If a service is truly essential in certain communities, let the people who believe that make the case in their states, or fund it themselves. Leave D.C. out of ...
A federal judge temporarily blocked a provision in the One Big Beautiful Bill Act that would cut off federal Medicaid funding to Planned Parenthood and other organizations “primarily engaged in family planning services” that also provide abortions. Predictably, the outcry against this provision in the legislation has been swift and emotional: this is an “attack on health care,” we’re told, and patients will lose access to essential services like STI screenings and cancer tests.
Jeffrey Blehar and Dan McLaughlin have discussed the legal aspects of this issue. What’s missing from the conversation about it that I see in the press is, as always, even the faintest acknowledgment that if voters, the public, and state officials think these services are so essential, they can fund them themselves.
This idea is not radical. It’s rooted in how our system is supposed to work.
For instance, the private sector isn’t powerless here. My colleague Jack Salmon informs me that a large part of the funding for Planned Parenthood comes from the private sector to begin with. He writes to me, “Financial Statement of Planned Parenthood shows that about 1/3 of their funding is government, 1/5 is from fees (services), and almost half is charitable support. Of that 34%, some will be state government funding as Medicaid reimbursements are 17% to 50% state-funded under FMAP. The Federal share is, therefore, probably closer to 24% than 34%.” Also, the private donors fund 91 percent of the national level Planned Parenthood Federation of America and 42 percent of local clinics, for a combined total of 47 percent. Planned Parenthood calls the private funding “evidence of our robust grassroots support.” Great. Let private sources fund more of it if they think it is essential.
State governments are not powerless either. If Massachusetts, California, and New York want to ensure that Planned Parenthood’s doors stay open, they are free to allocate state taxpayer dollars to make that happen. And if some rural communities want to fund a women’s health clinic offering the full range of reproductive services, nothing in federal law stops them from raising money locally to do so.
But instead of holding those debates at the state or local level, we immediately rush to the courts and insist that the funding must come from Washington, D.C.
This reflex is part of a deeper problem: a political culture in which every program, every priority, and every budget line item must be nationalized. If something is valuable, we assume that it must be federally funded. If the federal government steps away, we act as though the service will vanish forever. That’s incorrect. Unfortunately, this way of thinking has been behind much of the federal government’s expansion over the last 100 years and our inability to scale it back.
Funding Planned Parenthood or any similar organization is not a federal function. The services such organizations provide are not public goods. A public good, in the economic sense, is something that is non-excludable — meaning that, once it’s supplied to someone, no one else can be excluded from enjoying it. Public goods include things like national defense and the rule of law. A health clinic operating in a particular state, serving a particular population, is a classic example of a local service. There’s no justification for dragging federal taxpayers, many of whom live in states that don’t share the same political or cultural views, into funding something that can be funded locally.
Yet, when the federal government attempts to step back, the narrative becomes apocalyptic. Patients will be left without care! Clinics will close! People will die! These cries are used not just to justify the status quo but to shame anyone who dares to ask the most basic policy question: Who should pay for this?
And that’s the real issue. The federal government has been allowed to sprawl into every corner of American life for so long now that voters have stopped asking the most important questions: Is this a federal responsibility, or should it be handled by states, local governments, or civil society?
In a properly functioning federalist system, programs like Medicaid would be much more state-driven. States would decide their own priorities. Voters would weigh trade-offs more clearly. And programs that communities genuinely value — like women’s health services — would find funding through democratic means tailored to local preferences. There would be accountability, transparency, and diversity in outcomes.
Instead, what we have today is fiscal confusion and moral outsourcing. People demand that the federal government fund services they aren’t willing to pay for themselves. They push the costs onto future taxpayers through deficit spending. And they treat any attempt to return responsibilities to the states as a betrayal of justice, rather than a restoration of constitutional balance.
For the record, I would say the very same thing for funding that has nothing to do with Planned Parenthood.
Federal overreach is corrosive. It doesn’t just increase the size of government; it shifts responsibility away from the people who use and value programs onto faceless taxpayers with no real say in the matter. It masks trade-offs. It erodes accountability. Worst of all, it makes every political disagreement a national crisis.
If Planned Parenthood is truly essential in certain communities, let the people who believe that make the case — in their states, in their legislatures, to their neighbors and fellow taxpayers. That’s democracy. That’s federalism. And that’s how we build a system in which public spending reflects real public support, not political inertia, interest-group pressure, or social media frenzy.
The answer to this controversy is simple: If you want it, you fund it. Stop insisting that the federal government do it all — because the more we ask Washington to be responsible for everything, the less responsive and responsible our government becomes.