SCOTT DETROW, HOST:
Right now, a network of medical clinics that provide abortion in Maine are staring down deep funding shortfalls because of a new federal law that cuts them out of Medicaid. This is in a state where, according to a recent report from the Pew Research Center, nearly 3 in 4 residents think abortion access should be legal in all or most circumstances. NPR's Selena Simmons-Duffin has this report from Maine.
SELENA SIMMONS-DUFFIN, BYLINE: It was winter 2020 - the first COVID winter - in Oxford, Maine. Ashley Smith got a phone call from an ex-partner.
ASHLEY SMITH: Somebody that I haven't spoken to in a couple of months is like, oh, hey. Hate to reach out and tell you this, but...
SIMMONS-DUFFIN: They'd tested positive for a sexually transmitted infection called chlamydia.
SMITH: I just quickly did a Google search to see who was going to be in the area that I could just schedule an STI test, and that Google search led me to Maine Family Planning in Norway.
SIMMONS-DUFFIN: Which was very close by, and they got her in quickly. Smith works in restaurants as a server. She doesn't have health insurance, so she came ready to pay cash. But the test was free.
SMITH: They made that process so easy and, like, so painless.
SIMMONS-DUFFIN: From then on, that's where Smith went when she needed a doctor. Maine Family Planning has been around a long time - 50 years. They have 18 clinics all over the rural state, so there was still one nearby when she moved. She's gone there for pap smears, breast exams. She once went to get a physical to work at a summer camp.
SMITH: I was like, I know that you guys offer primary care. Can you basically just take my weight and tell them that my blood pressure is OK?
SIMMONS-DUFFIN: She says, most importantly, they diagnosed a chronic condition for her - premenstrual dysphoric disorder. She says getting that treated has improved her quality of life dramatically.
SMITH: It's night and day who I am.
SIMMONS-DUFFIN: Clearly, she is a fan of Maine Family Planning. So much so that the 36-year-old has turned into an advocate. In March, she fought off nerves to testify in the state legislature at a committee hearing.
(SOUNDBITE OF ARCHIVED RECORDING)
SMITH: I'm here because these nonprofit clinics are my only source of health care.
SIMMONS-DUFFIN: The need for advocacy is because of recent actions by the federal government, and because in addition to cancer screenings and STI testing and all the rest, Maine Family Planning provides abortion care. After the Supreme Court overturned Roe v. Wade three years ago, 12 states banned abortion outright and more passed severe restrictions. States like Maine have moved in the other direction - to expand access. Now the Republican-led federal government is moving to restrict abortion access in states where it's legal and protected, using federal funding as its lever.
(SOUNDBITE OF DOOR CREAKING)
VANESSA SHIELDS-HAAS: Hey.
SIMMONS-DUFFIN: Hi.
SHIELDS-HAAS: Come on in.
SIMMONS-DUFFIN: To be specific, Medicaid funding is now unavailable to Maine Family Planning clinics for any services. Vanessa Shields-Haas is the nurse practitioner at the clinic in Thomaston, Maine, a small town along the coast.
SHIELDS-HAAS: This is our larger exam room.
(SOUNDBITE OF DOOR CREAKING)
SHIELDS-HAAS: Here we do most of our yearly wellness visits. We do vulvar biopsies and vasectomies and intrauterine inseminations as well for people...
SIMMONS-DUFFIN: Just like Ashley Smith, who needed a basic physical for her summer camp job, many of her reproductive health patients come in needing primary care too. Seventy percent of Maine Family Planning patients only see them as their doctor.
SHIELDS-HAAS: I can treat your tick bite or your bronchitis. I tell people, if you cut your finger off or you're having a heart attack, I'm going to send you to the emergency room, but there's a lot of - many other things that can be treated here. And because...
SIMMONS-DUFFIN: Clinics like this one were already prohibited from getting Medicaid reimbursement for abortion because of the Hyde Amendment which passed in the 1970s. What's new now is a provision in the One Big Beautiful Bill Act that Congressional Republicans passed this summer, which blocks several health care organizations, including Planned Parenthood and Maine Family Planning, from receiving any Medicaid funding for any services for one year.
SHIELDS-HAAS: So since July 4, since the bill was passed, we haven't been reimbursed for visits for patients who use Medicaid as their insurance. And we've been seeing all of those patients for free. We haven't been turning them away.
SIMMONS-DUFFIN: A lot of her patients do seasonal jobs. Half of Maine Family Planning's patients are on Medicaid.
SHIELDS-HAAS: Maybe they're working at a hotel or they're waiting tables, they're serving lobster rolls to hungry tourists, starting oyster farms. These are entrepreneurs. These are people that are working really hard.
SIMMONS-DUFFIN: Shields-Haas tries to be there for them for whatever they need. She's acutely aware that there aren't enough doctors in this rural state. She calls the new law infuriating.
SHIELDS-HAAS: Unfortunately, decision-makers in Washington are having such a profound impact on what we can and can't do. Not being able to be reimbursed for the visits is - it's really crippling financially.
SIMMONS-DUFFIN: The person tasked with troubleshooting that problem is George Hill, Maine Family Planning's president and CEO. He works about an hour's drive away at the organization's headquarters in Augusta.
GEORGE HILL: I've been in the field since 1987, so close to 40 years.
SIMMONS-DUFFIN: Over those years, many presidential administrations have been hostile to their work, he says.
HILL: This is, by volume and velocity, probably the worst that we have seen.
SIMMONS-DUFFIN: Maine Family Planning filed a lawsuit to challenge the law that blocks them from getting Medicaid funding. In its response to the suit, the federal government said the provision furthers Congress', quote, "goal of reducing abortion," and suggested Maine Family Planning could stop providing abortions to get its funding back. For now, while that lawsuit works its way through the courts, Maine Family Planning cannot receive Medicaid funding. That's $2 million - 20% of their budget - gone.
HILL: That's difficult. You have to make some difficult decisions. Either you generate more money, more revenue, or you cut costs.
SIMMONS-DUFFIN: In the short term, they've had to cut some services. On November 1, Maine Family Planning ended primary care services at three clinics in the far reaches of the state. Staff helped nearly a thousand patients find new doctors. Hill hopes that decision will help preserve the rest of what they do.
HILL: We have a mission, and our mission is to make sure that access to sexual and reproductive health care - the full range of sexual and reproductive health care - is available to as many patients as possible.
SIMMONS-DUFFIN: They also received some additional funding from the state to help fill the gap, and he says they're exploring new ways to raise revenue. He quotes the late Democratic lawmaker Pat Schroeder.
HILL: You can't roll up your sleeves and get to work if you're wringing your hands. We're going to keep doing what we're doing. We're not going to stop.
SIMMONS-DUFFIN: Selena Simmons-Duffin, NPR News, Augusta, Maine.
(SOUNDBITE OF TAY IWAR SONG, "REFLECTION STATION") Transcript provided by NPR, Copyright NPR.
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