“You know, first, most Planned Parenthood settings are in urban areas, urban areas that have lots of OB/GYNs. . . . Now, as it turns out, the folks who don’t have access to those cancer screenings live in rural areas. They live in areas where there are not enough physicians. So the idea is that we want someone to have to drive — a lower-income person drive — three hours to a Planned Parenthood facility there to get her screening, or would we rather take that money and put it back in the rural area to allow her to get her health care there?”
— Sen. Bill Cassidy (R-La.), health-care debate on CNN, Sept. 25, 2017
With the House planning to vote Oct. 3 on an antiabortion bill, we dug into this common talking point by opponents of abortion rights.
During a recent health-care debate on CNN, a woman asked about the provision in the Senate’s most recent Affordable Care Act repeal bill that would restrict federal funding to Planned Parenthood. The woman said a Planned Parenthood cancer screening in her mid-20s found ovarian cysts and benign tumors, and criticized the bill for blocking health care for women, “especially for those who live in the many parts of this country that are not served by community health centers.”
Cassidy, co-sponsor of the now-failed bill, said most Planned Parenthood health clinics are in fact in urban areas, rather than rural areas or areas without enough physicians. Is that accurate?
Medicaid is a major source of revenue for both Planned Parenthood clinics and federally qualified health centers. So legislation to “defund” Planned Parenthood proposes pulling Medicaid funding and other federal grants from Planned Parenthood and redirecting them to “federally qualified health centers,” which are required to provide care to everyone regardless of whether they can pay, and do not provide abortion services.
Federally qualified health centers are required to serve medically underserved populations and areas with health professional shortages.
“Medically underserved” is defined as “too few primary care providers, high infant mortality, high poverty or a high elderly population.” The “health professional shortage” designation is made based on the ratio of primary care, dental or mental-health medical providers per population.
These designations can be made in both rural and urban areas. In fact, a hospital can be designated its own health professional shortage area, even if it is in an urban area. The federal government uses these designations to recruit health-care professionals and allocate money, targeting areas with documented shortages.
Planned Parenthood is not required to serve these populations — but it does in many urban and rural areas of the country. A breakdown of health center locations provided by Planned Parenthood shows 56 percent of its health centers are in rural, “medically underserved” or “health professional shortage” areas. We spot-checked about half of the 600-plus Planned Parenthood locations to verify the organization’s list, and found no reason to doubt its veracity.
However, these three terms are not interchangeable. And a “medically underserved” or “health professional shortage” designation doesn’t necessarily mean that everyone there is medically underserved all the time, according to federal health officials. Individuals’ access to care depends on many factors, including Medicaid eligibility and transportation access. So you may live in an area that has none of these designations but still be unable to afford transportation or quality medical care.
Plus, these designations are not broken down by women’s health needs, so it’s not a perfect measure in this context.
Cassidy’s staff pointed us to the two Planned Parenthood health clinics in Louisiana, which are in Baton Rouge and New Orleans. (The woman who asked the question of Cassidy was from Wisconsin, and Cassidy did not specify during the debate that he was referring only to Louisiana.)
While New Orleans and Baton Rouge are the largest cities in Louisiana, the Planned Parenthood clinics in both cities are in federally designated health professional shortage areas, according to the Department of Health and Human Services database. This underscores how being an urban or large city does not always correlate to adequate access to health care.
Still, Cassidy has a point. There are far more federally qualified health centers than there are Planned Parenthood clinics, particularly in the rural South, and both types of centers provide cancer screenings and women’s health services (other than abortions).
But they’re not directly comparable. Federally qualified health centers serve a larger and more diverse patient population than Planned Parenthood because they offer more comprehensive services (primary, dental, behavioral health). And Planned Parenthood offers more contraceptive services than federally qualified health centers.
Moreover, according to Guttmacher Institute, a reproductive-health research organization, 24 states have restrictive laws or policies that make it difficult for abortion providers to open or operate.
It’s unclear whether these federally qualified centers can completely absorb Planned Parenthood’s workload, or whether investing in the federal health centers would solve the access-to-care barriers for women. (The Congressional Budget Office explored this issue in 2015. We dug deeper into this issue here.)
Out of 3,233 counties or county equivalents in 2016, there were 1,640 with a federally qualified health center but no Planned Parenthood, and only 30 with a Planned Parenthood but no federally qualified health center, according to the Congressional Research Service.
But there was overlap in many of the counties. Out of 382 counties with a Planned Parenthood health clinic in 2016, 352 of them — 92 percent — had both a Planned Parenthood health clinic and a federally qualified health center, according to CRS. There were 1,192 (37 percent) without either facility.
A spokesman for Cassidy said that the overwhelming majority of primary care shortage areas in Louisiana are outside of urban cities, and yet the two Planned Parenthood clinics are in the state’s two biggest cities. He noted that in Louisiana, there are over 240 federally qualified health center locations. Cassidy believes in prioritizing federal funds for health centers outside of the urban areas, the spokesman said.
“Given that we have limited dollars to spend, it’s important that we prioritize funding to health centers that best reach the underserved and provide greatest access to patients,” the spokesman said. “Dr. Cassidy believes it’s a better use of our money to prioritize funding for community health centers, which outnumber Planned Parenthood clinics by a ratio of 120 to one in the state, and do an excellent job of providing women with the comprehensive health-care coverage they need in the areas of that state that need it most.”
(Thanks to Washington Post data reporter Anu Narayanswamy for helping us sort through federal health data.)
The Pinocchio Test
There are many federally qualified health centers in certain areas that may be geographically easier for women to visit than a Planned Parenthood clinic. While these centers provide cancer screenings and family planning services, they serve a more general population, so the two types of centers are not entirely comparable. The federally qualified facilities are required to serve federally designated “medically underserved” populations and “health professional shortage” areas.
Planned Parenthood does not have such a requirement, but it’s not accurate to say that “most Planned Parenthood settings are in urban areas” and areas with enough physicians. Roughly half of the organization’s clinics are located in areas that are rural, or are federally designated as medically underserved or health professional shortage areas. These designations don’t necessarily mean that everyone in the area has limited access to care, or that they can’t access cancer screenings at facilities other than Planned Parenthood. But it does show that Cassidy’s claim is wildly exaggerated, worthy of Three Pinocchios.
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