Defunding Planned Parenthood could overwhelm other clinics, leave women with few options

Planned Parenthood would be cut off from Medicaid funding for one year under the Senate’s health-care bill. That would leave other clinics scrambling to pick up the organization’s Medicaid clients, in some cases needing to more than triple their contraception caseloads. And in the likely event that clinics can’t expand that much that quickly, the bill would leave many of Planned Parenthood’s 2.4 million annual patients without care, at least temporarily.

Republicans such as House Speaker Paul D. Ryan (R-Wis.) who support the defunding say that community health centers can make up the difference. These health centers, also known as federally qualified health centers or FQHCs, receive federal funds to provide health care to low-income people, sometimes offering reproductive services such as birth control and STI testing.

But data from the Guttmacher Institute, which advocates abortion rights, shows the gap that would be left by defunding Planned Parenthood, which serves one-third of all contraception clients among family-planning clinics nationwide, would be very difficult to fill. In some states, Planned Parenthood serves six times as many contraception patients as FQHCs. Under the defunding, people on Medicaid, who make up more than half of Planned Parenthood’s clients, would probably have to go to other clinics. If FQHCs in those states were to absorb those patients, as Republicans say they could, they would have to multiply their caseloads overnight. And if the budget cuts forced Planned Parenthood clinics to limit their hours or close their doors, there would be even more patients for FQHCs to take in.

“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,” according to a Guttmacher report.

[See which states would be hit hardest by the Senate’s Obamacare repeal bill]

Recent events seem to back up that assertion. It’s not realistic for FQHCs to grow that much that quickly. In a time of rapid expansion, after the implementation of the Affordable Care Act brought more federal funding and patient demand, FQHCs were able to serve 25 percent more patients in 2015 than in 2010. But they’re still unable to meet demand, according to the Guttmacher report. And in Texas, where Planned Parenthood was cut off from Medicaid beginning in 2013, the number of contraceptive claims by low-income women dropped by about a third, according to a study in the New England Journal of Medicine.

Supporters of the defunding contend that it wouldn’t worsen access to contraception. “Birth control is widely available, through many places,” said Kristi Hamrick, a spokeswoman for the antiabortion group Americans United For Life. She says shifting women from Planned Parenthood to FQHCs would “save them time, money and effort” because those health centers provide other services, such as primary care. And it would take money and patients away from Planned Parenthood, a major abortion provider nationwide.

Rural health centers could see a spike in caseloads

The burden on FQHCs — and on the women who could no longer access birth control — would be most acutely felt in rural areas, where clinics are more sparse. This shows clearly in the data for New York, where Planned Parenthood locations in rural areas upstate serve a far greater proportion of contraception patients than they do in New York City. If patients were turned away from Planned Parenthood en masse, rural clinics would face much greater growing pains, potentially leaving many more women without care.

In some rural areas, it’s not just a matter of local FQHCs having to increase their caseloads. Planned Parenthood is often the only clinic around for hundreds of miles. In rural central Minnesota, for instance, people would have to drive at least two hours to get to their nearest FQHC for contraceptive care. Not only would those distant clinics have to absorb local Planned Parenthood clientele, they’d also have to take in those from around the state for women to maintain access to contraception.

Clinics in rural areas aren’t the only ones who would see an influx of patients under a Planned Parenthood defunding.

Urban health centers in right-leaning states could also be buried in new clients.

Low-income women in many cities across the country rely on Planned Parenthood to get contraceptives, though the difference is especially stark in red states. In these areas, a defunding could also overwhelm the local FQHCs.

At this point, it’s unclear whether the Senate GOP’s bill will pass, and whether the final version will defund Planned Parenthood. Republicans will need almost all of their senators to support it, but numerous senators have already expressed concern or outright opposition. And Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) have specifically noted their opposition to cuts from Planned Parenthood. A vote on the bill could come as early as late July.