When she was 24, Christy Miceli was working full time and finishing up college classes. At the time, she was living without health insurance, which was unavailable to her through either her work or her parents.
"The only medical care I was receiving was the care I got through Planned Parenthood for my yearly physicals and yearly pap smears to get my birth control," said Miceli, now 38.
House Speaker Paul Ryan and others have made it clear they want to see Planned Parenthood defunded because the nonprofit organization provides abortion services. (In reality, only three percent of its services are abortion-related and no federal funds go toward abortion services.) Among House Republicans' 100-plus-page proposal to replace the Affordable Care Act (which Trump has demanded the House vote on today), there's a provision that does just that. If the bill passes, Planned Parenthood will lose its eligibility as a Medicaid provider, or be "defunded," for a year.
That means the millions of people who depend on Medicaid and other federal assistance won't be able to turn to Planned Parenthood for their wellness checks, birth control, and—perhaps most frighteningly—cancer screenings. According to Planned Parenthood's annual report, nearly 72,000 women in 2014 had cancer detected earlier or had abnormalities identified through screenings offered by the health care organization.
Miceli, who now owns a small customization company specializing in screenprinting and embroidery, lives in Wisconsin—Ryan's home state. In 2003, she visited her local Planned Parenthood health center, as she had done every year since she was in high school. This time, however, her pap test came back abnormal, and her doctor called her in for a follow-up test. When that screening also came back showing severe cervical dysplasia—meaning the cells on her cervix were undergoing abnormal changes—her doctors sent her to another health center for more testing.
"That's where I saw my cervix on a TV for the first time," she recalls, "and had my first cervical biopsy, which was very painful." As she was cramping and bleeding, she says she wanted nothing more than to hug her grandparents. She hadn't told her family yet what was going on, expecting to do so after the ordeal was over. "But that day I really just wanted to hug my grandma and grandpa. So I drove to their house [after the procedure], but they weren't home. I just sat outside their house and cried for like half an hour."
It took Miceli more than a year and a half to have a pap test come back cancer-free. During that time, she underwent three LEEPs—or loop electrosurgical excision procedures, which removes cancerous cells by scraping away a layer off the cervix—and cryotherapy, which destroys abnormal tissue by freezing it off. While Planned Parenthood does not perform these procedures, Miceli says they helped her find affordable treatment. For example, for her first LEEP, she says she paid about $350. (The cost of cervical treatment cancer varies by state, but one site estimates a patient without insurance will pay at least $1,500 for one procedure.) "My cervix was very expensive for a few years," she says.
According to the American Cancer Society, more than 4,000 women will die from cervical cancer this year. Almost 13,000 new cases of invasive cervical cancer will also be diagnosed.
In a study published in CA: A Cancer Journal for Clinicians, the authors note how important screenings are: "approximately one-half of the cervical cancers diagnosed in the United States are in women who were never screened, and an additional 10% of cancers occur among women not screened within the past 5 years." Research has also found that getting vaccinated for HPV can help protect against the types of HPV that cause cervical cancer. HPV vaccination is one of Planned Parenthood's core services.
Dr. Raegan McDonald-Mosley, chief medical officer for Planned Parenthood Federation of America, says cervical cancer is relatively rare in the US, "but that's largely due to aggressive screenings and now the HPV vaccine. In other countries where they don't have ubiquitous access to pap smear exams and cervical cancer screenings, cervical cancer plays a much better role in the burden of disease in their countries."
McDonald-Mosely says it would be hard to estimate what the impact will be on cervical cancer rates if people can no longer turn to Planned Parenthood for their screenings. "But knowing that we do 270,000 pap tests a year, and detect 72,000 cancerous or precancerous abnormalities, without access to the essential care that we provide, you'd have to surmise that many of those patients would find barriers to care," she says. "If these people aren't getting the screening tests and aren't having these abnormalities detected in an earlier phase, then it could potentially lead to more people having more aggressive or more invasive disease than would have been detected had their local Planned Parenthood health center been able to take care of them."
She also points out that significant health inequities already exist in this country: For patients who live at low incomes and for people of color, the rates of cervical cancer are much higher. In fact, a study published in January found that black women in the US are dying from cervical cancer at a rate 77 percent higher than previously thought.
"While trends over time show that the racial disparities gap has been closing somewhat, these data emphasize that it should remain a priority area," said Anne Rositch, an epidemiologist at Johns Hopkins and the study's lead author, in a statement. "Black women are dying of cervical cancer at twice the rate as white women in the United States, and we need to put in place measures to reverse the trend."
That's why, McDonald-Mosely says, "we need to be making access more ready and more available to women of color in this country instead of less available, which is what 'defunding' would do in this circumstance."
According to a poll released earlier this month from the Kaiser Family Foundation, 75 percent of Americans want to see Planned Parenthood continue receiving federal funding to pay for treatment for STDs, cancer screenings, and birth control. Just in Wisconsin alone, where Miceli lives, more than 40,000 patients used Medicaid in 2015 to pay for their visit to a Planned Parenthood health center in the state.
Miceli has been cancer-free for more than 10 years, though she is unable to have children. "My cervix is nothing but scarred tissue now," she says. But she credits Planned Parenthood with saving her life. "Back then, that was just my doctor."
She adds: "I'm pro-life. I'm pro-my life. Abortion is a huge hot button topic for these lawmakers, but they need to keep in mind that you can be both pro-life and pro-Planned Parenthood."