'A concerted effort': Decades of antipathy fueled Missouri Planned Parenthood fight

Jonathan Shorman and Jeanne Kuang
Kansas City Star

Jefferson City, Mo. — As the Missouri House prepared Wednesday to advance a bill blocking Planned Parenthood from treating patients who receive Medicaid, Rep. Mary Elizabeth Coleman summed up her support for the measure by repeating a line she had heard from an anti-abortion lobbyist.

Planned Parenthood, "they kill babies," the Arnold Republican said.

The push by anti-abortion legislators to prohibit Planned Parenthood from receiving public dollars led to rancorous debates in the General Assembly over the past week as legislators met in a special session to renew a tax critical to funding Medicaid.

Planned Parenthood operates the state's sole abortion clinic, in St. Louis. A network of other clinics offer cancer screenings, sexually transmitted infection testing and other reproductive health services. While abortion isn't covered by Medicaid, some of Planned Parenthood's non-abortion services are reimbursed by the health program.

At the Planned Parenthood clinic in St. Louis, anti-abortion protesters stand in front of the clinic on May 30, 2019. Restrictions on abortion in Missouri and other neighboring states has made Kansas a regional spot for women seeking to end their pregnancies.

The General Assembly adjourned Thursday without passing legislation limiting Planned Parenthood. But the Republican drive against the group is rooted in a deep, long-running antipathy that will continue well into the future.

National efforts against the organization date back decades, to the years after Roe v. Wade legalized abortion across the country in 1973. In Missouri, lawmakers have been trying to marginalize the provider for more than 20 years.

"There has been a concerted effort over a number of years to prevent Planned Parenthood from participating in the Medicaid program," said Mandy Culbertson, director of communications and marketing at Planned Parenthood Great Plains.

On Wednesday, the House voted 109-45 to bar abortion providers and their affiliates from receiving public funds, a measure that in practical terms would affect only Planned Parenthood. Since public funds are already prohibited from going toward abortion, any additional bans would affect Planned Parenthood's ability to receive reimbursements for other services it provides.

The Senate adjourned without approving the measure, killing it, but GOP leaders promised a committee to study the issue in the months ahead. Several lawmakers also expect Gov. Mike Parson, a staunch abortion opponent, to limit payments to Planned Parenthood through his executive authority. Barring that, the proposal is also almost certain to be resurrected in 2022.

The continued reliance of residents on Planned Parenthood for health care "has clearly remained a point of frustration for the Legislature," Culbertson said. In 2018 and 2019, Planned Parenthood of the St. Louis Region and Southwest Missouri treated more than 29,000 patients, according to its annual report.

Culbertson added that the legislature "has shown that it is willing to sacrifice STI testing and cancer screenings to spread misinformation — calling birth control abortion — instead of having a thoughtful conversation about the services Planned Parenthood provides."

Years of fights over funding

The latest offensive comes after abortion opponents suffered a series of defeats in their attempts to take on Planned Parenthood in recent years. Legislators have regrouped and are taking another run at weakening the organization.

This time, Republicans are raising concerns that under Democratic President Joe Biden, a long-standing in federal ban on tax dollars funding abortions could expire. But recent history makes clear legislators have cited a variety of justifications for taking on Planned Parenthood, though all of them ultimately come back in some shape or form to the fact it provides abortions.

"Vitally important we have it in statute both for a legal perspective for future court cases that may ensue, and also just to show on the record, what we've been doing in many ways before in the past ... to be able to stand and show that as Missouri we are strong supporters that there's no public tax dollars to go toward abortion or abortion providers," said Rep. Sara Walsh, an Ashland Republican who is considering a run for Congress.

Susan Klein, executive director of Missouri Right to Life, said "every pro-life bill gets challenged" in court.

"But you've stood there before," she said, addressing lawmakers during a hearing, "and you've fought the fight to make sure that unborn babies are not killed with our tax dollars and now we're asking you to do it again."

The General Assembly went as far as holding a special session in 1997 that included a focus on family planning services. In lawsuits more than 20 years ago, abortion rights opponents and supporters battled over whether lawmakers could restrict family planning funding from Planned Parenthood.

In the late 90s, lawmakers began withholding family planning funds from Planned Parenthood. The Star that year called the fight "among the most divisive issues" in the legislature. Over the next several years, Planned Parenthood and its opponents fought in the courts over the funding.

"The Missouri legislature has had it in for Planned Parenthood since the late 1990s," said Elizabeth Nash, interim associate director of state issues at the Guttmacher Institute, an organization supportive of abortion rights.

For a time, abortion faded as a dominant obsession of legislators. In 2013, Phill Brooks, considered the dean of the Missouri Capitol press corps, observed in a column that one of the major changes to the General Assembly in recent years had been the cooling of abortion politics.

But that focus quickly reemerged.

The General Assembly approved a 72-hour waiting period for abortions in 2014 over Nixon's veto. For women seeking abortions in Missouri, the waiting period meant spending three days in St. Louis near the state's only abortion clinic or traveling back and forth — barriers that might discourage women from getting the procedure or prompt them to seek it in another state.

In 2015, videos alleging Planned Parenthood mishandled fetal tissue spurred calls for investigations in multiple states. Missouri Attorney General Chris Koster found no evidence of improper behavior at the St. Louis clinic. Planned Parenthood was later awarded $2 million in a federal lawsuit over the videos.

In 2016, lawmakers cut Planned Parenthood out of the Uninsured Women's Health Program, an extension of family planning services to low-income women who don't qualify for Medicaid. To do so, Missouri gave up the program's federal aid, which covered 90% of its costs. The state spends more than $6 million a year on it.

Parson then signed into law a near-total ban on abortions in 2019. A federal court has stopped the measure from going into effect while legal challenges are underway. Abortion opponents are hopeful a U.S. Supreme Court decision expected next year could pave the way for the law's enforcement.

Even if the ban, which criminalizes abortions after eight weeks of pregnancy, never goes into effect, the number of abortions in Missouri has fallen precipitously in recent years. In 2015, 4,765 were performed. In 2019, the number was 1,471. Last year, just 46 abortions were performed at the Planned Parenthood St. Louis clinic, according to the Department of Health and Senior Services.

In 2018, Missouri began withholding Medicaid payments from Planned Parenthood after the General Assembly included provisions in the state budget stopping the organization from receiving them. Planned Parenthood sued, setting off a legal battle that culminated in a June 2020 decision by the Missouri Supreme Court that the budget bans were unconstitutional.

The General Assembly's actions were a "naked attempt" to legislate through the budget bill, the court said. By tethering the issue to renewal of the FRA tax instead, anti-abortion legislators were trying to maneuver around the court's objection.

"Now when you look at the Missouri Supreme Court, we were not able to make policy by way of the appropriations bill," said Rep. Nick Schroer, an O'Fallon Republican, on Tuesday. "That's why we're here today, to figure out what you cannot do within the appropriations process, we're here to do in statute."

'Political theater'

Schroer said lawmakers were answering "the promise that we made to Missouri taxpayers to defund Planned Parenthood."

Democrats on Wednesday accused the bill's proponents of wasting legislative time to target the organization for political purposes.

"All it was was a political move," House Minority Leader Crystal Quade, a Springfield Democrat, told reporters. "We're going to see Republicans primary each other left and right, and what you saw today on House Bill 2 was simply talking points for folks to cut commercials."

Republicans on the House floor pushed back on accusations of "political theater."

"This is not political theater," Schroer said. "I ran on this issue. This is my number one issue."

Over the past two years, Missouri and Planned Parenthood have also battled over the abortion license awarded to its St. Louis clinic. Parson's administration revoked the license in 2019 after inspectors reviewed medical records and were able to find patients with complicated abortions by creating a spreadsheet that included the fetus' gestational age and the last normal date of Planned Parenthood patient's periods.

In May 2020, an administrative hearing commissioner ruled the license was wrongfully denied. The Parson administration reissued the license for one year. The Department of Health and Senior Services confirmed Tuesday it had renewed the license for another year, until June 2022.

Still, Parson suggested Thursday his administration may once again scrutinize the license.

"We know before in the licensing process, that was a problem. They weren't running a safe clinic. So we're going to look at that," Parson said. "If you're running by the laws and you're meeting all the requirements, then we're not going to shut anybody down just cause we want to shut somebody down."