To the surprise of literally no one, President Trump’s 2018 budget proposed stripping all federal funds, including Medicaid dollars, from Planned Parenthood. Proponents of this argue that if Planned Parenthood clinics end up shuttered, women can simply access care elsewhere. But growing research shows that’s the opposite of what actually happens.
We got even more evidence of this with a report on the capacity of federally qualified health centers (FQHCs) to fill the gaps left when a Planned Parenthood clinic is forced to close its doors. In a policy paper from the Guttmacher Institute released last week, author Kinsey Hasstedt wrote that while FQHCs are a critical part of the health care safety net — they serve about 25 million people each year, most living below the poverty level — they simply can’t absorb the millions of women who currently get their contraceptive care at Planned Parenthood. Right now, about 10,700 safety net clinics receive some form of public funds to provide poor and low-income women with family planning services. FQHCs are part of that safety net of clinics, which all together deliver contraceptive care to more than 6 million women.
Yes, FQHCs got a big boost via the Affordable Care Act, which included billions of dollars to expand their capacity and build new clinical sites. Still, Hasstedt writes that “FQHCs could not readily replace Planned Parenthood health centers.” To understand why, Hasstedt breaks down the dynamics of how federally funded family planning services are delivered and received. According to the Guttmacher paper, even though Planned Parenthood clinics account for just 6 percent of all safety net family planning providers, they serve 32 percent of all safety net contraception clients. In comparison, FQHCs account for 54 percent of safety net family planning sites and serve 30 percent of safety net contraception clients.
In analyzing 2015 data on safety net family planning clinics and patients, Hasstedt and colleagues found that if Planned Parenthood were cut off from federal family planning funds, FQHCs in 27 states would have to double their contraceptive client caseload to fill the void. In nine states, FQHCs would have to triple their caseload. In all, FQHCs would be left struggling to serve an additional 2 million women who could no longer get services at a Planned Parenthood clinic.
Getting down to a more localized level, researchers found that in 13 percent of the 415 U.S. counties home to a Planned Parenthood clinic, there simply isn’t a FQHC that provides contraception care. In 67 percent of those counties, FQHCs would have to double their capacity to serve all the women now served by Planned Parenthood; in 26 percent of counties, FQHCs would have to serve six times the number of contraception patients than they currently do.
In addition to the sheer numbers, the quality of contraceptive care at Planned Parenthood is typically better than at FQHCs, which makes sense since Planned Parenthood is specifically tailored to meet women’s health needs. For instance, the policy paper noted that Planned Parenthood typically offers a greater variety of contraception, which means women have more opportunity to find a contraceptive method that fits their personal needs.
In narrowing the funding stream down to the Title X program only, which is the sole source of federal funding dedicated just to family planning, researchers found similar results: FQHCs would have to substantially increase their capacity to absorb the needs of millions more family planning patients. On top of that, Hasstedt noted, FQHCs are already struggling to meet an overall increase in demand for their services — adding millions of women previously served by Planned Parenthood to that demand seems likely to overwhelm the system.
Hasstedt concludes: “The suggestion that FQHCs become the main source of publicly funded family planning care is a matter of political convenience, not a viable policy proposal.”
To download a copy of the paper, visit the Guttmacher Institute.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.