New evidence from the Guttmacher Institute shows that it is unrealistic to expect federally qualified health centers (FQHCs) to serve the millions of women who currently rely on Planned Parenthood for high-quality contraceptive care. The argument that FQHC sites could easily absorb these clients has been key to social conservatives’ efforts to shutter Planned Parenthood health centers by excluding them from various public funding streams, including Medicaid.

Guttmacher’s findings are detailed in a new Guttmacher Policy Review analysis that outlines why Planned Parenthood health centers, as well as providers supported by the Title X national family planning program, are essential to the nation’s family planning safety net. Guttmacher calculated these data in response to a request from Sen. Patty Murray (D-WA), in her capacity as ranking member of the U.S. Senate Health, Education, Labor and Pensions Committee, for information on women’s ability to obtain publicly funded contraceptive care in the face of policy threats to Planned Parenthood and Title X.

FQHCs are an essential part of the nation’s overall health care safety net, delivering a broad range of primary care services to 25 million people annually. However, only 60% of FQHC sites nationwide reported offering contraceptive care to at least 10 women per year in 2015 and were considered part of the network of safety-net contraceptive providers. 

“FQHCs are indispensable, but to suggest they could easily step up to replace Planned Parenthood is a politically expedient argument that willfully ignores the facts on the ground,” says Kinsey Hasstedt, author of the new analysis. “These attacks put millions of U.S. women at very real risk of being unable to obtain the basic, high-quality care they need and deserve.”

To take on Planned Parenthood’s current clients, FQHC sites providing contraceptive care would have to at least double their contraceptive client caseloads in 27 states. In nine of those states, these FQHC sites would have to at least triple their capacity. Nationwide, FQHC sites would need to take on an additional two million contraceptive clients.

In 13% of the 415 U.S. counties with Planned Parenthood health centers, there are no FQHC sites providing contraceptive care. In another 67% of these counties, FQHC sites providing contraceptive care would have to at least double their capacity in order to serve all of the female contraceptive clients currently served by Planned Parenthood; in 26%, they would have to serve at least six times the number of contraceptive clients they do today. Put differently, 85% of Planned Parenthood’s contraceptive clients (1.7 million) are in the 333 counties where FQHC sites would have to at least double their capacity to provide those services, or where there are currently no FQHC sites providing contraceptive care.

Socially conservative policymakers are also seeking to wholly eliminate or undermine the Title X family planning program, by directing Title X funding to FQHC sites while excluding providers focused on reproductive health, some of which also offer abortions with separate funding. Here, too, the evidence shows that FQHCs would face immense challenges in sustaining the current reach of the Title X program.

FQHC sites providing contraceptive care would have to at least double their contraceptive client caseloads in 41 states, and at least triple them in 27 states, in order to maintain the capacity of what is now a diverse and robust network of Title X–supported providers. Nationwide, this would add up to an additional 3.1 million clients. At the local level, 2.8 million (91%) of the contraceptive clients currently served by Title X–supported centers that are not FQHCs are in counties where FQHC sites would have to at least double their capacity, or where there is no FQHC site providing contraceptive care. 

“Asking FQHCs to become the main source of publicly funded family planning care in the United States is not a viable policy proposal,” says Hasstedt. “Worse, this push is happening against the backdrop of efforts to repeal the Affordable Care Act and drastically cut the Medicaid program, which would put enormous stress on the health care safety net, including FQHCs. Despite their claims to the contrary, proponents of these proposals are jeopardizing women’s ability to obtain contraceptive and other basic healthcare, not protecting it.”

 

New and updated resources

Guttmacher’s new analysis is available here:

Federally Qualified Health Centers: Vital Sources of Care, No Substitute for the Family Planning Safety Net,” by Kinsey Hasstedt

Two analyses first released in January 2017 have been updated to reflect the newest data:

Understanding Planned Parenthood’s Critical Role in the Nation’s Family Planning Safety Net,” by Kinsey Hasstedt

Why We Cannot Afford to Undercut the Title X National Family Planning Program,” by Kinsey Hasstedt