By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
The often-quiet summer months in Washington, DC, were roiled this year by videos attacking Planned Parenthood Federation of America and its affiliates for facilitating the donation of fetal tissue at the request of some women having an abortion. The organization has strongly denied any wrongdoing, and multiple state investigations have turned up no evidence that it has profited off of such donations or otherwise violated the law.1
Nevertheless, conservative lawmakers at the federal and state levels have used the controversy to renew their long-standing attacks on Planned Parenthood and its provision of abortion services by attacking the organization’s receipt of government funding for providing contraceptive care, cervical cancer screening, sexually transmitted infection testing and treatment, and other related care. The Hyde amendment, nearly four decades old, bars the use of federal dollars for abortion, with few exceptions.
Policymakers also have proposed new restrictions on fetal tissue donation and research, despite its well-established value for medical research, and are some are using the controversy as further ammunition for enacting new abortion restrictions.
If successful, attempts to defund Planned Parenthood, which are intended to ultimately drive the organization out of business entirely, would have a major impact on low-income people’s access to affordable family planning care. Many proponents of defunding argue that other healthcare providers, namely federally qualified health centers (FQHCs), easily could fill in the gap. However, despite their rapid expansion in recent years, FQHCs are serving only about one-quarter of the estimated need for low-cost primary care.2 Replacing Planned Parenthood in the family planning safety net would be a substantial strain on FQHCs’ resources and capabilities.
A new analysis from my Guttmacher Institute colleagues, conducted in response to a request from the Congressional Budget Office, helps demonstrate how central a role Planned Parenthood serves in that safety net.3 In 68% of the 491 counties in which they are located, Planned Parenthood sites served at least half of all women obtaining contraceptive care from safety-net health centers in 2010 (the most recent year for which data are available). In 21% of these counties, Planned Parenthood sites were the only safety-net family planning centers.
In fact, Planned Parenthood’s role in providing care is disproportionate to its presence. Although Planned Parenthood sites accounted for only 10% of safety-net family planning centers nationwide in 2010, they served 36% of the 6.7 million U.S. women receiving contraceptive care from such centers. The average Planned Parenthood health center serves significantly more contraceptive clients each year than do safety-net centers run by other types of providers: 2,950 clients per year, compared with 330 contraceptive clients at the average FQHC. In addition, Planned Parenthood sites are more likely than other sites to offer a wide range of contraceptive methods, to offer oral contraceptive supplies and refills on-site, and to offer same-day appointments, all of which helps to make contraceptive care accessible to the women and men who need it.
As of mid-September 2015, whether Planned Parenthood will be defunded at the federal level remains unclear. Members of Congress have introduced multiple bills to strip the organization of funding through Medicaid, the Title X family planning program, and other public dollars. A bloc of conservative lawmakers, including several presidential candidates, has pledged to oppose any government funding bill that does not cut off Planned Parenthood, even if that results in a shutdown of the federal government. Republican congressional leaders, however, seem determined to avoid a shutdown and have acknowledged that conservatives don’t have the votes to force the matter in the Senate or override a presidential veto.4 Yet, they are likely to pursue other legislative options that would restrict access to abortion and that might endanger family planning funding. Notably, earlier this spring, House Republicans proposed to eliminate the Title X program entirely.
At the state level, attacks on Planned Parenthood are moving at a faster pace. Even before the latest controversy broke, 10 states had barred some pots of family planning funding from going to many safety-net health centers, most commonly those that provide abortion services or are affiliated with others that do so.5 In the wake of the videos, several additional states are trying to exclude Planned Parenthood from public funding, including three states (Alabama, Arkansas, and Louisiana) that have moved to kick Planned Parenthood out of the Medicaid program.6 The Centers for Medicare and Medicaid Services has reiterated to states that such actions violate federal Medicaid law (just as it did in 2011, in response to similar attempts by Arizona and Indiana), and lawsuits are pending in all three states.7
All of these fights can be expected to continue over the remainder of 2015 and into 2016, as state legislatures return from their breaks. The issue also will likely play a notable part in the 2016 presidential campaign, with most of the Republican candidates on record opposing government funding for Planned Parenthood.
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Wilson T. Planned Parenthood investigations uncovering no wrongdoing. RH Reality Check, Aug. 6, 2015; accessed at http://bit.ly/1KgSBDg.
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Rosenbaum S. Planned Parenthood, community health centers, and women’s health: Getting the facts right. Health Affairs Blog, Sept. 2, 2015; accessed at http://bit.ly/1JBqSN6.
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Frost J, Hasstedt K. Quantifying Planned Parenthood’s critical role in meeting the need for publicly supported contraceptive care. Health Affairs Blog, Sept. 8, 2015; accessed at http://bit.ly/1K4WVlL.
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DeBonis M, Snell K. Wary of shutdown, GOP leaders try to refocus abortion debate. Washington Post, Sept. 14, 2015; accessed at http://wapo.st/1QD0vZN.
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Guttmacher Institute. State family planning funding restrictions. State Policies in Brief; accessed at http://bit.ly/1NyctEj.
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Ferris S. Planned Parenthood files lawsuit against Arkansas. The Hill, Sept. 11, 2015; accessed at http://bit.ly/1F3cDSI.
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Armour S. States warned over ending Medicaid funds for Planned Parenthood. Wall St J, Aug. 12, 2015; accessed at http://on.wsj.com/1DKdvv1.
