Today the House of Representatives will vote on President Trump and Paul Ryan’s American Health Care Act (AHCA), which makes good on the GOP’s long-standing promise to defund Planned Parenthood. The proposed law would prohibit one of the nation’s largest health providers from receiving Medicaid reimbursements, cutting the organization off at the knees and threatening to rob the most vulnerable of Planned Parenthood’s 2.5 million yearly patients of their trusted health provider. GOP leaders insist that community health centers (CHCs) will step in and fill the void left by Planned Parenthood, but this is just one of many myths the party is peddling to garner support for the proposal.
The truth is, there is simply no replacement for Planned Parenthood. Here are a few reasons why.
CHCs do not have the capacity to take on Planned Parenthood patients. In 2015, during one of the GOP’s many attempts to defund Planned Parenthood, California-based CHCs told Congress that stripping funding from the organization would put “untenable stress” on the CHC network, which did not “have the capacity for such an increase in care.” As it is, 95 percent of health centers nationwide report having at least one clinical vacancy, a gap that if filled would enable them to serve an additional 2 million patients. In addition to the increased patient demand that would be created by the defunding of Planned Parenthood, we must also consider that 24 million individuals would ultimately lose coverage under Trump’s plan, which would surely drive up demand on health providers that welcome low-income patients. As Sarah Rosenbaum recently described in Health Affairs, opening new CHCs or increasing the capacity of existing ones—both in terms of patient load and the services they are equipped to provide—is expensive and time-consuming. And as we’ve seen in Texas, just because they build it doesn’t mean the patients will come.
In some communities there are no other health providers. For many who use its services, Planned Parenthood is the first and last option. In 332 of the 491 counties where Planned Parenthood exists, the organization cares for at least half of women who rely on publicly funded family planning services, and in 103 of those counties Planned Parenthood serves all of those patients. More than half of all Planned Parenthood centers are located in areas that experience chronic health shortages or in rural or medically underserved areas, and more than one in four Planned Parenthood patients report it is the only place of care available to them.
CHCs do not have the same expertise as Planned Parenthood. If you listen to Paul Ryan and Health Secretary Tom Price, you might think you could just stroll into any community health center and get care identical to that offered by Planned Parenthood. But you’d soon find you’d been led astray. Planned Parenthood and other such providers offer a full range of primary care and reproductive health services, in part because of the comprehensive requirements attached to funding through Title X, the nation’s family planning program. They counsel on and provide all family planning methods, and test for pregnancy, and screen for STDs and cancer. They are equipped to deal with younger patients, non-English-speaking patients, and LGBT and gender non-conforming patients. And yes, some provide abortions, a service that one in three American women will seek out at some point in their reproductive life.
Community health centers, by design, offer a much broader set of services: dental care, diabetes management, pediatric care, treatment for opioid addiction, and mental health care, among many others. The majority of CHCs also provide family planning services, though rural health clinics—which provide care for 7 million individuals located in rural underserved areas—are not required to do so and generally are bound by many fewer requirements than CHCs. But even when CHCs do provide family planning, they are not equipped or required to provide the full range of reproductive health services offered at Planned Parenthood. As Rosenbaum explains, they therefore “typically develop collaborative and reciprocal referral arrangements with other community safety-net providers, including for more advanced contraceptive services than a health center might offer through its own program.” It’s not surprising that 40 percent of women who visit CHCs for primary care use a separate family planning provider. CHCs and Planned Parenthood rely on one another and make each other stronger.
Additionally, compared to CHCs, Planned Parenthood clinics are much more likely to offer same-day visits, have shorter wait times, offer prescriptions on site, and provide extended hours, all of which are critical for low-income women who often lack job flexibility and benefits such as paid sick leave.
We need more, not fewer, providers. The current family planning safety net is like the little engine that could, delivering incredible care and outsized health—and economic—benefits for a relatively small investment. But the number of individuals in need of publicly funded family planning services has increased 5 percent since 2010, and the current safety net only serves roughly 40 percent of the individuals in need of publicly funded family planning. Our leaders should be finding ways to broaden the net and include more individuals, not tearing it up and leaving millions in the lurch.
Planned Parenthood is more popular than Donald Trump and Paul Ryan. Planned Parenthood’s approval ratings hover around 60 percent, compared to Donald Trump’s 44 percent and Paul Ryan’s meager 37 percent. The Kaiser Family Foundation recently reported that nearly 90 percent of Democratic men and women—and more than half of Republican men and women—favor continuing federal funding for Planned Parenthood. One-third of those who believed funding should be stopped changed their minds when they heard doing so would make it difficult for low-income women to receive basic health services.
This is all to say nothing of the absurdity and cruelty of asking millions of individuals to abandon their place of trusted care. Or the sheer stupidity in effectively eliminating a high-quality, high-performing health provider from our already tenuous safety net. Or of conservatives’ medically erroneous and purely ideological assertion, implicit in the AHCA, that abortion is not an integral part of reproductive health care. (It is. Full stop.) Or of the fact that our political leaders are willing—yet again—to wager women’s health and lives in order to eliminate a constitutionally protected health service.
They’re lying to us. There is no upside for any of us if Planned Parenthood is defunded.