Sitting outside the Iowa Capitol, Chelsea Chism-Vargas recalled the moment in 2017 when she found out state lawmakers were trying to cut off her access to Planned Parenthood.
“I felt my shoulders go back and kind of a gasp like, ‘Oh my gosh, this is my program.’”
For years, Chism-Vargas was getting free birth control pills and annual reproductive health exams at Planned Parenthood through a federally-funded family planning program for low-income and underinsured Iowans.
“I really, really appreciated the program,” Chism-Vargas said. “It was amazing to not have to worry about finances that come with things that are really just there to protect me and make sure I have a healthy future.”
But Iowa’s Republican-majority Legislature replaced that program with a state-run system that excludes abortion providers. It blocked Planned Parenthood, UnityPoint Health and University of Iowa Hospitals and Clinics from participating.
That started on July 1, 2017. Since then, Iowa Department of Human Services (DHS) data show a significant decline in services provided through the program.
In the first three months of 2017, the original program that included Planned Parenthood and all hospital systems provided 3,185 reproductive health services. In the same time period in 2018, the new program provided 1,125 services.
“I think there’s a real concern about access,” said Jodi Tomlonovic, executive director of the Family Planning Council of Iowa.
She said this could result in more unintended pregnancies, worse birth outcomes, and more abortions.
“We could see a rise in STD rates because part of this program is to provide STD testing and treatment,” Tomlonovic said.
The number of people signed up for the family planning program is also shrinking. It went from 8,207 people in July 2017, to less than half that (3,996) one year into the new program. DHS spokesman Matt Highland said that’s in line with enrollment declines seen since the Affordable Care Act expanded access to health insurance.
But Chism-Vargas said she dropped out of the program because she didn’t want to be forced to find a new doctor. Unsure about alternative clinics, and knowing that she wouldn’t be able to get free birth control pills at Planned Parenthood anymore, she got an implant in her arm at the last minute.
“Switching to the implant didn’t seem like it was my choice,” Chism-Vargas said. “It seemed like it was a decision—well, it was a decision that my legislators felt that they could make for me.”
She said that’s what she thought about during the procedure.
“I just remember kind of lying there in one of the exam rooms at my Planned Parenthood, and just feeling pissed. And feeling defeated, really, because I had put a lot of effort to do my part to make sure that the defunding didn’t happen,” Chism-Vargas said.
When lawmakers first saw signs of declining program participation in January, DHS Director Jerry Foxhoven said his agency may have been “at fault” for patients not knowing where to go for services. DHS sent a letter to patients when the program changed, but Foxhoven later told lawmakers the agency may also have to conduct a public information campaign.
DHS declined to make officials available for an interview for this story. But IPR caught up with Foxhoven in July and asked if he ever launched a public information campaign to make sure patients know about alternative providers.
“We’re waiting with that because the legislature added some changes that will add more providers,” Foxhoven said.
Lawmakers decided in May to allow some UnityPoint Health locations to re-join the Family Planning Program.
“There’s been some public information. Not to the extent that we’d ultimately want to do,” Foxhoven said. “We’re hoping that just adding more providers is going to do a lot of it on itself. Is going to increase it.”
A UnityPoint Health vice president said in an email she does not know how many providers can re-join the program. But she said women’s health clinics in Waterloo and Muscatine will be eligible once the state approves administrative rules.
Tomlonovic of the Family Planning Council of Iowa said to increase participation, the state should let all provider groups back into the program.
“I think that it would be great if the department did more to work with providers in how the program works and how they can help their clients utilize their program,” Tomlonovic said. “And then more outreach in terms of helping potential clients know about the program.”
Tomlonovic has also been asking DHS to release more data from the new Family Planning Program. She was part of a work group that decided what data DHS should track to properly monitor the new program. But the department never publicly released any data from the program, except when reporters submitted requests under the Iowa open records law.
“I’m not sure why the department chose not to release that report,” Tomlonovic said. “I can only guess that perhaps it’s because the report did show that the program wasn’t working very well.”
“There is no legislative requirement for the Department to provide a report,” said DHS spokesman Matt Highland.
Without being able to use Family Planning Program benefits at Planned Parenthood, Chelsea Chism-Vargas was priced out of her local clinic. She had to switch to the county hospital for reproductive health services.
“I knew I couldn’t just sit back and let anything like this happen again in our state,” said Chism-Vargas, who is now working as an organizer for NARAL Pro-Choice America. “So that really motivated me to just get more involved. It was just more fuel for the fight to stay involved.”