Why Planned Parenthood matters in the age of the American Health Care Act
By Dr. Meenadchi (Meena) Chelvakumar, MD, MPH, Veteran Affairs Health Services Research and Development Fellow at Stanford Health Policy The views expressed by Dr. Chelvakumar are not reflective of official policy positions of the Department of Veteran Affairs.
The American Health Care Act (AHCA) proposed as a replacement for the Affordable Care Act (ACA) has drawn much criticism from both sides of the congressional aisle. As a family medicine physician who focuses on women’s health, I feel that one of the most distressing points in the proposed health care law is the prohibition of federal funds for Planned Parenthood.
Planned Parenthood is the most prominent safety-net provider of women’s reproductive and sexual health services in the country. The argument for blocking federal funds for this organization from those who back the AHCA primarily focuses on the organization’s potential interchangeability of federal funding with non-federal funding for abortion services, which would be in direct violation of the Hyde Amendment. That law, originally passed in 1976, prohibits the use of federal funds for abortion except in the case of rape, incest, or a pregnancy endangering the life of the mother.
There is no evidence that Planned Parenthood has ever violated this law. Furthermore, only 3 percent of Planned Parenthood’s operations are devoted to abortion; the remaining services include screenings for various cancers and STDs, family planning and contraception for women and men, and reproductive health research and education.
With respect to the 2.5 million clients Planned Parenthood serves each year, many proponents of defunding the organization — including Secretary of Health and Human Services Dr. Thomas E. Price — suggest that the gap in patient care could be filled by our nation’s network of Community Health Centers (CHCs), which provide primary care services in underserved areas and receive federal dollars if they meet a strict set of requirements.
Such a potential shift in public health resources has been extensively analyzed by health policy researchers and found to be unfeasible.
Though Planned Parenthood centers only make up 10 percent of publicly supported safety-net family planning centers, they serve 36 percent of the patients who receive publicly-supported contraceptives from these facilities. Additionally in 21 percent of the counties where a Planned Parenthood is present, it is the sole provider of contraceptive services for low-income women. In 68 percent of counties, Planned Parenthood provides contraception for at least half of these women.
Planned Parenthood additionally facilitates high-quality, timely care for women’s reproductive health in comparison to other safety-net organizations. For example, 91 percent of Planned Parenthood clinics offer at least 10 of the 13 reversible contraceptive methods compared with 48 to 53 percent of other types of safety-net organizations. Additionally, Planned Parenthood clinics are much more likely to provide onsite access and refills for contraceptive pills, the most prevalent form of contraception in the United States, in comparison to their CHC counterparts.
CHCs serve an incredibly important role in providing health care to the low-income communities of this country. They provide excellent care on extremely limited budgets and though they also serve women of reproductive age, they have a wider responsibility to provide comprehensive medical services, including mental health and dental services, as well as chronic disease management. When they are expected to ramp up their already stretched resources to fill in for Planned Parenthood, women’s health care suffers. These effects can be seen through the ongoing analysis of publicly funded women’s health care in Texas following its decision to exclude Planned Parenthood from state funding. Non-Planned Parenthood clinics had to increase their services by 81 percent to compensate for this loss; a 2013 report evaluating the Texas Women’s Health Program showed a significant drop in publicly funded contraceptive claims and a subsequent 27 percent increase in the state’s pregnancy rates in a population where the pregnancy intention rate was only 10 percent.
Sara Rosenbaum, a health policy professor and founding chair of the Department of Health Policy at George Washington University, noted in this analysis that when considering the possibility of CHCs covering the gaps left behind by a defunded Planned Parenthood, CHCs could be incredibly efficient, “but cannot perform magic.”
“Community health centers operate on modest budgets and repeatedly have been shown to be highly efficient,” Rosenbaum writes. “But no amount of efficiency can give them the means to ramp up quickly enough to replace the loss of preventive women’s health services of the magnitude that would result were Planned Parenthood clinics to close.”
Given the large role Planned Parenthood plays in delivering contraceptive care to the most vulnerable of women, I believe it would be extremely difficult to expect CHCs, which have a much broader mission in terms of the population they care for, to adequately fill in this gap while attending to all the other health-care services they need to provide. In the end, low-income, marginalized women and families would suffer the most and the only health care systems left to serve them would be grossly overstrained.
