When students at high schools in the Fresno area have questions about contraception or safe sex, they have a place to turn. Fresno Barrios Unidos, a non-profit organization that conducts sex-ed trainings at local schools and fields many of these questions, has a Planned Parenthood satellite clinic right at their Fresno offices, offering preventative care, testing for sexually-transmitted diseases, access to birth control and more.
But the partnership may prove difficult if the federal American Health Care Act (AHCA) becomes law. The bill, championed by the Trump Administration and approved by the House of Representatives on May 4, would cut federal funding to Planned Parenthood clinics, making it potentially difficult for them to keep their doors open.
Fresno, which already contends with higher than average rates of STDs and teen pregnancy, is bracing for a possible decrease in services, says Socorro Santillan, executive director of Fresno Barrios Unidos.
“The teen birth rate in our target area is almost three times the state level,” Santillan says. Fresno also has the state’s second highest rate of syphilis, with especially high rates among 15 to 24 year olds. “Whenever we do a presentation at local high schools, both our offices and Planned Parenthood are inundated with students who suddenly realize that if they’re sexually active, they might be at risk of pregnancy or contracting an STD.”
Contrary to the claim made by House Speaker Paul Ryan (R-WI) at the CNN Town Hall in January that “for every 20 Planned Parenthood centers there are 20 federal community health centers,” Santillan says the community health clinics she works with have indicated they would not be able to handle the influx of patients that would result from Planned Parenthood having to cut back on its services.
Reproductive Health Care Already Scarce
Planned Parenthood is a major provider of reproductive health care to primarily low-income men and women and those who live in underserved communities, says Kathy Kneer, CEO and president of Planned Parenthood Affiliates of California. For some, it’s their only source of health care.
Planned Parenthood has 115 clinics in California that serve 850,000-plus men and women a year, Kneer says. Their patients are primarily low-income and rely on the Medicaid program (called Medi-Cal in California). The Title X program, the only federal grant program dedicated solely to family planning and reproductive health services for low-income and uninsured patients, is another funding source that would disappear under the AHCA.
Planned Parenthood also provides abortions in a region underserved by abortion providers. Though the Hyde Amendment has prohibited the use of federal funds for abortion for the past 40 years, private fundraising efforts and state funding have helped provide these services for low-income women.
Ninety-seven percent of Planned Parenthood’s overall services in California are for non-abortion services, Kneer noted.
Last year, just in the Central Valley (including the cities of Fresno, Madera and Visalia), residents made more than 105,000 visits to Planned Parenthood, Kneer says.
If the AHCA becomes law, Kneer says Planned Parenthood centers in California would lose $175 million in reimbursements for services provided to patients insured under Medi-Cal. Planned Parenthood’s nonsurgical sites, like the satellite clinic in Fresno, which provide medical and contraceptive services, would be hardest hit by these changes.
Since most community health centers don’t provide abortion services, Kneer says women without access to one of Planned Parenthood’s surgical centers would have to travel long distances or forego an abortion altogether.
“Eighty-seven percent of our patients are on Medi-Cal and face barriers to health care including transportation and access,” Kneer says. “Our clinics are geographically located in areas where there aren’t other providers and they offer services like evening, weekend and drop-in care that community health clinics don’t offer.”
Clinics Facing Closure
At the Women’s Health Specialists of California, a group of clinics that provide reproductive health services, including abortion, birth control and sexual health screenings, outgoing executive director Shauna Heckert has just closed the doors on the organization’s Sacramento office.
The clinic, which has provided services to over 25,000 men and women each year for the past 30 years, has closed in a bid to ensure that the organization’s rural clinics in Chico, Grass Valley and Redding remain open.
“We had to close the Sacramento clinic due to the lack of adequate reimbursement for reproductive health services,” Heckert says. “Family planning and abortion providers have been facing the grim economic reality of Medi-Cal reimbursement for decades.”
Heckert notes it often takes two years for her non-profit to get Medi-Cal reimbursement for routine procedures such as the Depo-Provera birth control injection, and even when the money comes in, it’s often not enough.
“Medi-Cal rates in California are woefully inadequate to cover services,” Heckert says.
Heckert says that any reductions in federal funding from the Trump administration would prove to be the final nail in the coffin for her non-profit’s rural health centers.
“We’re already working on a shoestring budget and now we just closed one of our centers in a major urban area,” she says. “Without adequate funding, we wouldn’t be able to survive.”