Politifact-checks are almost never the last word, and the latest one from Politifact Georgia criticizing Congressman Barry Loudermilk for his assessment of women’s real healthcare alternatives to Planned Parenthood is a case in point. First and most important, the fact check misconstrues the heart of Congressman Loudermilk’s assertion that defunding Planned Parenthood will expand women’s access to health services. Although Politifact narrowly focuses on access to “services, from pap smears to birth control,” Congressman Loudermilk’s assertion refers to the fact that federally qualified health centers and community health centers offer a wide variety of vital health services that no Planned Parenthood touches.
Marguerite Duane, M.D., M.H.A., FAAFP, a board-certified family physician, is co-founder and Executive Director of the Fertility Appreciation Collaborative to Teach the Science, an organization dedicated to educating healthcare professionals and students about the scientifically valid natural or fertility awareness based methods of family planning. She also serves as an Adjunct Associate Professor at Georgetown University, and is a co-founder of Modern Mobile Medicine, a direct primary care house-calls based practice serving patients of all ages in the D.C. metropolitan area. Dr. Duane is one of our nearly 40 associate scholars. In this interview, she discusses community health centers, direct primary care, and natural or fertility awareness based methods of family planning.
To view this fact sheet as a PDF, see: Reallocating Planned Parenthood’s Federal Funding to Comprehensive Health Centers.
In 2015, the Congress of the United States adopted and sent to the President legislation whose effect would have been to reallocate funds from one family planning provider, Planned Parenthood, and redirect those funds to community health centers that typically offer family planning, but do not offer abortions. The goal of separating abortion from contraceptive services has long been a priority in national policymaking. In 2015 as well, Charlotte Lozier Institute, in partnership with Alliance Defending Freedom and other groups listed on the website, devised GetYourCare.org as a means to display the prevalence of these alternative, community-run and community-based providers. Overall, there are now at least 20 of these community providers for every Planned Parenthood clinic in the United States. Because of different word usage and the particular confines of each way of defining alternatives, different ratios can be assigned in discussing these far more prevalent alternatives for women, particularly Medicaid-eligible women. The information below sets out these definitions and why they yield diverse, but nonetheless accurate, ratios for women’s options.
Types of Health Centers
Q: What types of health centers are included in CLI’s national and state maps?
A: There are numerous types of health centers which serve as our nation’s “safety-net,” including but not limited to the following which CLI has included in its national and state map counts: Federally Qualified Health Center (FQHC) Service Sites, Rural Health Clinics (RHCs), and Look-Alikes (LAs). These are also the same health centers on GetYourCare.org.
Q: What are Federally Qualified Health Centers (FQHCs)?
A: Federally Qualified Health Centers (FQHCs) are the main organizations receiving a government grant under the Health Center Program Section 330 of the Public Health Service Act to serve medically underserved areas or populations. FQHCs are required to provide comprehensive services to an underserved area or population, offer a sliding fee scale, have an ongoing quality assurance program, and have a governing board of directors, the majority of whom are patients of the health center. FQHCs are required to provide health care services to patients regardless of their ability to pay, and also must offer transportation assistance as an enabling service.
Q: What are Federally Qualified Health Center (FQHC) Service Sites?
A: Each FQHC may operate multiple health clinics known as “FQHC Service Sites” where healthcare is provided. In order to compare apples to apples, it’s appropriate to compare the number of these actual clinic locations operated by FQHCs to the actual center locations of Planned Parenthood.
Q: What are Rural Health Clinics (RHCs)?
A: Rural Health Clinics are federally funded health centers providing services in areas designated as non-urban and underserved or having a current healthcare shortage. RHCs meet the requirements of Section 330 of the Public Health Service Act and are certified to receive special Medicare and Medicaid reimbursements.
Q: What are Look-Alikes (LAs)?
A: Also known as FQHC Look-Alikes or Health Center Program Look-Alikes, these health centers meet all of the requirements of the Health Center Program including providing comprehensive health care services, but do not receive government grant funding under the Health Center Program. Look-Alikes are, however, eligible for reimbursement through Medicare and Medicaid under similar methodologies as FQHCs; are eligible to purchase discounted drugs through the 340B Federal Drug Pricing Program; and may access National Health Service Corps providers.
Q: Is there any overlap between FQHCs and RHCs?
A: No, health centers that are approved as FQHCs may not be concurrently approved as RHCs, and vice versa.
Q: What are Community Health Centers (CHCs)?
Differences in Cited Numbers of Health Centers
Q: How many Federally Qualified Health Centers (FQHCs) are there currently?
A: There are 1,375 main FQHCs according to the latest Health Center Program Grantee Data published by the Bureau of Primary Health Care. These FQHCs operate multiple health clinics (FQHC Service Sites) at which health care is provided.
Q: How many FQHC Service Sites are there currently?
A: The nation’s FQHCs operate more than 10,500 FQHC Service Sites as of January 2017, according to the Health Resources and Services Administration (HRSA).
Q: How many Rural Health Clinics are there currently?
A: There are 4,134 RHCs as of the most recently updated list provided by the Centers for Medicare and Medicaid Services in September 2016.
Q: How many Look-Alikes are there?
A: There are 244 Look-Alike clinic locations as of January 2017.
Q: What does the count of “1,200 health centers” refer to?
A: This refers to the 1,198 main FQHCs in 2012, as cited in a March 2015 Government Accountability Office report which compared government funding sources of FQHCs and six other organizations including Planned Parenthood Federation of America.
Q: What does the count of “1,300 health centers” refer to?
A: This refers to the 1,278 main Federally Qualified Health Centers (FQHCs) identified by the federal Health Resources and Services Administration (HRSA) and available at the time of CLI’s map production in summer 2015. FQHCs, however, operate numerous health clinics (FQHC Service Sites) where health care services are provided.
Q: What does the count of “9,170 health centers” refer to?
Q: What does the count of more than “10,000 health centers” refer to?
A: This may either refer to the current total number of FQHC Service Sites (10,500) where health care services are provided as of January 2017 or the total number of FQHC Service and Administrative-Only Sites (10,030) at the time of CLI’s map production in summer 2015 according to HRSA. CLI did not include any Administrative Only Sites (564 in summer 2015) in any calculation or map of health centers because these locations do not provide health services.
Q: What does the count of “13,500 health centers” refer to?
A: This refers to the sum of three kinds of health centers: more than 9,100 Federally Qualified Health Center Service Sites, approximately 300 FQHC Look-Alikes, and approximately 4,100 Rural Health Clinics (RHCs) at the time of CLI’s maps publication in the summer of 2015. These are also the health centers that are included in GetYourCare.org.
Q: Where does the ratio, “13 health centers for every one Planned Parenthood,” come from?
Q: What is the current ratio of FQHC Service Sites only to Planned Parenthood centers?
A: There are 10,500 FQHC Service Sites and 639 Planned Parenthood centers listed as of January 2017, yielding a ratio of 16 to one.
Q: Where does the ratio, “20 health centers for every one Planned Parenthood,” come from?
A: This refers to the expanded calculation comparing the total of 13,540 health centers (9,100 FQHC Service Sites, 300 Look-Alikes, and about 4,100 Rural Health Clinics) to the 665 Planned Parenthood centers listed on Planned Parenthood’s website as of the summer of 2015.
Q: What is the current ratio of the sum of FQHC Service Sites, Look-Alikes, and Rural Health Clinics to Planned Parenthood centers?
A: There are a total of 14,878 health centers (10,500 FQHC Service Sites, 244 Look-Alikes, and 4,134 RHCs) to 639 Planned Parenthood centers, yielding a ratio of 23 health centers for every one Planned Parenthood. This ratio is helpful for putting into perspective the tens of thousands of low-cost comprehensive healthcare options available for women, though Look-Alikes do not currently receive Health Center Program funding.
Reallocating Government Funds away from Planned Parenthood and towards Federally Qualified Health Centers
Q: Why were Federally Qualified Health Centers included as alternative sources of care for women in the context of defunding Planned Parenthood and reallocating the federal funds?
A: Prior to the production of CLI’s Health Center-Planned Parenthood maps, the Government Accountability Office released a March 2015 report examining the government funding sources of Planned Parenthood Federation of America and five other organizations in comparison to that of the country’s Federally Qualified Health Centers (FQHCs). The report was requested by more than 60 Members of Congress. Following the release of investigative videos in the summer of 2015, Planned Parenthood argued that women’s health care would be severely threatened should it be defunded of its federal money. Recalling the GAO report and seeking to compare apples-to-apples, CLI created an initial series of graphs comparing the 9,170 FQHC Service Sites, actual health clinic locations, to the 700 Planned Parenthood locations.
Q: Why are Rural Health Clinics also included on CLI’s maps?
A: Rural Health Clinics are also an important part of our nation’s federally funded health care safety net serving Americans in specifically rural areas with a health care shortage. RHCs have enhanced reimbursement rates for providing Medicaid and Medicare services.
Q: Why are FQHC Look-Alikes also included on CLI’s maps?
A: We included FQHC Look-Alikes because they have been identified by HRSA and certified by the Centers for Medicare and Medicaid Services as meeting the same requirements of the Health Center Program, including providing primary and preventive care to patients, though they do not receive grant funding under that program.
Q: Under the budget reconciliation language, what alternatives do low-income women have?
A: Under the budget reconciliation draft language, Medicaid-eligible women continue to have full family planning coverage. They can use their Medicaid benefits at any other Medicaid-accepting health care provider. This includes the nearly 15,000 FQHC Services Sites, Look-Alikes, and Rural Health Clinics that outnumber Planned Parenthood by a ratio of at least 20:1. It also includes thousands of Medicaid-accepting physicians’ offices and walk-in clinics. Also under the budget reconciliation draft language, new funding is reallocated to FQHCs. Under this provision more than 10,500 FQHC Service Sites would be eligible to receive funding compared to the 639 Planned Parenthood locations.
2017 Report on Publicly Available Audits of Planned Parenthood Affiliates and State Family Planning Programs
A federal judge heard arguments on November 9 on Planned Parenthood’s challenge to an Indiana law requiring that an ultrasound be performed on a woman seeking an abortion at least 18 hours before the abortion is scheduled to take place.
Innovative pro-life legislation signed into law by Indiana Governor Mike Pence in March of this year is now facing extinction via the legal process.
The law, which forbids doctors from performing an abortion if the reason for the abortion is based on the “race, color, national origin, ancestry, sex, or diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability,” was scheduled to go into effect on July 1.
On October 7, the Charlotte Lozier Institute (CLI) filed two separate comments to the Department of Health and Human Services regarding its proposed rule on entities qualifying for the government’s Title X family planning funds. The proposed rule (Compliance with Title X Requirements by Project Recipients in Selecting Subrecipients, 81 FR 61639-61646), which was published September 7, seeks to preclude states from taking action to “restrict participation by certain types of providers as subrecipients in the Title X Program…”
The Charlotte Lozier Institute (CLI) and Americans United for Life (AUL) recently filed an amicus brief in a major lawsuit over the late-term abortion videotapes collected by the Center for Medical Progress (CMP). This lawsuit involves a vital public policy question: Can an association of abortion providers like the National Abortion Federation (NAF) successfully block the release of videos that show members of their organization potentially engaged in encouraging, supporting or facilitating the acquisition and/or sale of body parts from the unborn during the abortion process?
The Minnesota Department of Health publishes an extensive and organized annual abortion report that presents important public health information, including demographic statistics, while protecting the anonymity of women. Additionally, Minnesota reports the volume of abortions performed at each facility in the state.
Minnesota’s abortion trends provide a glimpse of what is happening to the abortion market on a national scale. Similar to national trends, the total number of abortions in Minnesota has decreased, one abortion facility has closed, several have merged, and Planned Parenthood increasingly dominates the market.
To view as PDF, see Fact Sheet: Government Funding Sources for Planned Parenthood
Thanks to a data point in Planned Parenthood’s annual report for 2013-2014, it’s public knowledge that the organization received $528.4 million in funds from all levels of government in that fiscal year. These funds are largely from the U.S. government and primarily from the Medicaid program, which is the primary federal-state program paying for direct medical services to the poor, defined for most purposes as individuals and families with incomes at or below 133% of the federal poverty line (FPL).
Ever since the summer of 2015 Congress has engaged in sustained debate over federal funds distributed to clinics affiliated with the Planned Parenthood Federation of America. In January of this year, Congress passed and sent to President Obama a budget reconciliation bill that would have had the effect of eliminating Medicaid reimbursements to Planned Parenthood that range into the hundreds of millions of dollars. These funds are part of annual government payments to the organization from a variety of programs (see the fact sheet here) that totaled nearly half a billion dollars each year from 2010-2012, and $553.7 million according to Planned Parenthood’s 2014-2015 annual report.
President Obama vetoed the reconciliation measure on January 8, which also would have affected major parts of the Affordable Care Act, and Congress failed to override the veto on February 2, 2016, voting 241-186 in favor of the override, well short of the two-thirds vote necessary to overcome the President’s objection.
Of all the Planned Parenthood data being looked at today as a result of release of the agency’s annual report, one of the more significant is the continued decline in its client total for reversible contraceptive methods (excluding services like sterilization and emergency contraceptive kits). This number is distinct from its contraceptive services total, where discrete services provided to a single individual are separately tallied, leading to a higher overall figure for services and a reduction in the apparent significance of a single “service” like abortion. The reversible contraceptive client total simply refers to the number of women coming to Planned Parenthood to obtain reversible contraception like oral contraceptives, barrier methods and IUDs, and this number continued to drop in 2014 – by more than 122,000 women, or more than 5.7 percent of those clients.
An editorial in Nature, one of the world’s leading scientific journals, recently covered the political debate surrounding fetal tissue harvesting and the editors’ perceived threat to this form of research with the defunding of abortion giant, Planned Parenthood. The article, “Fetal tissue research under threat,” was published on December 7th but was corrected soon after on December 8th.
Nature issued a correction in an area where there is a significant amount of uncertainty. The correction states, “An earlier version of this article incorrectly stated that six clinics recovered legally allowed costs for fetal tissue. In fact, we are unable to determine the exact number of clinics. Also uncertain is the number of remaining clinics that still supply the tissue. The text has been updated to reflect these uncertainties.”
By an overwhelming margin, American women and men report more favorable opinions of life-affirming pregnancy centers offering abortion alternatives, as compared to organizations providing abortions such as Planned Parenthood, according to a 2014 national poll commissioned by the Charlotte Lozier Institute (CLI).
One thousand American women aged 18-44 years and 300 men of the same age range were surveyed about questions related to health behaviors, specifically geared towards unexpected pregnancy decisions and care. Overall opinions and impressions about experiences were measured to contrast views towards organizations which provide abortion alternatives at the community-based level and those which offer and refer for abortion. (In addition, the survey population was polled on four direct measures of attitudes on the life issue including general pro-life and pro-choice sentiment as well as opinions on time limits and exceptions with respect to abortion laws. These results comported with a nationally representative sample within the margin of error.)
On November 17, the Ohio House Committee on Community and Family Advancement held a hearing on proposed legislation to defund Planned Parenthood and reallocate over $1 million yearly in government funding to other Ohio medical health centers. Following the hearing, the Committee recommended and the Ohio House passed H.B. 294 by a vote of 62-33.
Thomas M. Messner, J.D., Senior Fellow in Legal Policy for the Charlotte Lozier Institute, submitted the following written testimony in support of the bill. To view in PDF format, please see HERE.
In response to the Planned Parenthood scandal involving late-term abortions and harvesting fetal tissue from aborted babies, some are clinging to the claim that women, especially low-income women living in medically underserved areas, rely on the organization as their only healthcare provider. Further scrutiny has revealed that low-cost, publicly-funded health centers outnumber Planned Parenthood facilities 20 to one nationwide, care for 23 million Americans, and even provide more health services.
Aside from the sheer number of the combined sum of 13,000+ Federally Qualified Health Center (FQHC) service sites and Rural Health Clinics (RHCs), two aspects of these centers distinguish them and their mission: transportation assistance and accessible locations.
In a radio interview on the Diane Rehm Show on July 30, Terry O’Neill of the National Organization for Women (NOW) made a series of claims regarding Planned Parenthood that deserve a much closer look. O’Neill asserted that, “The claim that we can somehow replace Planned Parenthood overnight – you shut down all the Planned Parenthood’s [sic] clinics and that they could be replaced overnight, is silly and specious.”
It is indeed silly and specious because none of the proposals pending in Congress would shut down Planned Parenthood clinics and replace them, overnight or anytime. Instead, the discussion is about shifting the $528.4 million of total government funds away from Planned Parenthood and to the thousands of existing community health centers and other providers. As the following points make clear, Planned Parenthood can absorb the cut considering its relationship with private donors and its excess revenue, while on the other hand, community health centers have the capacity to acquire and serve new patients. Proposals in Congress to “defund” Planned Parenthood, therefore, merely reallocate women’s health expenditures to agencies that offer women a full menu of primary care.
This map and state chart depict the number of federally-funded health clinics that serve low-income, medically under-served populations in the United States in comparison to the number of Planned Parenthood centers. If Planned Parenthood, the nation’s largest abortion provider, were to be defunded from receiving over $500 million in taxpayer funds per year, there already exist over 13,000 non-abortion providing Federally Qualified Health Center (FQHC) service sites and Rural Health Clinics (RHCs) that could receive this sum instead and continue to provide comprehensive primary and preventive healthcare.
Update: 9/30/2015: To view the locations and contact information for community health centers near you, please visit wwww.GetYourCare.org, a new interactive resource website launched by pro-life and pro-women organizations including the Charlotte Lozier Institute.
Late last week, the Department of Health and Human Services (HHS) rose to the defense of the embattled Planned Parenthood organization, which is currently caught up in a fetal tissue and organ harvesting scandal following an undercover investigation by the Center for Medical Progress.
In a letter addressed to Senators Joni Ernst and Roy Blunt, HHS insisted that they know of no breach of the law in the actions taken by Planned Parenthood in its selling of fetal remains. In the letter, Jim Esquea, the HHS’s assistant secretary for legislation, wrote, “We have confirmed that HHS researchers working with fetal tissue obtained the tissue from non-profit organizations that provided assurances to us that they are in compliance with all applicable legal requirements.” Additionally, Mr. Esquea went on to assert, “The use of fetal tissue in medical research has been an instrumental component of our attempts to understand, treat, and cure a number of conditions and diseases that affect millions of Americans.” The letter continues, “In addition, research using cell lines derived from fetal tissue has also played an essential role in the field of vaccine development.”
Over the past few weeks you have most likely seen – unless you work at the White House – the undercover videos released by David Daleiden and the Center for Medical Progress, which show various Planned Parenthood employees discussing the harvesting and sale of fetal organs and body parts. The negotiations caught on camera suggest that these transactions are not at all unusual for the organization nor are they limited to these few incidents but are, in fact, systemic throughout the organization. This suggests that Planned Parenthood, which performs about 330,000 abortions a year in the United States, has found a way to make abortion even more profitable.
Note (9/4/2015): The author wishes to acknowledge an error in the originally published version of this article. Due to a mistake in interpretation the cost of patient care at a Community Health Center (CHC) was stated as $1.67 per patient per year rather than the obviously much-larger $1.67 per patient per day. The original article cited by CLI was comparing the much-lower per diem cost of CHCs relative to the cost of hospital inpatient care, emergency room visits, and other alternatives. The reallocation of the current Planned Parenthood funding of $528.4 million in annual spending from federal, state and local government sources would finance care for an additional 866,869 women if the $1.67 per diem cost claimed by CHCs is used. Other CHC documents suggest that full access to current fiscal year discretionary funds plus another $3.6 billion from the mandatory Health Center Fund could establish CHC capacity for another 11 million patients, a figure that suggests an even lower per diem cost than $1.67. Even at $1.67 per day, a full reallocation of the $528.4 million could serve a minimum of 31 percent of Planned Parenthood’s unique annual client base of 2.8 million individuals. A $528.4 million reallocation represents 41 percent of Planned Parenthood’s current budget. The calculation presumes that the annual cost per patient for women of childbearing age in a CHC is the same as the overall per patient average in a CHC, and that Planned Parenthood’s per diem per patient cost for the transferred services equals the full CHC per patient cost, which is unlikely given the much wider scope of CHC services. Mr. Donovan sincerely regrets the error.
In the wake of the spreading scandal over the sale of human organs extracted from unborn children, members of Congress are calling for the end of federal funding of Planned Parenthood. A first attempt in the U.S. Senate to do this failed on Monday of this week, but a dozen more Senators voted for the cut-off than did so the last time it was considered, in 2011. A cut-off would be condign punishment for an elite institution long given to dismissive responses to evidence of ethical misconduct, but the latest charges are hardly the only reason to wean this mega-wealthy nonprofit from the federal dole. In truth, the stand-alone Planned Parenthood facility is obsolete.
Pregnancy help centers (PHCs), also known as pregnancy resource or care centers and in the past as crisis pregnancy centers, are more likely to be welcomed than Planned Parenthood facilities into communities across the country, according to a 2014 poll commissioned by the Charlotte Lozier Institute.
Survey respondents were asked, in separate questions, whether as far as they knew there was either a Planned Parenthood facility or PHC currently in their community. To measure desirability, each set of respondents who said there was no such facility was then asked a follow-up question, “Would you like one?”
While Planned Parenthood is the nation’s largest abortion provider, having performed 327,653 abortions in 2013, federally qualified health centers (FQHCs), which operate in service sites in both rural and urban locations, offer low-income populations health services similar to those provided by Planned Parenthood, but do not perform abortions.
To view as PDF, please see “Abortion World Leaders.”
The United States is second in the world in number of abortions each year. If Planned Parenthood were included for comparison, it would rank sixth in the world in number of abortions carried out annually; and the International Planned Parenthood Federation would be fourth in the number of abortions carried out per year.
|England and Wales||189,800|
Annual abortion numbers for countries 2008, PP USA 2013, IPPF 2014
 Most recent verifiable data for international abortion numbers, 2008 from: Sedgh G et al., Legal Abortion Worldwide in 2008: Levels and Recent Trends, International Perspectives on Sexual and Reproductive Health 37, 84, 2011; Sedgh G et al., Legal Abortion Worldwide in 2008: Levels and Recent Trends, Perspectives on Sexual and Reproductive Health 43, 188, 2011; PP USA 2013 information accessed at: https://www.sba-list.org/wp-content/uploads/2015/10/12.31.14fact_sheet_pp_2013_2014_annual_report.pdf; IPPF 2014 numbers from: Table 1 in http://www.ippf.org/sites/default/files/ippf_apr2014_15_web_4.pdf
Much has been claimed recently regarding the usage of fetal tissue for research. This brief overview provides the facts on the history of fetal tissue research and transplants.
Last Thursday Alaska Governor Bill Walker announced that he would use his executive authority to expand Alaska’s state Medicaid program under the federal Affordable Care Act. Walker’s proposal would extend Medicaid eligibility to all Alaskans earning less than 133 percent of the poverty line. Walker reported that he sent a letter to the Alaska legislature’s Budget and Audit Committee, giving legislators the required 45-day notice of his plan. The committee can make recommendations, but Walker said he has legal authority to move forward without the legislature’s approval.