Ominous storm clouds loom on the horizon for Martha’s Vineyard Family Planning (MVFP), a resource acknowledged as crucial by Island health professionals, teens, and many adults. There is no big storm yet. Services at the MVFP clinic are only slightly reduced this month and should continue uninterrupted through the summer, but cuts in federal funding, reductions in donations, and an increased demand for services combine to push MVFP into an unsustainable financial position. Income for FY10, ending in June, will not cover expenses.
MVFP provides about 1,500 clients a year with gynecological exams; pregnancy testing and options counseling; birth control information, counseling, and supplies; HIV and other STD testing; emergency contraception, and other help. No one is denied services because of an inability to pay.
Health Imperatives, of which MVFP is one of nine divisions, receives funds from state and federal agencies, most through Title X of the US Public Health Service Act (amended 1970). Federal and state funds account for about half of MVFP’s income. The rest comes from fees paid by clients or their health insurers, and from donations. Recently, the federal government has cut Title X funding, at the same time that everything is costing MVFP more and clients can afford to pay less.
When it became clear that MVFP would not be able to meet June’s expenses for testing, supplies, rent, utilities, and salaries, Health Imperatives ordered that the staff be furloughed for two days this month, which means they will lose two days’ pay and the clinic will be open on two fewer days. Additionally, Health Imperatives transferred some federal funds budgeted for later in the year, a delaying solution that only robs Peter to pay Paul.
Sheldon Barr, director of Health Imperatives, told The Times in a telephone interview that major changes are happening in health care. “Federal legislation is changing the way health care services are delivered. MVFP clients pay on a sliding scale. However, all those who have insurance cannot be charged, even though insurance companies don’t pay what the service actually costs.” The recent cuts have made matters worse.
Canary in the coal mine
Patty Begley, program director of MVFP, told The Times, “In the years since 1978 we have weathered unbelievable political storms, financial storms.” But she is concerned about the end of this year. “What happens in December? If the trend continues and our resources can’t pay our expenses, there may be layoffs,” she said. “Is this the canary in the coal mine?”
Linda Leonard, school nurse at the Martha’s Vineyard Regional High School told The Times that the loss of the MVFP clinic, however unlikely, would be “a huge loss, an incredible loss.” She explained that while most of the services are, in theory, available from primary care physicians or other sources, MVFP has a reputation in the community, particularly among the students she works with, for privacy, confidentiality, and trust. Ms. Leonard works closely with MVFP and often refers students there.
Janice Brown, school nurse at the Martha’s Vineyard Public Charter School, agrees. “It would be devastating for those who use the clinic,” she said. She pointed out that not just young women but also young men go there. And adults as well as teens. The privacy of the remote location and the trust that the staff has developed over the years means that teens go for pregnancy, AIDS, or STD testing when they would be afraid or ashamed to go anywhere else. “They feel comfortable there, not just the teenagers themselves but the mothers of teenagers,” she said.
Mr. Barr told The Times that he is not concerned that MVFP will have to close its doors. “I don’t think that’s going to happen,” he said. The leadership of Health Imperatives is taking steps to balance the books through such steps as controlling costs, raising fees for those who can afford to pay, tightening billing to insurers, and renegotiating contracts with insurers.
Friends of Family Planning (FFP), a 501 (c)(3) nonprofit organization, raises money to support MVFP, most visibly with the art show and sale at the Agricultural Hall during Memorial Day weekend. Miriam Gerson, president of FFP, told The Times in a telephone interview that no new fundraisers are planned for now, but she conceded that FFP may have to increase its efforts. Ms. Gerson is also on the board of Health Imperatives.
As an example of cost-cutting, FFP — which owns the clinic’s office — has reduced the rent. However, the original rent exactly covered FFP’s mortgage, and so donated funds earmarked for other MVFP uses will have to be used to make up the difference. Another example of robbing Peter to pay Paul.
A visit to the MVFP clinic reveals that maintenance costs are already cut to the bone. Ms. Begley’s desk chair is frayed and threadbare, the door to her office doesn’t close properly, the sidewalk is in poor repair. But if you ask a worried teenager, she will tell you those things don’t matter at all. What matters is that the people who work there can be trusted.
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