People who testified at a legislative hearing Monday on a budget provision that would prioritize which clinics get federal family planning funds disagreed on whether the provision added by Gov. Pete Ricketts was needed.
They also disagreed about its effect on Title X providers, depending on how it's interpreted, and whether patients would continue to have access to care.
Planned Parenthood of the Heartland became the focus of much of the testimony, as did an audit by the Nebraska State Auditor's office, which was brought up by Bo Botelho, chief operating officer for the Department of Health and Human Services.
The provision in the budget bill (LB944) would allow the state to prioritize federal family planning funding for clinics that do not provide or refer for abortions.
Ricketts put the provision, which is similar to language included last year in the 2017-19 budget, in for a second time, saying Nebraska is a pro-life state, and the state’s budget should reflect those values.
Action by Congress last year allowed Nebraska to take new steps to protect unborn life by ensuring that Title X dollars are not used to fund abortions, he said.
Health clinics, including Planned Parenthood, are prohibited from using federal funds to perform abortions. But abortion opponents have argued that any Title X money given to Planned Parenthood frees up other money that can be used for abortions.
With the Ricketts provision, health providers that receive Title X funding for services such as breast exams, contraception, treatment of sexually transmitted diseases and cancer screening would be required to show a legal, physical and financial separation from any abortion services, including referrals or counseling, that they provide.
Botelho said a state audit showed abortion services were mixed into Title X funding, but he didn't have a lot of answers to senators' questions about it.
The audit was for fiscal year 2014-15 and he said HHS did not have adequate monitoring procedures to ensure payments were for allowable services.
Monthly expense reports were reviewed, the audit showed, but invoices and supporting documentation were not required.
Planned Parenthood of the Heartland had abortion-related services charged to its grant.
Julie Reno, former manager of Title X programs for HHS who retired in December, said the Title X program was audited three years in a row, and the main focus was Planned Parenthood.
Many of the audit findings on use of Title X funds for abortion services were financial coding mistakes, she said.
Appropriations Committee member John Kuehn said Reno was illustrating the very problem that prompted the need for the Ricketts provision, to ensure funding for family planning services is separated from abortion services.
"When we have organizations that there is not a clear delineation within the organization of how the funds are used, we open ourselves up to these potential mistakes. And these mistakes are costly," Kuehn said.
No one wants to restrict access or eliminate a provider, he said. The provision would ensure absolute separation, clarity and integrity of the programs. He said he was incensed by what the audits showed and how it jeopardizes the entire Title X program in Nebraska.
"These agencies all do wonderful work," Reno said. "The federal government has never had a problem (with the use of Title X funding by clinics). The problem has been here, because it's been a constant witch hunt against birth control and family planning.
"If you're worried about women being able to receive (sexually transmitted infection) treatment, if you're concerned about children in poverty, if you care about Nebraska women suffering from cancer, if you'd like to see fewer children in foster care, you must be against LB944," Reno said.
Last year, the Legislature removed Ricketts' Title X provision, with the recommendation that senators study it over the interim and bring it back as a policy issue rather than a budget issue.
When Ricketts announced he would bring it back, Planned Parenthood of the Heartland attorney and public affairs manager Meg Mikolajczyk responded that his action was a direct attack on the organization and part of an extreme agenda to dismantle reproductive health care access. It could mean 8,000 Nebraskans would lose access to the health care they receive at Planned Parenthood, she said.
The attacks on Title X and Planned Parenthood were politically motivated and medically ignorant, she said.
Jeff Tracy, director of the Community Action Health Center in Gering, testified that, as drafted, the budget provision would put all Title X clinics at risk, including those that serve low-income women in rural communities.
Nebraska's health centers serve nearly 85,000 patients annually, he said. They are safety-net clinics that provide care regardless of insurance status.
"With many miles separating Title X providers in rural Nebraska, elimination of even one provider would severely limit access to reproductive health care," Tracy said.