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 Away from the headlines, however, the group is facing other major
challenges, including one from a far different source: the
Affordable Care Act, which it avidly supports.
Many formerly uninsured women who once depended on Planned
Parenthood for low-cost access to birth control, abortions and other
reproductive healthcare have gotten coverage under President Barack
Obama’s healthcare law, making them less reliant on the
organization’s 700 clinics.
In many states, Planned Parenthood is losing clients as newly
insured patients turn to medical providers included in their health
plan's networks, according to data provided to Reuters and
interviews with more than two dozen of its affiliates.
“Some people relied on us because they were uninsured prior to the
Affordable Care Act. Now they can go anywhere for care, and some of
them have been,” said Lori Carpentier, president and CEO of Planned
Parenthood of Mid and South Michigan, which expects to treat 58,000
patients in 2015, down about 15 percent from the 68,000 it treated
in fiscal 2012, before major parts of the law went into effect.
The ACA has also brought some benefits to the organization, its
leaders say. In interviews, affiliates all reported a significantly
larger percentage of insured visitors among their remaining
patients. Some locations – including Ohio, New York City, Chicago
and the Northwest – are even adding clients as they expand services
to better compete for women with medical coverage.
Still, Planned Parenthood client numbers nationwide are on the
decline. Part of the drop in patient numbers can be traced to
decisions by legislatures in Republican-leaning states like Texas to
cut funding to affiliates beginning in 2011.
The declines then accelerated after Obamacare took full effect in
2014, when Planned Parenthood served 2.68 million patients, down
about six percent from 2.84 million a year earlier, according to
numbers last updated in July.
The decline was apparent even in areas like upstate New York, New
England and parts of the Midwest, which have not seen decreases in
state funding.
Some declines are considered positive. The U.S. abortion rate is
down, for example, and Obamacare has increased contraceptive
coverage, making it easier for women to afford long-lasting birth
control methods such as IUDs, which require fewer office visits.
“Data about health centers and patients will fluctuate,” said Kim
Custer, executive vice president of health care, Planned Parenthood
Federation of America. “But at the end of the day, Planned
Parenthood has a unique relationship with our patients, some of whom
would not be able to get healthcare anywhere else.”
The National Right to Life Educational Trust Fund, an arm of one of
the nation’s biggest anti-abortion groups, said the numbers could
suggest that women are acting on their beliefs once they have a
choice of provider.
Insurance coverage allows them to “go someplace where they can get a
broader range of services and can avoid a place that also does
abortions,” said Randall K. O’Bannon, director of education and
research at the group.
A DIFFERENT MODEL
Planned Parenthood’s latest public battle has come from the
anti-abortion group Center for Medical Progress, which began posting
secretly recorded videos online in July. The center says the tapes
show Planned Parenthood engaged in illegal sales of fetal tissue.
Planned Parenthood denies the charges, saying that a few affiliates
donate tissue for research and are paid a small fee to cover costs.
In recent weeks, citing the videos as a reason, several
Republican-leaning states including Louisiana and Alabama have moved
to defund Planned Parenthood by ending agreements under the Medicaid
program for the poor. Democrats are calling the controversy a “War
on Women,” saying it could delay final action on the federal
spending bill.
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But even before the most recent dispute, Planned Parenthood had
begun reconsidering its model of serving primarily the poor. It has
spent hundreds of millions of dollars in recent years to expand
services, upgrade buildings and improve customer service, hoping to
better compete for more affluent insured patients and tap a more
stable source of revenue than public funding.
Many states now provide services that promote broader wellness and
preventive healthcare, including prenatal care, screenings for men,
sex education for teenagers and smoking cessation counseling.
“The Affordable Care Act hit at the same time we were defunded by
the state," said Kelly Hart, director of government relations at
Planned Parenthood of Greater Texas. "We realized we needed to
diversify our patient base if we wanted to be viable in the 21st
century.”
The law is reshaping U.S. healthcare, encouraging consolidation of
hospitals and medical practices and increasing competition from
walk-in clinics. About 17 million more people have insurance now
than in 2013 through private insurance plans, many of which are
subsidized by the government, or the expansion of Medicaid,
according to the Rand Corp.
“Twenty-five years ago, this was about rights, justice and access,”
said Clare Coleman, president and CEO of the National Family
Planning & Reproductive Health Association and a former Planned
Parenthood affiliate CEO. Now there are additional concerns. “Can
you make it financially? Do you have the right revenue mix? Are you
running in debt or running a reserve?”
A major focus is to attract Millennials, now in their 20s and early
30s, with online scheduling and short wait times. Some affiliates
are trying programs that use smartphone apps to help determine if
patients need tests, access birth control and provide advice without
an office visit.
Many are offering more services to men, older women and the gay and
transgender communities. They also are expanding partnerships with
other medical providers. One affiliate in the Midwest, for example,
works with pediatricians who refer sexually-active teenagers
interested in obtaining an IUD.
Last month, painters added finishing touches on a new $9 million,
14,000-square foot Planned Parenthood health center in Long Island
City, Queens. Just beyond the guarded entrance is a round sign that
says “Welcome” in 11 languages.
The atmosphere is bright and airy with walls painted in shades of
yellow, blue and green, with no obvious references to reproductive
health other than the name.
“You have to have a great customer experience,” said Joan Malin,
president and CEO of Planned Parenthood of New York City, which
oversees the Queens facility. “Word of mouth brings people in.”
(Reporting by Jilian Mincer; Editing by Michele Gershberg and Sue
Horton)
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