennedy: That’s a great question and this is what keeps me up at night. I would say first and foremost, we’re really grateful to the state of Oregon and to our legislative allies, because towards the end of long session they allocated $10 million to the two Planned Parenthood affiliates to bolster, support and stabilize the affiliates, knowing we were going into this fight. We are super grateful for that money and that has allowed us, in the short term, to be able to see our full volume and our full scope of Medicaid patients and services.

However, to your point, that money is already being drawn down on. And we will run out of it shortly. So we are really looking forward to working with the legislators and the governor on a viable long-term funding strategy for Planned Parenthood so that we can continue to take care of low-income folks in Oregon.

Miller: Is the closure of clinics one of the possibilities on the table right now?

Kennedy: Yes. And it breaks my heart to say this because every day there is so much need. What we are finding on the ground is the more that we open, the more hours that we open, the more days of the week that we open, patients are coming in for services, people need us. And Oregon is not immune from this. Anybody who loses 65% of their revenue overnight is faced with having to make difficult choices. It really comes down very simply to if Oregon does not step in, does not fulfill the promise of protecting reproductive health care and protecting our right to abortion, health centers in Oregon will close, yes.

Miller: Can you tell us what Washington Governor Bob Ferguson has announced and if that’s different from what you’re saying, the money that the legislature provided, the $10 million?

Kennedy: The money that the legislators provided is different; that was really meant to support and to stabilize the two affiliates. For many years, we have been running operating deficits because Medicaid reimbursement rates are not keeping up with the cost of care. I’ll give you a quick example: it costs us at PPCW $340 to do a Pap smear. That’s all in – the lab, the staff, the house and the building electricity. We [used to be] reimbursed $81 for that Pap smear. So for many years, we’ve been dealing with flat Medicaid reimbursement rates that don’t cover the cost of care. And that $10 million was really meant to help stabilize our organizations, knowing that we’re going into an even bigger fight.

What Governor Ferguson did is he boldly and proudly stood behind Planned Parenthood and said that Washington state is willing and able to provide 100% backfill for all federal Medicaid dollars that Planned Parenthood will be ineligible to receive. They’re setting up essentially what is an alternative payment system so that Planned Parenthood continues to operate as normal, seeing a huge, tens of thousands of Medicaid patients. And instead of billing Medicaid, the claim will go to state directed funds.

Miller: How much money would that mean in Oregon for the year?

Kennedy: We’re looking at around upwards of $15 million annually for the two Planned Parenthood affiliates to completely replace the federal dollars that are lost. And we’re working very closely with OHA to validate those numbers and come up, so that we have full transparency when we’re making this ask to the state.

My strong preference is that we come up with an alternative payment system. We are not necessarily looking for a blank check. We just want to deliver health care and then get reimbursed for that health care as we have been doing for our lifetimes.

Miller: Obviously, when we’re talking about backfilling federal reductions in Medicaid, the loss to Planned Parenthood is dwarfed by the overall state hole that we’re looking at now because of this same bill. So how do you think about the totality of what you’re asking for, what you’re hoping to see from lawmakers? And I haven’t heard anybody say that it’s possible there is not enough state money to do this anyway. So I guess I’m just wondering about the politics of backfilling this part when you’re thinking about all the money that the state is looking at as a whole right now.

Kennedy: I’ll start by just saying as a OBGYN and physician CEO, the incoming Medicaid cuts that will start to take effect at the end of next year, beginning of 2027, are devastating for this state and for the country. And we will have worse health outcomes for decades because of those incoming cuts.

As a Planned Parenthood provider and as a leader, what we also know is that when those Medicaid cuts take effect, safety net organizations like Planned Parenthood are going to be even more necessary. We have traditionally always taken care of the people who have fallen through the cracks, always taking care of people who don’t actually have health insurance. And our services are going to be even more necessary. I am trying to ensure that our organization sees us through this coming 12 months so that when those Medicaid cuts hit, that we’re here to be able to care for people who need us most.

And the final thing I would say, and this is true of all of Medicaid, but the services that we provide, the 90% of what we provide, is basic preventative care. That care saves money in the long run. We diagnose and treat very early pre-cancer cells on the cervix, and we can do that for a couple of hundred dollars, as I talked about. In contrast, if those cells remain untreated, in three, five, 10 years, that is now an extremely expensive, lethal, extremely painful death that Oregon then diagnoses in an emergency room and has to care for that patient through their end of life. The same is true of all of the infections that we treat, which can be easily treated in our health centers. If they’re left untreated, they spread, they become long-term diseases that then dramatically impact the person’s quality of life and also end up being a lot more expensive because they get treated in the emergency room.

So yes, it is upfront money. We’re looking for sustainable funding. And there’s no doubt in my mind that the services that Planned Parenthood provides are saving the state and actually saving lives.

Miller: I’m curious how you think about the national political story here? I remember before the rollback of Roe v. Wade, people would talk about polls saying, even in red states, there is support for abortion access, that a majority of Americans like the status quo and want to see a constitutional right to abortion. And there was talk that there would be political blowback, which didn’t fully materialize. Now we’re looking at what seems to be so far the successful national defunding, a kind of backdoor way, of Planned Parenthood.

I’m wondering if you think the hope that there would be political blowback to removing access to abortion, if that was unfounded?

Kennedy: I do not think that. But I think we are seeing a delayed reaction and the effects of the Trump administration successfully flooding the zone. There is so much harm being caused in so many areas that it has been difficult, admittedly, to break through around abortion access and reproductive health care access. But there is no doubt that Oregon, and nationally, the bulk of people are behind us and want this right, want basic health care. And so I do deeply believe that this is going to cause blowback. And it’s going to take a couple of years. The next shot we have is the midterms and then two years later the presidency. And that’s coming, there’s no doubt that that’s coming. But it is very challenging to feel this pain so acutely and immediately that we’re feeling at Planned Parenthood, and not have more outrage about it.

Miller: In a press release about the Washington state replacement for Medicaid reimbursement funding, Governor Ferguson said this: “We must step into this temporary gap to ensure women continue to have access to potentially lifesaving care.” Do you see this as a temporary gap? Or the beginning of a long-term federal approach or at least a couple of years version of federal pullback to Planned Parenthood support?

Kennedy: I think it is highly likely that the next budget reconciliation bill a year from now will include defund language as well. And then I’m hopeful that depending on the midterms, that that language would then be blocked. So I think if I were a betting person, I would bet that this is our reality for two years.

And we’re doing everything we can internally to be as efficient as possible, to save money. We’re an incredibly lean organization and we will stay that way. But there is no other funding source available to us if Oregon State doesn’t step in. That is just the reality. And if Oregon decides that they cannot or will not backfill Planned Parenthood the way that Washington state is doing, the way that California has is in conversations about, then we’ll be the only state on the West Coast that sees Planned Parenthood shuttering its doors and abortion access will be in jeopardy.

Miller: Sara Kennedy, thanks so much.

Kennedy: Thank you, Dave.

Miller: Sara Kennedy is the president and CEO of Planned Parenthood Columbia Willamette.

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