When Dr. Jamila Perritt was at a Washington, D.C. clinic recently, she saw a 17-year-old girl come in for testing and birth control bills. Perritt said the teenager was paying out of pocket for everything because she didn’t feel comfortable using her parents’ insurance.
Perritt, who is an American College of Obstetricians and Gynecologists member, said this isn’t the first case of a teenager seeking out STD/STI treatment without parental knowledge. Many teenagers want to ensure their health is kept confidential.
Perritt’s patient wanted to be tested for STDs but also get birth control pills. However, she was unable to afford both options.
Birth control can cost between $20 and $50 a pack or more if paying out of pocket. However, the Planned Parenthood clinic where the young girl came to was able to reduce her 30-day pack of birth control pills to $12. The cost can be significantly higher in other places – some places charge up to $200 while others are tested for free thanks to the Affordable Care Act.
When the woman opted for the pills only, the clinic worked with her and got her screened. They were able to do this through the Title X program funds, which financially assists with family planning and other preventative health services for underinsured and uninsured individuals.
Perritt said patients often go without any care because of cost concerns including low-income people, people of color, young people and people who are uninsured or underinsured. She said these are also the same groups that tend to have higher STD rates such as chlamydia and gonorrhea. The rise in STIs, as seen across the nation, is mainly centered on these populations. She attributes the problem to costs and care access.
Based on information from the Centers for Disease Control and Prevention, the U.S. had over two million new cases of gonorrhea, chlamydia and syphilis in 2017. Over 1.7 million of those cases were for chlamydia, with another 555,608 cases being gonorrhea and more than 30,000 syphilis cases (primary and secondary).
Perritt said it takes a large group of people and effort to ensure that one person gets the care they want and deserve.
If the Trump Administration goes ahead with its Title X changes, clinics like Planned Parenthood will not be able to offer this kind of care at a lower cost.
Title X family planning clinics have an important role in making sure people have access to an array of family planning and preventative care services. The U.S. Department of Health and Human Services, funds are necessary for education, counseling and on-site testing services.
National Association of County and City Health Officials Senior Analyst Rebekah Horowitz said funding for the above services has declined significantly in the last 15 years, leading to a drop in health departments offering STI-related services.
She said it’s putting pressure on people getting insurance so they can get the medical care they need from providers. Horowitz said there is a stigma centered on sexual health issues that make it harder for patients to talk to their doctors. She said any movement that pushes people toward private providers means many will stop seeking out care for the services.
Health departments are the key providers for these services, providing treatment to those who tested positive for STI, as well as their partners and others who engage in risky behavior that can lead to an STI. Horowitz said the process for these partner services includes interviews with the infected people and other people they could have infected and bring them in to be tested, diagnosed and treated if positive.
The New York City Department of Health has eight sex health clinics open to people 12 and older. They can walk in without an appointment and get tested for STIs for little to no money. Immigration status and parent consent are not needed, and the results can be retrieved online.
The Baltimore City Health Department has a clinic and outreach social media program called “Your Health is Your Power” for STI testing and condom use. Posts regularly remind people to get tested for STIs and receive condoms. Patients are eligible for testing services via their insurance be it Medicare, Medicaid or private insurance.
Seattle pediatrician Dr. Cora Breuner said most patients are unaware of their insurance company’s deductibles. And, if the deductible is too high, most understand that the tests are not covered by their company until the deductible is met. A state or federal insurance plan often waives deductibles for testing.
People who are unable to afford the care or can’t see their family doctor often come to Planned Parenthood clinics thanks to their low-cost or free testing services and private results.
New Jersey’s Planned Parenthood Communications Manager Casey Olesko said 56 percent of the Planned Parenthood health centers are a primary health care source, especially those in medically underserved, rural or health professional shortage locations. If there is no Planned Parenthood in these places, people may not have any place to turn to for their healthcare.
New Jersey is also not immune from the rise in STDs and has 17 clinics that provide free testing for HIV, chlamydia and gonorrhea. The state is seeing an increase due in part to former Gov. Chris Christie’s defunding of Planned Parenthood and other preventive health care services. Christie’s vetoes have led to a $50 million loss in family planning services. Six of 58 clinics have closed around the state, with 14 others scaling back their hours.
Back in May, the Trump Administration suggested a domestic gag rule limiting patients’ access to these services and stop abortion providers. If it were implemented, it would keep millions of patients from getting the birth control and STD testing and treatment they needed that Planned Parenthood now provides. Planned Parenthood services 41 percent of Title X patients.
Planned Parenthood Federation of American Senior Director of Medical Services Dr. Gillian Dean said the Trump/Pence administration is making it harder for people to get the care they need that Planned Parenthood has to offer. She said it doesn’t matter where a person lives or who they are; they have the right to get result STD testing, treatment and education in a non-judgmental location.
Perritt said it’s dangerous to have lawmakers decide what kind of health care women can have and who they can see. It’s also disheartening to see them take away programs that are helping people who cannot otherwise afford to pay for these services. The most vulnerable are at risk for having these services taken away by politicians.
Written by Mark Riegel, MD
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