Indiana officials contend the state's Planned Parenthood chapter could end a fierce legal dispute over abortion funding by simply separating its abortion business from other services.
But advocates for the organization view the idea as a red herring pushed by critics seeking to entirely defund the country's largest abortion provider. Their skepticism is fueled by experiences from Planned Parenthood chapters in two other states where non-abortion services were targeted even after such a split.
"They want to put providers of safe abortion care out of business, and they will do so however they can," said Ken Lembrecht, president and CEO of Planned Parenthood of North Texas.
The two sides will make arguments Thursday to the 7th U.S. Circuit Court of Appeals in Chicago, and it's unlikely the legal skirmish will end there.
Indiana is one of the major fronts in a nationwide battle between social conservatives and Planned Parenthood. Gov. Mitch Daniels signed a law in May that made Indiana the first state to deny the organization Medicaid funds for general health services including cancer screenings.
State officials argued federal law bars Medicaid from covering abortions in most circumstances and that Planned Parenthood indirectly funds the procedures by mixing the Medicaid money with other revenue. Indiana's chapter won a temporary injunction in June to continue receiving the funds while the debate progresses through the court system.
Planned Parenthood performs more than 5,500 abortions annually in Indiana.
State attorneys suggested in a brief filed in August that Planned Parenthood should just separate its services to ensure no public money goes toward abortion. While officials with the state group say they're open to that, the outcomes of similar battles in Missouri and Texas give them pause.
Texas set up a Medicaid waiver program in 2005 to provide family planning services for low-income women but banned abortion providers from receiving any of the funds. In response, that state's Planned Parenthood formed a separate abortion affiliate.
But Roger Evans, senior director for public policy for the national organization, said legislators later changed the rules to disqualify funding for any provider even affiliated with an abortion provider. The goal, he said, wasn't to stop abortion funding but to "hobble" Planned Parenthood itself.
"They're looking for ... every little tactic they can use," Evans said.
Indiana state Sen. Scott Schneider, author of the proposal to defund Planned Parenthood, called the organization's split in Texas a "superficial" one. He said the group simply "moved the abortions to the second floor."
Missouri's Planned Parenthood chapter split up in 2001 following a court ruling. Three years later, the Legislature largely eliminated state family planning funding, leaving thousands of low-income women who didn't qualify for Medicaid without any preventive health care, said Paula Gianino, president and CEO of Planned Parenthood of the St. Louis Region & Southwest Missouri.
Betty Cockrum, Planned Parenthood of Indiana's president and CEO, said she fears lawmakers eventually will decide to target the organization's non-abortion services, even if the law only aims for the abortion money.
"If that doesn't satisfy the Legislature, my question is, what's the shelf life? The Legislature might change the rules in 2013 or so," she said.
Indiana Family and Social Services Administration spokesman Neal Moore said the agency, which administers Medicaid in the state, could not comment about the proposal to split up services because of the pending litigation.
Planned Parenthood officials in Missouri and Texas say it's inefficient and unnecessary to separate the services, which requires also separating such things as board meetings and bank accounts.
"It's incredibly cumbersome," Gianino said.
She said sophisticated accounting programs are available that can track the separate funding without physically splitting them up. Schneider said the issue isn't accounting practices but whether taxpayer is used to subsidize the termination of pregnancies.
Officials with Planned Parenthood argue women who seek elective abortions aren't the ones who get hurt in the funding disputes because federal funds generally can't be used to pay for abortions anyway except in cases of rape, incest or to save the life of the mother.
Rather, Evans said, the services most affected are women's health procedures such as pap tests, cancer screening and treatment for sexually transmitted diseases.
The clash in Indiana mirrors similar debates over Planned Parenthood in Congress and numerous states.
An effort to defund Planned Parenthood was at the heart of debate over a possible federal government shutdown earlier this year, and a Republican-led House panel last month asked the organization to produce records proving it doesn't spend public money on elective abortions. A nationwide coalition of anti-abortion groups said last week it is preparing to push legislation in all 50 states requiring that pregnant women see and hear the fetal heartbeat before having an abortion.
Officials in Texas this year slashed the family planning budget by two-thirds, from $111.5 million to $37.9 million for the two-year budget period, said Carrie Williams, a spokeswoman for the Texas Department of State Health Services. Planned Parenthood of Austin spokeswoman Sarah Wheat said that the family planning cuts left about 300,000 Texas women without health care.
In Indiana, Cockrum says the Medicaid ban stands to affect around 9,300 women who rely on Planned Parenthood for their health care.
Schneider says those women can simply go elsewhere.
"We've identified numerous outlets that provide women's health services that do not provide abortions, so this is not about women's health. This is about taxpayers funding abortion providers," he said.
Cockrum, however, says many of those other providers don't offer all the services that Planned Parenthood provides.