When the Trump administration suddenly freezes federal funds to more than 100 family planning clinics this spring, the organization's Michigan branch has already discussed its financial situation in depth.
“The leadership team and our board have been planning for months to try to fill these gaps to see how we continue to provide care,” said Ashlea Phenicie, chief external affairs officer for family planning in Michigan.
The only option is clear. 14 family planning clinics in Michigan serve thousands of women. To save busy clinics in the state, or where women have few other options, the team will have to close multiple clinics, including the only one on the state’s Upper Peninsula, a large, isolated, mostly rural area surrounded by Lake Michigan. On Michigan State’s homepage, Ann Arbor, two clinics in the city will merge.
This is a reality across the country.
At least 20 family planning clinics have been closed or will be closed within one year. Health care organizations have been under pressure from nearly all U.S. providers for decades — low insurance reimbursement rates, low Medicaid expansion rates, rising health care costs provided and forcing hospitals and health clinics across the country to close.
Unique, Family Planning, a nonprofit that serves more than 2 million patients each year, many of whom are uninsured, underinsured or eligible for Medicaid, has also become the first target of sharp funding initiated by the Trump administration.
"What's different this time is that it's more thorough. It's a deeper cut that will affect more clinics and more people," said Farzana Kapadia, professor of epidemiology and population health at the New York University School of Global Public Health.
In March, the Trump administration will fund funding by excluding many family planning clinics from Title X, a federal grant program that provides funding for family planning and reproductive health care. Then, in late May, House Republicans suffered another big blow, voting to end funding for Planned Parenthood as part of the settlement bill.
Federal law has restricted federal funds to be used for abortion unless incest, rape or whether the mother's life is at risk, but passed a law called the Hyde Amendment.
However, if passed, the settlement bill would cut off Medicaid reimbursement to provide any nonprofit that primarily provides family planning or reproductive health care services that can provide abortions that exceed the exception of the HYDE amendment and receive more than $1 million in Medicaid reimbursement in 2024. As a national organization, the program parents are a program parents.
If the bill passes in the Senate, it will prevent family planning clinics from charging for any health care services, including cancer screening, health checks and birth control. It is unclear whether the new legislation applies to family planning nationwide or state-by-state.
More than half of family planning patients are covered by Medicaid and the 2023 publicly funded health plan, with approximately 36% of all Title X services provided by Family Planning Clinic. Eliminating these sources of funding will cut hundreds of millions of dollars a year from family planning care costs. Using federal funds for any type of care at family planning clinics is a way to oppose abortion rights, and even if they provide other care, it can also try to close clinics that offer abortion.
PHENICIE said Republican lawmakers seem to understand that even if the funds cannot cover the program, cutting off the clinic from Title X and Medicaid reimbursement would also make abortion clinics dangerous. Whether the cuts in funding will affect all family planning clinics, whether they provide abortion services or not.
"They know that most of our patient bases are Medicaid or need X Title X to pay for care, and they know that cutting off this will allow them to cut off the chances of abortion and are willing to make the deal," she said.
Before the cuts, family planning was already operating on the thin edge. Now, the clinic is working hard to lose money.
“These numbers are so devastating that there is no other option than closing some centers and consolidating others and then investing in virtual health centers that can serve people across the state,” Phenicie said.
According to the recent KFF Health poll, at least one-third of women said they had gone to a family planning clinic for care and one-tenth of men. Polls found that nearly half of black women went to a family planning clinic.
According to the 2024 annual report, abortion is the main reason why the Trump administration ends its support for clinics, accounting for only 4% of services provided by family planning services.
The vast majority of family planning services involve women’s basic health care, including the diagnosis and treatment of urinary tract and yeast infections and screening for cervical and breast cancer. Some locations provide vaccination for HPV, hepatitis B, Covid and flu vaccines.
More than half of the care is associated with testing for sexually transmitted infections and treatment. Another 25% are offering access to contraceptives, usually low-cost or no-payment methods. The report shows that cancer screening and other non-abortion services account for 18%.
These important medical services are not waving the clinic's opponents.
January, R-Ky. Senator Rand Paul has introduced a bill that attempts to ban family planning in the same way as the federal settlement bill. The bill is called the Appropriations Family Planning Act.
"My commitment to protecting life is not only derived from science and principles. Life begins with conception, and I spend a lot of time in the Senate struggle to protect the right to life," Paul said in a press release.
About 40% of family planning funds come from government health care reimbursements and grants. Many locations offer sliding scale payment options for those who can’t afford healthcare. Part of the money comes from the government's plans that are now being cut.
"The cuts are actually to reduce care opportunities for people without insurers or underinvested, and cannot provide tax breaks for those who are able to afford health care," said Capadia of NYU.
Wendy Stark, president and CEO of Planned Parenthood in Greater New York, said that even if patients have private insurance, “the reimbursement rate cannot meet primary care costs.
“The U.S. health care system pays a small amount of health care funding to primary and preventive care,” Stark said. “We sit in the miniature version of it.”
Earlier this year, Planned Parenthood announced that it would sell the buildings in its only Manhattan location. Family planning locations are also closed in states throughout the Midwest and other countries that voted for abortion rights, including Vermont.
In late May, Family Planning announced that it would close four Minnesota clinics within one year. In Dobbs' decision overturned Roev. After Wade, the state was the first to break down abortion rights into legal rights, but only one closing clinic had an abortion.
Four of the six family planning clinics in Iowa will be closed, including one in Ames, where Iowa State University is located. Three Illinois clinics, without any abortion clinics, ceased operations in March. In April, three locations in Michigan were closed, two were merged, and the right to abortion was incorporated into state law. Two locations in Utah closed in May after losing a lot of money in May due to Title X freezing.
“Even with insurance, we’re subsidizing almost every visit we do,” Stark said. “We also have a lot of patients who don’t have insurance.”
The decision to sell the Manhattan clinic was a strategic but difficult decision, she said. The revenue from the sale can help make other clinics operate in the state. Both patients and staff at the Manhattan Clinic can be absorbed by other New York City in family planning, which can minimize the impact of closures.
“When we merge at certain locations, we look at the entire area. We can take patients to the next nearest health center, and are there other clinics that can send patients to?” Stark said, adding that this is even more difficult in rural areas that already have very low health care options.
“If we face further erosion of our financial situation, we will have to make harder decisions,” she said.
Several state-level laws prohibiting family planning, and received Title X funds in the decade before sweeping the federal exclusion case.
Robin Marty, executive director of WAWC Healthcare in Tuscaloosa, formerly the Women’s Center in West Alabama, said the states could provide health care in states with recently facing closed plans for parenting.
“If there is no family planning, we will be a lesson in bringing our resources.”
Family Planning operates only one brick-and-mortar clinic in Alabama, Birmingham, but offers telemedicine throughout the state. There are only two in Louisiana, one in Panhandle, Florida.
Mississippi has no physical clinic, which has the highest teen birth rate in the country. Alabama and Louisiana are in the top seven, according to the Centers for Disease Control and Prevention Data. Mississippi also has the highest mortality rate. Louisiana ranked second. Alabama ranks fourth.
“People don’t have a place to get free birth control, sexually transmitted infection screening or maternal care,” she said.
WAWC Healthcare is one of the only providers in Alabama, operated by a state or county outside of a federally qualified health care center. Although the clinic does accept Medicaid, the clinic has relied heavily on non-government grants without obtaining the title, Marty said.
“Every time I apply for a grant, I know I only have about 10% chance of getting it, but I do it anyway because that’s the only way my patients can get cared for,” she said. In addition to the grant, “we rely on donations about $50 each time the donors they contact.”
Marty said other clinics that offer the same services as family planning, which already operate on razor thin margins, will be further exacerbated by the closure, if not losses. The strain will be delivered to the patient.
“You’re talking about people living at or below poverty levels, who can’t afford health care on their own, and then you’re eliminating their primary source of health care,” Capadia said.
GOP Megabill blocks family planning wages, awaiting the fate of the Senate this week, among other Medicaid cuts. Currently, Title X funds are frozen in family planning in 20 states.
According to family planning, if the "big bill" passes, another of about 600 family planning will be in danger.
Phenicie said when Title X funding cut off Michigan’s family planning between 2019 and 2021, the number of people seeking preventive care at their locations fell 75%.
She added that while other medical centers can use Title X funds to pay for access, they cannot absorb what patients cannot see in family planning.
A month before the closure of this year, Planned Parenthood Michigan kept the open plan of four closed clinics to honor all dates that have been completed and spent hours trying to help patients with telehealth in other clinics or through telehealth with family planning.
"Even if they want to continue care, their options will be limited if they can't be covered by Title X and cannot use Medicaid," Phenicie said.