Community Health Centers Can’t Go It Alone

A women's health clinic in San Antonio, June 2016.

This column contains a correction.

Last week, the House passed a bill to repeal the Affordable Care Act, or ACA, by a narrow margin: 217-213. Just weeks after President Trump signed a bill that overturned a critical Obama administration rule that protected Title X providers and provided health care to nearly 4 million people a year, women’s health is now under attack more broadly. The American Health Care Act, or AHCA, threatens essential health benefits,* restricts abortion access, cuts Medicaid funding, and jeopardizes economic security for millions of women. In an attempt to shut down Planned Parenthood health centers, conservatives insist that community health centers, or CHCs, can shoulder the burden of Planned Parenthood’s client base should their doors close. This romanticized notion of CHCs and their capacity not only jeopardizes the health and well-being of millions of low-income people—it also puts the entire health care system at risk by destabilizing the Title X network.

Let’s be clear: Title X, the nation’s only federal program devoted to family planning services, grants more than $200 million a year to nearly 5,000 clinics. It pays for contraception; education and counseling; breast and cervical cancer screenings; and sexually transmitted infections, or STI, screenings, among other services. It has never in its 47-year history funded abortion services due to the Hyde Amendment—a budgetary amendment that restricts the use of federal funds for abortion coverage. While it is true that CHCs outnumber Planned Parenthood health centers, a recent study shows that Planned Parenthood provides care to more than 1.5 million clients who rely on Title X, approximately one-third of all people that the Title X serves nationally. In general, CHCs struggle to meet the demands of their existing client base due to financial and clinician shortages. Worse, many do not provide comprehensive reproductive health care and often refer their patients to family planning providers, such as Planned Parenthood health centers, to receive birth control, pelvic and breast exams, STI tests, and other forms of care.

CHCs are essential but limited in the services they provide

The measure overturning Title X protections, while targeting Planned Parenthood, does not defund it, as it is often stated. It does, however, embolden states to block access to Title X family planning centers, which can harm Planned Parenthood clinics and CHCs alike. The results can be dangerous, as many women would lose their only resource for health care, particularly if they live in rural areas where there is already limited access to medical care. Clients in rural areas are more likely to be low income, lack health insurance, and rely heavily on Medicaid. Nearly 90 percent of women in rural towns are forced to drive an hour to get to the nearest hospital offering health services. According to the American Congress of Obstetricians and Gynecologists, or ACOG, women of reproductive age in rural areas use contraception less and are more likely to have an unintended pregnancy. This is why it’s critical that more than half of all Planned Parenthood health centers reside in rural or medically underserved communities and provide care to these populations who rely on Medicaid and/or the Title X family planning program.

Furthermore, in states such as Mississippi, Texas, North Carolina, and Idaho, legislators are attempting to close Planned Parenthood health centers and use state funds to subsidize crisis pregnancy centers, or CPCs. CPCs are funded by anti-abortion groups and churches, and they claim to offer medical care to pregnant women. In reality, CPCs do not provide reproductive health services. With no medical staff or services onsite, they instead provide faith-based counseling and misinformation to dissuade women from having an abortion.

State efforts like this don’t just harm women—they hurt families living paycheck to paycheck. While many federally qualified health centers, or FQHCs, provide comprehensive reproductive health services, they alone cannot fill they needs of all women seeking services throughout the nation. Unfortunately, the capacity for most FQHC clinics is stretched thin by the number of patients they currently see. And where there are health care deserts, women will struggle to maintain their economic security and well-being.

All Title X family planning clinics are invaluable to low-income families

Clinics that receive Title X funding, whether they are Planned Parenthood or independent clinics, are life lines to low-income families, particularly those on Medicaid. These clinics are essential to providing care to the nation’s most vulnerable women and families. Ensuring that low-income women and women of color receive the care that they deserve hinges on expanding access to Title X family planning clinics, as Title X family planning has contributed to the health and well-being of clients for nearly 50 years.

The benefits of generational access to Title X is nothing to scoff at. Currently, the nation is experiencing historic low rates of teen pregnancy and a 30-year low for unintended pregnancies. Publicly funded clinics have helped women prevent 1.9 million unintended pregnancies in 2015 alone. Without Title X funding, the unintended teen-pregnancy rate would have been 44 percent higher. The current administration’s actions jeopardize hard-fought progress to reduce unintended pregnancy, putting young women’s futures and their economic security at risk.

All Title X family planning clinics help women control their reproductive lives regardless of race, income status, or family size, which inevitably contributes to their economic security. A failure to strengthen Title X, unlike the Obama administration, compounds the challenges that teens, low-income families, women of color, and rural families face across this country. While CHCs play an important role, they cannot absorb the Planned Parenthood client base, as many conservatives claim, because Planned Parenthood is more likely than others to serve high volumes of clients seeking contraceptive care. Planned Parenthood is essential to the provider network and works in tandem with CHCs, hospitals, and other independent organizations. It is also a trusted source for information and resources. Seventy-five percent of Americans oppose “defunding’ Planned Parenthood, including more than half of Trump voters and the majority of voters in key Republican-held swing House districts.

So while the president has repeatedly promised to invest and empower women, his actions have shown an all-out assault on women and working families. His efforts have undermined women by recommending budget cuts to the Department of Health and Human Services and the Centers for Disease Control; attempting to repeal the ACA and restrict Title X funds from Planned Parenthood; and attacking workers’ rights. Only the words of the prolific James Baldwin appropriately sum up the first 100 days of this administration: “I can’t believe what you say because I see what you do.”

Heidi Williamson is the Senior Policy Analyst for the Women’s Health and Rights Team at the Center for American Progress.

*Correction, May 11, 2017: This column has been corrected clarify the effects of the AHCA.