Contrary to recent claims by House Speaker Paul Ryan, R-Wis., experts say the nation’s community health centers don’t have the staffing or funding to handle the estimated 400,000 people who could lose access to care if Planned Parenthood’s federal Medicaid funding is shuttered.
Ryan wants to cut the group’s federal funding, including more than $400 million in annual Medicaid reimbursements, as part of legislation to repeal the Affordable Care Act, also known as Obamacare. The loss would take roughly half the group’s revenue and fulfill a longtime conservative desire to bankrupt the organization that provides a host of reproductive health services, including abortions.
Defunding Planned Parenthood could create a mini health crisis for low-income men, women and teenagers across the country who depend on the organization for preventive care, birth control, cancer screenings and treatment for sexually transmitted diseases. In addition to the estimated 400,000 who would lose their care if Planned Parenthood is defunded, the Congressional Budget Office estimates that anywhere from 150,000 to 650,000 patients could face reduced access to care.
“In the Central Valley, it would be really devastating, and that’s to put it mildly,” said Liz Figueroa, vice president of public affairs for Planned Parenthood Mar Monte, which has centers in Fresno, Madera, Merced, Visalia and Bakersfield.
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In 2016, patients made more than 105,000 visits for services covered by federal funding at the centers in Fresno, Madera and Visalia.
Ryan said Planned Parenthood patients could be absorbed by the nation’s 1,300-plus community health centers, which provide the same services as Planned Parenthood – minus the abortions – at more than 9,000 sites nationwide. Planned Parenthood and its affiliates operate more than 650 health clinics nationwide.
In the Central Valley, it would be really devastating, and that’s to put it mildly.
Liz Figueroa, Planned Parenthood Mar Monte
“There are so many more (community health centers) and they provide these kinds of services without all the controversy surrounding this issue,” Ryan said during an appearance on CNN last week. “We don’t want to commit taxpayer funding for abortion. Planned Parenthood is the largest abortion provider.”
Planned Parenthood uses federal funding to treat Medicaid patients and subsidize other health services, and by law cannot use those funds to provide abortions.
But cutting off federal dollars that Planned Parenthood uses for other health care services will cripple the organization, thereby preventing it from providing abortion services, said a man handing out “Stop the Violence” pamphlets to women walking into the Planned Parenthood clinic on Fulton Street this week.
“We have lots of federally qualified clinics that these funds would be redirected to that would be well-suited to take care of women,” said the man, who declined to give his name.
Planned Parenthood “is not the only shop in town,” he said. “This is just the best funded and best advertised shop in town.”
But federally funded community health centers have their own staffing, funding and logistical challenges that will make it hard to pick up Planned Parenthood’s slack, said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center in Washington.
“They’re already strapped trying to care for the patients they have, and to absorb all these additional patients who now go to Planned Parenthood just isn’t feasible,” Borchelt said. “There’s just no way that the community health centers could pick this up. People would lose access to care and they would lose their ability to get the services they need.”
Stephen Schilling, CEO at Clinica Sierra Vista that operates health centers in Fresno and Bakersfield, said community health centers taking over Planned Parenthood patients would not be an easy fix. “I appreciate the fact that members of Congress are predisposed to thinking positive about community health centers being able to step up and handle this, but the reality is, there’s a workforce and capacity challenge.”
If Congress is unwilling to invest in a workforce program, Schilling said, “I don’t know how the hell we’d do it because we’re already slammed with patients of our own.”
Located in impoverished areas with high infant mortality rates and few health care providers, health centers offer a full range of medical services, including dentistry and mental health and substance abuse treatment, to more than 24 million patients. Studies have found the centers improve community health outcomes and are linked to reduced hospitalizations, emergency room visits and better chronic care management.
We don’t want to commit taxpayer funding for abortion. Planned Parenthood is the largest abortion provider.
House Majority Leader Paul Ryan
More than 70 percent of health center patients earn at or below the poverty level, according to the National Association of Community Health Centers.
And even though health centers’ clinical staff has nearly doubled since 2000, virtually all health centers have at least one clinical staff vacancy. Seventy percent need another family physician, according to a recent report from the community health centers association. Hiring and retaining clinical staff is difficult for health centers because of high turnover due to a shortage of health care workers. If properly staffed, the centers could serve 2 million more patients, the group says.
“But they don’t have it,” said Sara Rosenbaum, professor of health policy and management at George Washington University. “I mean, they’ve got needs ranging from newborn babies to old people needing long-term care.
“And to suddenly have the rug pulled out on a critical safety-net provider for family planning? They would try to rally to the cause. They always do. But to think this would be a seamless transition from one provider to another with plenty of capacity is simply to not understand the health care system.”
Rosenbaum estimates the new Planned Parenthood patients would cost health centers about $800 per patient per year.
“Because you don’t just acquire the reproductive needs of a new patient, you acquire the whole needs of a new patient,” Rosenbaum explained.
Pedro Elias, director of public affairs in Fresno for Planned Parenthood Mar Monte, said patients seen at the centers in the central San Joaquin Valley come in for more than contraceptive care. “Planned Parenthood is more than birth control,” he said. “We are part of the medical community. We’re a medical provider. It’s women’s health in general.”
On Monday at the Planned Parenthood center on First Street in Fresno, Christina Lee, 32, had an appointment for a sore throat. She is without insurance at the moment, she said. “This was the only place that was affordable to me.”
A 21-year-old patient said she has been coming to the First Street clinic for two years for contraception. It would be difficult to pay for the care elsewhere, she said, but she comes to the clinic because of confidentiality. She doesn’t want her family to know she is on birth control.
Georges Benjamin, executive director of the American Public Health Association, said transferring Planned Parenthood patients to community health centers could lead to longer waits for care at the centers, many of which already have waiting lists for care.
“So you lengthen waiting times and what happens, in many cases, is that care gets delayed. And in many cases, they don’t get the care at all,” Benjamin said.
That could lead to more unwanted pregnancies and sexually transmitted diseases, Benjamin said.
And Schilling said community health centers are facing a fiscal cliff. “We could be staring at a 60 percent reduction in funding ourselves.”
Investment from Congress and $11 billion provided by the Affordable Care Act from 2011 to 2015 have funded new health centers and increased capacity and staff at others.
But health centers lack a stable funding source and instead rely mainly on patient revenue and Medicare and Medicaid reimbursements. Federal grants make up more than 20 percent of their funding. But $5.1 billion in federal grant funding for health centers is set to expire next September unless Congress reauthorizes it.
“Without congressional action, health centers will once again face a 70 percent reduction of funding,” according to recent congressional testimony from Daniel Hawkins of the National Association of Community Health Centers.
“We urge Congress to take action well before the September 2017 expiration of the Health Center Fund” to make the source permanent and “reduce the uncertainty caused by year-by-year renewals of this critical investment in access to care,” Hawkins’ written testimony said.
Schilling said the potential for Planned Parenthood centers to reduce services puts community health centers in a tough spot. “This is a completely, totally political discussion and we, community health centers, are getting a little caught in the middle of it.”
CORRECTION: An earlier version of this story had the wrong title for House Speaker Paul Ryan.