Gov. Chris Christie's veto of nearly $7.5 million in state funding for 58 family-planning centers has become the centerpiece of debate on the final impact, as a legislative effort to overturn the veto has died.
Christie originally eliminated the funding – without prior announcement – from the state budget in March. Three months later, Assemblywoman Linda Stender (D-Fanwood) sponsored a bill that would have restored the money to the centers.
Christie defended his decision as another in a long line of necessary budget cuts. "I don't believe it's an appropriate expenditure of money," he said June 23, during his monthly call-in radio show on New Jersey 101.5 FM. "That's my opinion."
On July 23, he vetoed the bill that would have restored the family-planning funds, leaving officials from local chapters of Planned Parenthood to join federal officials, health policy experts and local doctors in wondering how New Jersey's low-income residents – including those in Westfield – will be able to afford breast and cervical cancer screenings, gynecological exams, HIV tests, contraception and other health services.
"With the stroke of a pen, Christie denied thousands of women access to birth control and healthcare," Stender says. She and others accuse Christie, who ran as a conservative, anti-abortion Republican, of allowing his ideological views to interfere with sensible public health policy.
"There's more going on here than funding," says Triste Brooks, CEO of Planned Parenthood of Greater Northern New Jersey, which operates 10 health centers in seven counties, including two in Union County. "It's his opinion, he said. What experience as a prosecutor gives him the background in women's healthcare to make that decision? I'm not going to pretend to know where his view is coming from. But it's not fiscal."
In the days following the veto, Stender held slim hopes that she could collect enough votes for a veto override. Last week, however, three Republican assemblymen and six Republican state senators who had originally voted for the measure said they would not support an override. The senators attributed their change of heart to economic, not ideological, factors.
"We will vote to support maintaining a balanced budget," the senators said in a joint statement issued last Tuesday.
Members of the governor's media-relations office now claim that the issue is dead, and say that the governor "will not be commenting on this issue." When asked during the June 23 radio show whether he would ever restore family-planning funds, Christie was unequivocal: "No."
Brooks argues that the cuts will cost the state much more than the $7.5 million that Christie contends is being saved. She points out that the federal government matches 50 to 76 percent of states' funding for Medicaid programs in general healthcare outside of family planning – and that the federal government pays 90 cents of every dollar the state would otherwise spend on family-planning services for Medicaid recipients. She adds that 136,000 women and men received state assistance for family-planning services in 2009. Based on that number, Brooks and federal healthcare authorities estimate that the lost funding means that 40,000 patients will lose access to services this year.
"We will have an increase in patients seeking OB services," says Rudine Smith, CEO of the Neighborhood Health Services Corporation, which operates the Plainfield clinic. "It may cause money to be used more rapidly." She says she couldn't yet estimate how much it will cost to take on the new patients.
Michele Jaker, executive director of the Planned Parenthood Affiliates of New Jersey, says that of the $7.5 million that New Jersey allocated for family-planning services for Medicaid and non-Medicaid patients in last year's budget, the federal match helped the state recover about $1.8 million of the roughly $2 million spent on Medicaid patients. The remaining $5.5 million was divided evenly as grants to the state's 58 family-planning clinics, where uninsured patients who did not qualify for Medicaid could be treated. Unless state funding is restored, New Jersey will lose all matching federal money.
"They couldn't find even a million dollars?" Brooks says. "They killed a 90 percent match of Medicaid funding."
State and federal dollars could not be used for abortions, Brooks and Jaker say. That ban included the so-called "abortion pill," which medically terminates a pregnancy within the first trimester.
Instead, the funds paid for routine gynecological exams, pregnancy tests, blood pressure screenings, anemia and diabetes screenings, contraception, breast and cervical cancer screenings, tests and treatment for sexually transmitted infections, HIV testing and sexual education programs.
Christie, however, asserts that the family-planning cuts will not reduce access to women's healthcare services. "Family planning has nothing to do with mammograms," he said during the June 23 radio show, interrupting host Eric Scott mid-question. "Don't put the two of them together. They don't have anything to do with each other."
Wendy Chavkin, a professor at the Mailman School of Public Health at Columbia University, vehemently disagrees. "Family planning is a key component of women's healthcare," she says. "To state otherwise is to fly in the face of all medical and public health expertise."
As she explains: "Health does not fall into ready compartments. Health is a spectrum…. To silo out the piece that has to do with women's sexual and reproductive health…implies that it is separable from all other aspects of health. That is not the case, behaviorally or physiologically."
Moreover, of the 58 family-planning clinics that had received state funding, all of them provided mammograms on-site or referrals for free or low-cost mammograms. But Brooks now says that she and other clinic directors are facing the stark reality that, to make ends meet, they will have to layoff staff, reduce their clinics' hours or close healthcare centers entirely. "Nothing is off the table," she says.
The Cut and Veto, and Westfield Residents
The Plainfield Planned Parenthood clinic on Park Avenue is the closest to Westfield, a two-story, brick and metal structure roughly two miles away. Center supervisor Dorothy Barr says that roughly eight patients visit weekly from nearby suburban communities.
A "vast majority" of those who visit are black and Hispanic, between the ages of 20 and 30, Jaker says. But patients range from older adults who cannot afford the cost of a regular doctor's visit, to teenagers who are seeking low-cost contraception or are too nervous to visit their own doctors.
In addition to the healthcare services listed above, the Plainfield center offers emergency contraception (the morning-after pill), HPV and hepatitis vaccines, men's health services (hernia and sexually transmitted infection screenings), HIV testing and counseling and lesbian-gay-bisexual-transgender counseling. Patients receive free confidential consultations with a counselor before they are examined by a nurse or doctor. The center also includes a separate educational facility, which patients must generally visit to receive free contraception devices.
Christie maintained in the June 23 radio show that the family-planning cut and veto would not limit women's access to low-cost medical care. "No woman is not going to get healthcare because of this," he said.
If the Plainfield facility does close, however, the next closest low-cost or free health clinic is the Plainfield Health Center, a federally funded clinic that is part of the federally qualified health center (FQHC) network. When Muhlenberg Hospital closed in August 2008, the Plainfield clinic became one of only a few health centers in the region to offer OB/GYN and sexual-health services. It is already overburdened: Smith, CEO of the Neighborhood Health Services Corporation, says that patients face waits of least two weeks before they see a doctor, unless they say they are pregnant.
"You can't wait for weeks, especially with young people," Brooks says. "Does he think people are just going to stop having sex?"
The veto also undercuts the "family-cap" welfare policy that New Jersey instituted in 1992, says Diana Romero, an associate professor of urban public health at Hunter College, and a widely regarded expert on states' family cap policies. According to the policy, signed into law by Gov. James Florio, women receiving Medicare, Medicaid or other cash assistance cannot receive any additional aid for more than one child.
"Publicly funded family planning allowed these women to choose when they wanted to have a child and, frankly, allowed them to comply with welfare regulations," Romero says. But with the veto, "On the one hand, we're telling them, 'If you're poor and get cash assistance from the state, you can't have more than one child.' The insult is that the already-limited resources that the poor had to control their fertility will now be reduced or eliminated."
Costs vs. Consequences
Brooks, Stender and other opponents argue that the governor's veto will ultimately have grave consequences for New Jersey. They assert that reduced access to free contraception, sexual education and counseling services will cause the number of sexually transmitted diseases to rise and go untreated, but they're most fearful that it will trigger a spike in unwanted pregnancies, driving more women from schools and from the workforce – or worse.
"Abortions are going to go up," Brooks says, "which I think everyone's trying to prevent."
They also argue that reduced access to gynecological exams and breast and cervical cancer screenings will result in costlier crisis and emergency treatment for women.
"It defies fiscal responsibility," Stender says. "It will cost the state in lost federal dollars, and it will cost the state another $40 million in Medicaid for people who end up in emergency rooms instead of receiving preventative care."
Before the July 23 veto, the funding bill's sponsors offered a compromise: facilities that offered abortion services – even though those services are not paid for by public dollars – would be wholly ineligible for state and federal funds. Christie, however, declined the deal.
Veto Override in Doubt
The week after Christie's veto, Stender said that she would seek an override. Initially, it seemed she could succeed: the bill passed with sufficient support for an override in the Senate, and it would need 11 votes for an override in the Assembly – a large, but not impossible, number to achieve. When it passed in June, it did so with 13 abstentions, including Assemblymembers Jon Bramnick (R-Westfield) and Nancy Munoz (R-Summit).
Late last Monday, however, three Republican assemblymen who had originally voted for the bill said they would not support an override, according to a report on NJ.com, the website for The Star-Ledger. The following day, six state senators also said they would not support an override.
Stender flatly rejected the legislators' fiscal justifications for the cuts. "I think it is conservative-right-wing-speak that women can't have access to birth control, that they cannot have control of their reproductive health," she says. "It is the governor showing his true colors on where he stands on women's rights."