Seattle may be booming, but a major King County agency is shrinking fast. Public Health - Seattle & King County is short $15 million a year, prompting the agency to close clinics and cut anti-tobacco efforts.
But few public health program are getting hit harder than family planning services, and experts say those cuts will cost far more than they savein the long run.
Family planning encompasses birth control, STD testing as well as treatment and screening for breast and cervical cancer. Nurse practitioner Beth Kruse handles all of that for about 800 women a year who use the public health clinic in Seattle’s Columbia City.
Showing off her exam rooms and tiny lab, the offices and drug dispensary, Kruse noted the clinic’s recent remodel.
“We’ve had a lot of changes in this last year,” said Kruse, a tall, thin nurse practitioner with short hair and hip glasses. “And then ending up with the layoff notice was pretty demoralizing for everyone.”
This clinic will shut down in January. A neighborhood health center located in the same building will be able to take some of the clients and will add pediatrics services. But stand-alone family planning services will go away here, as well as at clinics in Auburn and north Seattle. Planned Parenthood is taking over family planning at Public Health’s White Center clinic.
State funding for family planning has dropped by more than 15 percent in the last five years, and another 15 percent cutis possible next year. Federal money has also declined.
About a fourth of the 12,000 or so people who use the program countywide are expected to lose access.
'What’s Going To Happen To All Of Those Women?'
Elizabeth is one of Kruse’s long-time clients. (We’re only using her first name because sexual health is so personal, and because Elizabeth is an undocumented immigrant.)
”I worked before for 12 years in my job, but now I lost my job. I stay only at home,” she said.
That has made money even tighter than usual for Elizabeth’s family, and her immigration status means she can’t get public insurance. Here at Columbia City, she has been able to pay on a sliding scale, and she’s struggling to find another clinic she can afford.
Even with the Affordable Care Act, this clinic serves a lot of uninsured patients. Some are immigrants like Elizabeth, others are the so-called “young invincibles” who often go without coverage but are at high risk for STDs and unintended pregnancies. And health workers say they serve a number of people who have insurance but don’t feel safe using it because the policyholder, perhaps a parent or an abusive partner, would be notified of the charges.
Elizabeth said she is deeply concerned about those other women.
“So now what’s going to happen to all of those women? Where are they going to go? Who’s going to help them?” she asked, speaking through Kruse’s translation because she did not want to be misunderstood.
She added in English: “I’m very, very sad, too. I want to come here for more years.”
Analysis: Every $1 Spent On Family Planning Saves $7 Later
Kruse has been working with women like Elizabeth her whole career. She said she has felt called to this field since childhood.
“When I was just a teenager, I was 15 and my best friend who was 14 got pregnant by accident,” she said. “I started paying attention to where women’s choices and control of their own reproduction has so much to do with societal health.”
The field of public health focuses heavily on prevention, and family planning is a prevention poster child. The services are geared toward avoiding infections, cancers and unplanned pregnancies. An analysis by the think tank Guttmacher Institute finds every public dollar spent on family planning saves taxpayers more than seven dollars later.
Kruse said those costs, expressed by things like rates of sexually transmitted infections, start piling up right away when services disappear.
“What I'm afraid is going to happen here is, five years down the road, the epidemiologists are going to go, ‘Whoa, what happened in 2015?’ Well, duh. We can see right now. We know what’s going to happen,” she said.
'The Evidence Is There ... Yet We Constantly Have To Fight'
Research shows that women who lose access to publicly-funded family planning are at high risk for unintended pregnancies. If the 800 women who use this clinic do not get connected to other providers, more than 200 could have unplanned pregnancies within the next year, according to a Guttmacher Institute analysis.If 3,000 women lose access countywide, as projected, as many as 864 could become pregnant.
Heather Maisen, head of the program for Public Health, said those unplanned pregnancies are not only disruptive to women and families, but also very costly to Medicaid and other public programs. But she said Public Health has run out of short-term fixes to stave off the cuts, and it is exhausting to keep having to make the case.
“The evidence is there: cost-effectiveness to equity and social justice. You can look at it from any angle, this is what makes sense. And yet we constantly have to fight it. So it is very tiring, and frustrating,” she said.
Kruse is frustrated, too. She said these women she works with have no political clout, and that makes it too easy for officials to ignore them.
“Nobody is willing to fund these services,” she said. “Pediatric services are funded, because children are insured. Obstetrical services are funded because people care about pregnant women. It’s like nobody cares about women who aren’t actively engaged in reproducing. It’s really discouraging.”
Public Health – Seattle & King County has managed to soften some of its proposed cuts with help from local governments and nonprofits. But come January, family planning services are still set to take an outsized hit.
