Cutting off federal funding for Planned Parenthood — a longstanding conservative goal that is included in the Republican bill to replace the Affordable Care Act — would reduce access to birth control for many women and result in thousands of additional Medicaid births, according to the Congressional Budget Office.
Because nearly half of all births nationwide are to Medicaid patients, and many of those babies are Medicaid patients themselves, the budget office estimated that defunding Planned Parenthood even for a year would increase Medicaid spending by $21 million in the first year, and $77 million by 2026.
The budget office numbers, released this week as part of an overall analysis of the Republican health bill, are based on economic modeling, but real-life experience in at least one state shows a similar result.
In Texas, where the state cut off money to Planned Parenthood clinics in 2013, thousands of women stopped getting long-acting birth control in the first 18 months, and Medicaid pregnancies increased by 27 percent, according to a research paperpublished in The New England Journal of Medicine last year.
Planned Parenthood has long been a target of conservatives for being a leading provider of abortions in the United States, although abortions make up a small percentage of its services, which are more likely to include birth control and screening for sexually transmitted diseases. In fact, many of its clinics do not perform abortions; in Wisconsin, for example, only two of the organization’s 21 clinics do. Federal funding is never used to pay for them; since 1977, a law known as the Hyde Amendment has prohibited using federal money for abortions.
The Republican health bill would defund Planned Parenthood for one year. An earlier analysis by the C.B.O. estimated that permanently defunding the organization, as Republicans would like to do, would increase Medicaid spending by even more — $130 million over the next 10 years.
Republicans said they would make up the $500 million they are cutting from Planned Parenthood by giving an extra $422 million to federally qualified health clinics. Speaker Paul D. Ryan argues that those clinics have a “vast larger network” in “virtually every community” and provide health care to women with less controversy than Planned Parenthood, because they do not provide abortions.
But across the country, one in five counties served by Planned Parenthood have no federally qualified health clinics, according to the earlier C.B.O. analysis — including two counties in Mr. Ryan’s district in Wisconsin. The C.B.O. estimates that in those areas, cuts to Planned Parenthood would result in 15 percent of women losing access to health care.
Anti-abortion activists have produced lists of other federally qualified health providers who they say could provide many of the same family planning services offered by Planned Parenthood. But a list of 2,010 providers in Louisiana included hundreds of ophthalmologists, nursing homes, dentists, cosmetic surgeons and audiologists. A list of 300 alternate providers in Ohio included addiction treatment centers and food banks.
Republicans say their bill will increase health care choices and reduce federal spending. But opponents of the provisions on Planned Parenthood charge that they are more driven by the politics of abortion.
Babies born to Medicaid mothers become some of the program’s highest-cost beneficiaries, which increases the cost of the trade-off with family planning, said Sara Rosenbaum, a professor of health policy at George Washington University who has long studied community health centers.
“You’re trading a highly cost-effective benefit for a relatively high-cost population, and the cost of that population is even greater when the pregnancy is unplanned,” she said. “It’s a double whammy.”
Joseph E. Potter, director of the Texas Policy Evaluation Project, a research group that analyzed the results of Texas’ cuts to Planned Parenthood in The New England Journal of Medicine paper, said the measure reduced choice. “They think, ‘You’re asking people to change providers — what can go wrong?’ It’s a long list of things that can go wrong.”
The potential problems, he said, included finding a conveniently located provider with available appointments and affordable fees. In focus groups that followed up the study, women described being unable to pay $50 for birth control, or hundreds of dollars for follow-up screening for cervical cancer after an abnormal Pap smear — services that they had received free or at reduced costs from Planned Parenthood.
When the Planned Parenthood in Midland, Tex., closed in late 2013, it transferred about 5,000 patient medical records to Midland Community Healthcare Services, a federally qualified health center. About 2,000 of those were records of active patients who had been seen in the previous year.
But since then, only about 200 of those patients have “trickled through our door,” said Michael Austin, the community center’s chief executive.
“It’s an alarmingly low percentage, when you figure Planned Parenthood was probably seeing that many in a month or so,” he said. “These women are still out there, most of them still have family planning or health needs, and where they’re going is a mystery. You don’t have to be a rocket scientist to figure out what’s coming.”
Dr. Austin’s clinic was unusual in that it had a dedicated women’s clinic, with nurse practitioners and two obstetrician-gynecologists on staff. But normally, community health clinics are set up as general practice clinics to serve all patients, regardless of age or gender. They are ill-equipped to do family planning or screen for sexually transmitted diseases — they refer those patients to Planned Parenthood.
And in many places, federally qualified health clinics just do not exist.
The one federally qualified health center in Racine County, Wis., closed in 2015, after financial troubles. The county has been struggling with an increase in chlamydia and gonorrhea infections over the last four years, said Dottie-Kay Bowersox, director of public health for the city of Racine, in Mr. Ryan’s district.
The city clinic Ms. Bowersox oversees does screening for sexually transmitted infections, but it is open only a day and a half each week. For family planning and prenatal care, she refers patients to Planned Parenthood.
To get to the nearest federally qualified health clinic, she said, patients have to drive 35 minutes “on a good day” to Kenosha — where the clinic there has said it would have a hard time absorbing the new patients — or to Milwaukee, a 60-minute drive.
But many patients cannot afford cars, and there is little to no public transportation.
The federally funded clinics will have to absorb a heavy load. An analysis done in 2015 for the Congressional Budget Office by the Guttmacher Institute, which advocates for reproductive rights, including abortion, found that Planned Parenthood served 36 percent of patients who had obtained publicly subsidized contraception from safety-net health providers. Federally qualified health centers serve 16 percent of those patients. Planned Parenthood centers serve an average of 2,950 contraceptive clients per year, while federally qualified health centers serve 330.
Community health centers say it is not as simple as adding a few nurse practitioners or doctors to specialize in women’s health. When they absorb those new patients, they are expected to serve all of their health needs, which is more expensive than what Planned Parenthood did.
“You can’t provide the check one day and expect that the house is going to be built the next,” said José E. Camacho, the executive director general of the Texas Association of Community Health Centers. “You’re now asking health centers that provide a wide array of services to provide a wide array of services for what it costs Planned Parenthood to provide a focused service.”
In the meantime, he said, “people fall off the radar.”