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Emergency money to block the spread of the Zika virus won’t be coming any time real soon. A $1.1 billion funding measure failed to win enough support for an up or down vote in the Senate.
The major stumbling point wasn’t the money (though Democrats wanted additional funding). Rather, it was the strings that were attached to the measure as it relates to combatting the virus in Puerto Rico.
After the House passed the bill on a largely party line vote, Sen. Bill Nelson, D-Fla., berated it.
""The House Zika bill is a disaster," Nelson said June 24, 2016. "Not only does it take $500 million in health care funding away from Puerto Rico, it limits access to birth control services needed to help curb the spread of the virus and prevent terrible birth defects. This is not a serious solution."
We wondered about Nelson’s claim that the House Zika bill "limits access to birth control services needed to help curb the spread of the virus," in Puerto Rico.
What the bill said
The conference report (the bill that emerged from negotiations between top Senate and House Republicans) included two pots of money of particular importance for Puerto Rico. There was $80 million through the Social Services Block Grant program, and $40 million for community health centers. By and large, these dollars were targeted toward Puerto Rico, where the Zika virus has been transmitted widely by mosquitoes.
The words that limited how this money could be spent applied to the block grant program. Those dollars were "for health services provided by public health departments, hospitals, or reimbursed through public health plans."
Helen Hare, spokeswoman for the Democrats on the Senate Health, Education, Labor and Pensions Committee, told us this language cut out Profamilias, the Puerto Rican branch of Planned Parenthood.
"They are a key provider of women’s health care in Puerto Rico, and women would not be able to get the kind of care they need to protect themselves," Hare told us.
This is about more than abortion services, Democrats say.
Zika can be transmitted through sex. The Centers for Disease Control and Prevention says, "Condoms can reduce the chance of getting Zika from sex if used correctly from start to finish." Hare said Profamilias served 8,000 people in 2015.
Republicans counter that the bill would have funded many health clinics and women would not be denied care. Jennifer Hing, spokeswoman for Republicans on the House Appropriations Committee, told us that even though Profamilias would be ineligible, the money could go to clinics across the island.
There’s no debate that the limits applied to Profamilias. So the central question is, would that restriction make much of a difference?
There are two ways to sort this out. You can look at where clinics are located and you can look at if they serve different types of women.
Mapping health care
Many Puerto Ricans live in rural areas and struggle to get by on very modest incomes. Martin Kramer with the Health and Human Services Department’s Health Resources and Services Administration told us that the island territory has 20 community health centers operating at 84 sites. HHS sent them $5 million in April to fight Zika.
"That money was for contraceptive services, community education and to hire new staff," Kramer said.
Thanks to the Primary Care Association of Puerto Rico, there’s a map of where those clinics are.
According to HHS, that network provides contraceptive services to more than 16,600 women each year.
The map shows the municipal boundaries that serve as Puerto Rico’s counties. We went to the HHS Data Portal and a list of clinics in the public health insurance plan to add in hospitals and public health clinics. Out of a bit under 20 municipalities not served by the community health clinics, we found about eight that lacked any facility that we could identify.
What’s important to note is that everywhere Profamilias lists a clinic -- Arecibo, Caguas, Carolina, Isabela, Moca, Ponce and San Juan -- has another type of facility that would have been eligible for additional funding to combat the spread of Zika.
One expert we spoke with said that while Puerto Ricans may have had access to another clinic, Profamilias serves a specific type of client.
"The Planned Parenthood-style clinic tends to serve very young, very poor women," said Peter Shin, an associate professor in public health at George Washington University. Shin has studied health services in Puerto Rico.
"It takes a different set of tactics to reach the teenage or young adult women," Shin said.
Shin said these clinics generally do better at connecting with women who are more at risk at having unprotected sex. In addition, because poverty and Zika often go hand in hand, these women are more at risk because they are poor.
Nelson, along with many other Democrats, said the Zika funding bill would limit access to family planning and contraceptives that would help stop the spread of the Zika virus. The legislation would have blocked the flow of money to one organization, Profamilias, the Planned Parenthood chapter in Puerto Rico.
However, the bill also provided funds that would potentially help clinics and hospitals in nearly every municipality on the island. There would be some pockets without services, but it is unclear that Profamilias would be positioned to fill those gaps. At the same time, Profamilias serves women who might be more at risk of infection because they tend to be young and poor.
The statement is partially accurate but leaves out important details. We rate this claim Half True.
Bill Nelson, emailed statement, June 24, 2016
Congress.gov, House report 114-640, June 22, 2016
Centers for Disease Control and Prevention, http://www.cdc.gov/zika/transmission/sexual-transmission.html
Health Resources and Services Administration, Data portal
Peter Shin, et. al, Puerto Rico’s Community Health Centers in a Time of Crisis, George Washington University Milken Institute School of Public Health, Dec. 14, 2015
Primary Care Association - Puerto Rico, Primary health centers map, accessed June 27, 2016
Health and Human Services Department, HHS awards $5 million to Puerto Rico health centers to fight the spread of Zika virus, April 26, 2016
Clinica Preven, Servicios, accessed June 28, 2016
Interview, Martin Kramer, director, Office of Communications, Health Resources and Services Administration, June 28, 2016
Email interview, Matt Dennis, communications director, Minority Staff, House Appropriations Committee, June 24, 2016
Email interview, Jennifer Hing, communications director, Majority Staff, House Appropriations Committee, June 28, 2016
Email interview, Ryan Brown, spokesman, Office of Sen. Bill Nelson, June 23, 2016
Interview, Peter Shin, associate professor, Department of Health Policy, Milken Institute School of Public Health, George Washington University, June 28, 2016
Interview, Helen Hare, press secretary, Minority Staff, Senate Budget Committee, June 28, 2016
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