Does defunding Planned Parenthood really threaten women's health?

Washington D.C., Jan 18, 2017 / 15:56 pm

Congressional plans to strip Planned Parenthood of federal dollars have gained considerable media attention in recent weeks, leading to speculation about the impact that such a move would have on women's health.

Both the House and the Senate have passed measures to set up a vote to bar Planned Parenthood from receiving federal funds, which mostly come in the form of Medicaid reimbursements. According to its FY 2014-15 report, the organization and its affiliates received almost $554 million in taxpayer dollars, 43 percent of its total revenue.

The measures have been hailed as a victory by pro-life groups, and lamented as an attack on women's health care by those who support abortion.

But beneath the hype, what exactly would happen if federal funding were pulled from Planned Parenthood?

Years of controversy

The main argument against Planned Parenthood's federal funding is that it is the nation's largest abortion provider, performing around 330,000 abortions per year, and the Hyde Amendment prohibits federal dollars from directly paying for abortions.

Medicaid reimbursements and federal health grants are not supposed to go directly toward abortions, although a recent report by the Charlotte Lozier Institute and Alliance Defending Freedom claimed that, according to federal and state audits, taxpayer dollars were funding abortion-related services.

In New York, "hundreds of thousands of abortion-related claims were billed unlawfully to Medicaid" over a four-year audit, the report said. One audit in Nebraska "found a Planned Parenthood affiliate spending federal funds on abortion expenses" like "physician fees" for an abortionist and "employee travel" and "on-call" work time involving abortion procedures.

Planned Parenthood claims that abortions account for only three percent of the total services they provide, although fact-checkers – at the Washington Post among others – have taken issue with that claim, pointing out that Planned Parenthood counts each small procedure like a pregnancy test or a pap smear as a service provided, but abortion accounts for much greater cost and revenue for the organization.

During a town hall last week, House Speaker Paul Ryan explained that even if federal dollars are not going to direct payment for abortions at Planned Parenthood clinics, the current revenue may be fungible – it frees up other resources for Planned Parenthood to perform abortions.

Additionally, the organization has come under fire for multiple controversies in recent years.

A 2015 Alliance Defending Freedom report claimed that Planned Parenthood clinics in several states were not reporting suspected cases of sexual abuse of minors as they were supposed to by law.

Planned Parenthood doctors were also shown on undercover camera in 2015 discussing prices for the body parts of aborted babies with actors posing as representatives of a tissue procurement company. Those videos shone a light on the organization's role in the fetal tissue trade.

These controversies have strengthened calls for defunding. According to polls released by the pro-life group Susan B. Anthony List earlier this month, a majority of respondents in states that will be "battleground states" in the 2018 Senate races – like North Dakota, Florida, and Ohio – opposed taxpayer funding of Planned Parenthood.  

Providing alternatives

In his town hall comments, Speaker Ryan stressed: "We don't want to effectively commit taxpayer money to an organization providing abortions, but we want to make sure that people get their coverage."

"We believe that this can better be done by putting that money in federal community health centers," he added. "They are vastly bigger in network, there are so many more of them, and they provide these kinds of services without all the controversy surrounding this issue."

According to the Charlotte Lozier Institute, the research arm of the Susan B. Anthony List, such health centers are publicly-funded and exist in all 50 states, almost 10,000 in total, compared to around 650 Planned Parenthood clinics nationwide. The health centers served over 24 million people in 2015, while Planned Parenthood says it serves around 2.5 million per year.

There are also thousands of other rural health clinics that offer services including primary care and first response, as well as some vaccinations, though these facilities are not required to offer as many services as federally qualified health centers are. Some 4,000 crisis pregnancy centers in the U.S. also offer help for expectant mothers.  

According to the Department of Health and Human Services, the "main purpose" of federally qualified health centers "is to enhance the provision of primary care services in medically-underserved urban and rural communities."

These health centers do not perform abortions but they do provide services like pre-natal and perinatal care, diabetes screening, pap smears, checkups and mammograms, something Planned Parenthood president Cecile Richards has admitted her clinics do not provide, despite claims that they do. Planned Parenthood only provides referrals for mammograms, not the procedures themselves.

Would Planned Parenthood survive?

Removing federal funding from Planned Parenthood would not necessarily mean that the organization would shut its doors.

From 2011-2015, Planned Parenthood's annual reports indicate that its revenue exceeded expenses by more than $300 million.

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The organization also fundraises, and claims that the threat of defunding has considerably upped contributions from private donors.

The Congressional Budget Office in 2015 considered the potential consequences of defunding Planned Parenthood for a year. It found that it was uncertain whether the organization would be able to replace the lost funding.

"If none of the federal funds were replaced," the budget office said, some customers wouldn't receive any services that they would have received at Planned Parenthood, while others would go to other clinics accepting Medicaid payments.

"If almost all federal funds were replaced, CBO expects that most Medicaid beneficiaries currently served by Planned Parenthood would continue to obtain services from Planned Parenthood, but at no cost to Medicaid," they said.

Is it enough?

If Planned Parenthood did close its doors, would federally qualified health centers and pregnancy centers be able to handle an influx of patients seeking health care other than birth control or abortions?

When "family planning clinics" in Texas and Wisconsin closed due to state funding cuts, the number of women utilizing services like cancer screenings and checkups at clinics also went down, said Professor David Slusky at the University of Kansas.

But in those cases, there were cuts in funding in addition to redirecting some of the remaining state funds to health centers. In contrast, the current plan proposed by Congress would not cut funding, but simply redirect it.

Slusky told CNA that it is not clear from his research whether health centers would fill health care "gaps" left by the closure of some Planned Parenthood clinics. Part of this would depend on what other clinics were receiving funding. It is possible that some women would forego cancer screenings and other forms of care if they have to travel a greater distance to find a clinic.

Knowledge of other options would be key. Women going to Planned Parenthood clinics may not necessarily know of other crisis pregnancy centers, writes research analyst Dr. Jeff Pauls.

Many women he interviewed for his work "were unaware of the idea of the Pregnancy Help Center, although they occasionally referenced government health clinics as an alternative to Planned Parenthood."

The women were not necessarily admirers of Planned Parenthood, he wrote, saying that they "are most troubled by the waiting room practices demonstrated by the long waits, non-confidential medical conversations, and the general fear and mistrust of the low-income people who are frequent customers."

Ultimately, Charlotte Lozier Institute believes women will be able to access the care they need through other clinics. The number of Planned Parenthood patients has decreased recently and their total "prenatal services" are down 44 percent since 2010, they said. And according to the pro-life group Live Action, Planned Parenthood provides only 2 percent of the nation's clinical breast exams and 1 percent of the nation's pap smears.

If the organization's current federal funding were redirected to community health centers, those centers would see an average patient increase of two per week and almost surely would be able to meet the increased need.

And the centers have been growing, Charlotte Lozier Institute says, treating almost two million new patients and growing by 430 new centers in 2015.

The institute also pointed to a website showing locations of health centers and pregnancy centers and the services they offer, GetYourCare.org.

"Voters agree: taxpayer dollars would be better spent on community and rural health centers that provide comprehensive, whole-woman care," said Marjorie Dannenfelser, president of the Susan B. Anthony List. "Abortion giants like Planned Parenthood do not need or deserve taxpayer dollars."