Good experience, but scary news, at my Arkansas Health Dept family planning visit...

Scary news for the community, at least.

As you're aware, Planned Parenthood no longer receives Title X support for even their STD testing efforts here, let alone family planning.

I'm in a unique situation insurance-wise -- while the ACA demands birth control be covered, and Medicaid covers all forms of birth control, I'm disabled but worked enough prior that I only have Medicare. Medicare, currently primarily being a program that serves seniors, never was *required* to cover family planning. Many Advantage plans do, but only at 80%, and you have to look closely to see which they will or will not cover.

And my disability (Bipolar I) means that I don't need to have an unplanned pregnancy. I would need to be stabilized on medications that would not harm a child first before even considering reproduction. Additionally, pregnancy is extremely dangerous for women who have had a prior manic episode severe enough to progress to manic psychosis. I've only had one, but that's enough for them to have told me back when I was 22 that if I got pregnant I needed to be VERY careful.

So after trying every Medicare-accepting entity that would only be able to bill Medicare and being told they couldn't guarantee I could get the solution my psychiatrist and my gynecological history recommends -- Nexplanon -- without them ensuring Medicare would at least pay their 80%... I called and begged the Health Department to consider my medical expenses to bring me under the cutoff for Title X. They have that discretion.

It was a medical student who did my exam, and I complimented her on her delicacy during the pap (was just the truth). My arm will have a bandage around it for awhile, but doesn't hurt and the insertion was nothing compared to just the sounding of my uterus when I had Paragard inserted (let alone its removal after getting embedded). Their blood draw tech saw my tiny veins (I'm "fun-sized", wear size 3 shoes), didn't hesitate on grabbing the butterfly and my blood draw for my STD testing was painless.

And they said they will bill Medicare for what they can, and bill Title X for the Nexplanon. They should get better reimbursement through Medicare for the covered services (exam, pap, tests) than through Title X. I would have preferred to have used Planned Parenthood, but the experience was not bad at all.

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However... because it was a slow day yet still a long wait just because it's a doctor's office essentially, I had the opportunity to speak to one of the guys who does their STD testing counseling, and also tabulates reporting. I know the Health Department had my test records done at both Planned Parenthood and at a public health unit, so I'm assuming both always reported their results to the main systems. I don't think what he was describing was just a result of people getting tested at the DoH vs PP.

But I'd just said hi because I realized what he did there and wanted to thank him. My father died of AIDS, and I knew his job was important.

He said that the situation is getting really scary -- and he's afraid it's going to get worse. In public health it's well-known that the prevalence of treatable STDs indicates the likelihood of HIV entering a population as well -- that it means people aren't having safer sex and/or not learning they have one fast enough and getting it treated, and while testing increases are good the overall increases in positives vs negatives is what they look at. The usual results they have to give are that you have something that makes you drip or gives you PID. Prior to the defunding of PP, they had perhaps one positive for syphilis in their clinic a month.

Now they're telling people daily they have syphilis, at this clinic alone. And he said the state overall numbers are "really, really bad". Testing overall is down, but positives are up significantly. And antibiotic resistance is not far away.

Eeeerk.