Reproductive health care experts, though, say it’s a mistake to view Planned Parenthood and community health centers as interchangeable simply because they both offer government-subsidized contraception. Instead, they say, it’s more accurate to consider Planned Parenthood part of a vast health care ecosystem, where it has made itself indispensable by providing one thing — reproductive health care — well.
“Community health centers, unlike Planned Parenthood, have an obligation to see everyone in their communities for everything,”
said Sara Rosenbaum, a professor of health policy at George Washington University. “Ideally you want community health centers working hand in glove with organizations like Planned Parenthood, not replacing them.”
Removing Planned Parenthood from the fabric of the health care system wouldn’t just mean that community health centers would have to scale up their family planning departments; they’d have to be prepared to offer a full range of services. This could be an ambitious and expensive goal.
The question of whether community health centers would be able to provide reproductive health care in lieu of Planned Parenthood isn’t entirely hypothetical. Texas provided a dry run, of sorts, when it embarked on a series of efforts to divert funding away from Planned Parenthood in 2011.
First, the legislature instituted broad cuts to family planning services, spurring the closure of 82 clinics, one-third of which were affiliated with Planned Parenthood. Then, after an attempt to steer funds away from Planned Parenthood in the state’s federally funded Medicaid program was stymied by the federal government, Texas decided to forgo federal Medicaid dollars for family planning and set up a state-funded Medicaid lookalike called the Texas Women’s Health Program, which could legally exclude any clinic affiliated with an abortion provider. Iowa is considering a similar move: It would also create a women’s health network with no federal Medicaid support and no participation by abortion providers.
Texas’s example foreshadows what could happen if the Republicans’ defunding proposal goes through and states and localities don’t step in to fill the gap.
It’s hard to know exactly how many low-income women rely on Planned Parenthood; in Iowa, Planned Parenthood served 62 percent of women who received publicly funded contraception from a safety-net center in 2010, according to an analysis by the Guttmacher Institute, a research organization that supports abortion rights. Since then, some Iowa Planned Parenthood facilities have closed, and more women may have gained insurance under the Affordable Care Act, so the numbers aren’t up to date. Supporters of the Iowa bill say 221 existing health care sites are eligible to offer family planning care under their plan.
But even if the same amount of money is being spent on family planning, some women, when faced with a loss of coverage at Planned Parenthood, may not continue receiving services at other local clinics — either because of a lack of capacity or a lack of knowledge about where to go.
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Then there’s the fact that even if they are accepting new patients, community health centers are likely to have longer wait times for an appointment and might not carry a woman’s preferred brand or type of contraception at all. “Other clinics don’t necessarily have night or weekend hours,” said Kami Geoffray, CEO of Women’s Health and Family Planning Association of Texas, a network of family planning providers. At Planned Parenthood, “you can pick up your birth control pills at the counter and get a same-day IUD insertion.” Guttmacher data shows that Planned Parenthood sites are more likely than community health centers to offer a wide range of contraceptive services and to have a pharmacy on site. Planned Parenthood clinics are also likelier than other health care providers to offer same-day appointments.
