"Shared sacrifice." That is the rallying cry of budget-cutting politicians throughout New Jersey during these tough economic times. But as many in the Ocean County community are finding out, "shared sacrifice" is not always the reality of state budget cuts.
Kathy Fisher has worked at the Family Planning Center of Ocean County for 36 years in various positions. She is now the acting-president and CEO. The last couple years, she says, "have been the absolute toughest" of her career.
That is because the 2011 New Jersey budget completely eliminated state funding for family planning centers. A budget line that allocated $7.4 million dollars for basic reproductive healthcare services was "zeroed out" by Gov. Chris Christie in July 2010, and patients have been feeling the effects ever since.
Six centers in New Jersey have already had to close and many more, including the one in Lakewood, have had to scale back hours, let go of staff, and see less patients.
In Ocean County
The Family Planning Center of Ocean County, located around the corner from the Kimball Medical Center on Route 9 in Lakewood, provides medical services to low-income women. These services include general health screenings, breast exams, pregnancy testing and birth control. In 2010, the center served about 700 women from Toms River.
The center does not perform abortions, and has never performed abortions during its 40-year history. According to Fisher, that important message has been very difficult to get out to the community. "Everything we do here is really about preventing abortions and keeping women healthy," she said.
Fisher called the state cut for reproductive services a "targeted hit," and said that reproductive services were the only healthcare service completely eliminated by the Christie budget. "I understand the need for shared sacrifice, but elimination, that's devastating."
The center has already been forced to cut Saturday hours and enforce staff-wide furlough days. Two full-time positions and a part-time position have been eliminated (including the manager of the nursing staff), vacated positions have not been filled, and full-time positions have become part-time positions.
Demand Large as Staff Hours Cut
At a center with only 26 part-time and full-time staff (including administrative and educative staff), these cuts have resulted in an extreme shortage of manpower. The center has had to eliminate morning hours for medical visits. Appointments are now scheduled for afternoons and evenings only, with mornings reserved for administrative business.
The result of all these changes: a huge decrease in the number of patients the center can take on.
In 2010, the center saw 4,600 patients. In 2011, due to the cuts in hours, staff, and services, that number is expected to be closer to 3,500.
That is a drop of 1,100 patients.
Compounding matters, as Fisher pointed out, is that these women do not have many other options in terms of reproductive services. "The need is definitely there," she said. Ninety percent of the women the center sees are at least 150 percent below the poverty line. They rely on the center to meet their basic reproductive healthcare needs.
"We often have women tell us they never expected to be in this position. They once had health insurance, they don't have it now," Fisher said.
Certain services at the center are free to patients, while payment for other services is determined on a sliding pay scale, which is based on income and other factors.
A Place to Turn
Outside the numbers, the center provides an invaluable service to patients in terms of compassion, Fisher said. She recalled the story of a woman who came in for her birth control medication, but told Fisher that she would not have the money to pay until she received her next paycheck. The woman was amazed, Fisher said, to hear that she could have the medication now and pay when she had the money.
"We don't deny people service for an inability to pay at that moment," Fisher said. "There are very few places with that philosophy."
The center also does a lot of community outreach and community education, including teaching women how to check themselves for breast cancer and going to high-risk groups to impart the value of preventive screenings and breast exams. "The more educated people are about any subject, the more successful they'll be," Fisher said.
These educational services are unique to this kind of local family planning center. "I don't know who else would provide that," Fisher said.
Where Else to Turn
The center is adapting to the cuts as best they can, looking at many different ways of winning more grant money, strengthening collaboration with other organizations, and stepping up their fundraising projects in the community. "The question is always, 'Are we doing all we can with what we have?' " Fisher said.
Nevertheless there is an obvious problem if 1,100 less patients are being seen from one year to the next. Where are all these patients going? How are they getting access to basic services?
According to Assemblyman David W. Wolfe (R-Brick), the answer is federally qualified health centers, of which there are four in Ocean County. Wolfe said services have not been affected "dramatically" in Ocean and Monmouth counties.
Fischer disagrees. "Those centers cannot take on all of those patients," she said. And if they can take on some of them, Fisher said, "it will not be in such an expedient and efficient way."
Theresa Berger, the CEO of Ocean Health Initiatives, which operates three of the county's centers, said that while they have seen their numbers increase dramatically this year, that increase is consistent with the increases they have seen over the course of the last few years and is not directly related to family planning cuts. "This has less to do with family planning," Berger said, "and more to do with so many people just not having health insurance."
Berger also said that while Ocean Health Initiatives is opening a new center next year and have so far been able to deal with an increase in the number of patients, their services have less to do with family planning and more to do with general health services.
The State Budget
All the state budget wrangling may be null and void anyway if national Republicans get their way. Title X, the national law allocating federal money for basic reproductive services, was on the chopping block in the budget passed by the House of Representatives this year. Title X was signed into law by President Richard Nixon in 1972. According to Fisher and other experts, eliminating Title X funding would be the death of free-standing family planning agencies.
Commenting on Title X and the federal budget, Assemblyman Wolfe said, "Personally, I have been supportive of funding those programs fully." But, he said, budgetary issues sometimes dictated necessary cuts.
The governor's office did not respond to a request for comment.
For people like Kathy Fisher, however, the issue is local and immediate. "Every dollar spent on family planning centers like ours," Fisher said, "equals four dollars savings in Medicaid expenditures... We have reached out to assemblymen, state senators, and the governor. It is very easy to justify the need, but we're just not making any headway."
Democrats in the Statehouse, led by Sen. Loretta Weinberg (D-Bergen County), have been attempting to restore the state funding, but they have not had much success so far. The senator has proposed multiple different ways of making up the $7.4 million, but has not received any support from the governor or Statehouse Republicans.
For the sake of low-income women all across New Jersey, Fisher said she hopes the funding is restored quickly and fully. "We are celebrating our 40th anniversary this year," she said, "and we want to be able to continue to do the good work we've been doing here in Ocean County."
"When it impacts women," said Fisher, "it impacts the family as well."