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If GOP defunds Planned Parenthood, health centers can't handle patient flood

President Donald Trump is joined by the Congressional leadership and his family before formally signing his cabinet nominations into law, in the President's Room of the Senate, at the Capitol in Washington, January 20, 2017. From left are Vice President Mike Pence, the president's wife Melania Trump, their son Barron Trump, and Speaker of the House Paul Ryan, R-Wis. REUTERS/J. Scott Applewhite

WASHINGTON — Contrary to recent claims by House Majority Leader 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 about 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.

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.

"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."

Often 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.

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. "... It's not just a counseling visit and some birth control pills."

Health centers also are facing their own financial challenges. 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, senior vice president for public policy and research at 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.

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