Contrary to recent claims by House Speaker Paul Ryan, R-Wis., experts say the nation’s community health centers don’t have the staff 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 were defunded, the Congressional Budget Office estimates that 150,000 to 650,000 patients could face reduced access to care.
Ryan said those 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.
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“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 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.”
In California, a successful expansion program under the Affordable Care Act brought Medicaid beneficiary numbers to a nationwide high of 12 million. Now, health advocates worry about how the already overburdened safety net will hold up without Planned Parenthood.
As dramatic as California’s post-health reform enrollment was, so will be the spillover of patients losing coverage should the act be repealed, said Amy Adams, senior program officer for the California Healthcare Foundation, an Oakland-based nonprofit group that tracks state health trends.
About 1.4 million people purchased health insurance through Covered California, the state’s marketplace under the Affordable Care Act. Another 3.7 million adults became eligible for Medi-Cal under the federal guidelines, according to the state Department of Health Care Services. People who now use Medi-Cal to visit a doctor but couldn’t afford the cost out of pocket will end up in community clinic waiting rooms, along with former Planned Parenthood patients.
“California expanded Medi-Cal early and did a very good job at outreach and getting people coverage, and similarly with Covered California,” Adams said. “It’s a lot of people who could potentially be without insurance and need to find ways to get care.”
Currently, the state’s 115 Planned Parenthood clinics use $260 million in federal funds – 65 percent of the national total – to serve about 15 percent of all Medicaid recipients. The rest, who often struggle to find primary care physicians given the program’s low reimbursement rates, receive services on an as-needed basis at community clinics and emergency rooms.
If Planned Parenthood shuts its doors and its 850,000 low-income patients seek new medical homes, the shift will “put tremendous stress on the remaining providers,” said Carmela Castellano-Garcia, president of California Health+ Advocates, which represents community clinics and health centers throughout the state.
“This would just leave hundreds of thousands of individuals needing recourse for care,” she said. “This could be just the beginning of a cascade effect of withdrawn funding that could affect our state in a very significant way.”
Located in impoverished areas with high infant mortality rates and few health care 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.
More than 70 percent of health center patients earn at or below the poverty level, according to the National Association of Community Health Centers.
At the Sacramento Native American Health Center, a community clinic that serves patients of all ages and ethnic backgrounds, CEO Britta Guerrero said staff members historically have worked closely with Planned Parenthood to provide primary, mental health and reproductive care.
Unlike other, more crowded clinics serving Sacramento’s low-income population, the center is accepting new patients after a massive expansion, Guerrero said. Still, it would be a struggle to pick up the slack if Planned Parenthood left the picture.
“In Sacramento, the Planned Parenthoods have thousands of patients,” she said. “To absorb all of those patients and all of their health needs immediately would really be a tremendous strain on the safety net. We don’t turn anybody away, absolutely not, but it would take a transition.”
Nationwide, virtually all health centers have at least one clinical staff vacancy although staff numbers at health centers have nearly doubled since 2000. A recent report from the community health centers association found that 70 percent need another family physician. 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.