	Congressional Context

The Planned Parenthood Federation of America (PPFA) and its affiliated health centers (called Planned Parenthood Affiliated Health Centers or PPAHCs) have been topics of debate within the 114 th and 115 th Congresses. These discussions have raised questions about the services that PPAHCs provide and the availability of alternative facilities to provide similar services to disadvantaged populations. 1628 , the American Health Care Act of 2017 (AHCA), includes a one-year funding prohibition. H.R. Access to health care varies by location, as health systems and options vary considerably across states and localities. In some areas, one facility may be as accessible as another and may provide (or may be able to begin to provide) the same set of services. In other areas, this may not occur because, for example, only one provider exists, either in general or for a particular service type. Moreover, facilities located in the same geographic area may not be equally accessible for patients, as one facility may be located near public transportation routes while another may not. PPAHCs provide a narrow range of services to a more targeted population (i.e., family planning and related services to individuals of reproductive age), whereas FQHCs provide primary care, dental, and behavioral health services to individuals of all ages. For one health facility to begin to provide services to patients that had previously been seen at a different facility, one could argue that the receiving facility should
provide similar services, serve a similar population, and be located in a similar geographic area. This report is organized around these three dimensions and presents national-level data for both PPAHCs and FQHCs. In addition, these facilities are more coordinated with each other than are FQHCs. However, their service focus differs: PPAHCs focus on family planning services, and FQHCs focus on general primary care. There are many more FQHCs than there are PPAHCs; thus FQHCs provide far more services in a given year than do PPAHCs. However, despite the fact that there are nearly 15 times the number of FQHCs than there are PPAHCs, FQHCs in total provide fewer contraceptive services than do PPAHCs. Specifically, PPAHCs provided 2.9 million contraceptive services in 2014-2015 while FQHCs provided 1.3 million of these services in calendar year 2015. In addition, each individual FQHC provides far fewer contraceptive services than does the typical PPAHC. PPAHCs also serve a diverse population. FQHCs serve the population throughout their lifespan; for example, approximately one-third of patients are children. Locations of PPAHCs and FQHCs

PPFA affiliates are independent organizations and may choose the location of their facilities. PPFA reports that the majority of PPAHCs are located in health professional shortage areas (HPSAs), medically underserved areas (MUAs), or rural areas (see text box). Specifically, they are required to be located in MUAs or serve a medically underserved population, which are automatically designated as HPSAs (see text box). However, there is some overlap in the location of PPAHCs and FQHCs. Table 6 presents data on the number of counties that have either a PPAHC or an FQHC, or both facility types. These maps present only a portion of the health services available in any particular area; as such, they are not sufficient to infer meaningful information about the local health care system. This report may be updated if changes occur. Acronyms Used in this Report
Recent debates about federal funding for the Planned Parenthood Federation of America (PPFA) and its affiliated health centers (PPAHCs) have raised questions about the services that PPAHCs provide and the availability of alternative facilities to provide similar services to disadvantaged populations. This report provides background information and data that may be useful for policymakers evaluating these recent debates. Although a number of other facility types could potentially provide similar services as PPAHCs, this report focuses on federally qualified health centers (FQHCs)—a term used interchangeably with health centers or community health centers—because these facilities have been the focus of recent policy discussions, including the American Health Care Act of 2017 (H.R. 1628, AHCA) in the 115th Congress.
This report provides information on three central dimensions of health care. For one health facility to begin to provide services to patients that had previously been seen at a different facility, one could argue that the receiving facility should
provide similar services, serve a similar population, and be located in a similar geographic area.
This report provides national-level data on these three dimensions. Some selected findings include the following:
Services: Both PPAHCs and FQHCs provide family planning services; however, PPAHCs focus on providing family planning and related services, whereas FQHCs focus on providing more comprehensive primary care, dental, and behavioral health services. There are more than 15 times the number of FQHCs than there are PPAHCs; thus FQHCs provide far more services in a given year than do PPAHCs. However, despite providing more services overall, FQHCs in total provide less than half the number of contraceptive services than do PPAHCs. Specifically, in its 2014-2015 report (which covered federal FY2014), PPFA reported that its PPAHCs provided 2.9 million contraceptive services while FQHCs reported providing 1.4 million of these services in calendar year 2015. In addition, each individual FQHC provides far fewer contraceptive services than does the typical PPAHC.
Populations: Both PPAHCs and FQHCs serve a diverse, but disadvantaged population. PPAHCs focus their services on individuals of reproductive age, whereas FQHCs provide services to individuals throughout their lifetime. FQHCs served 24.2 million people in 2015, as compared to 2.5 million served by PPAHCs. Approximately one-third (31%) of FQHC patients were children in 2015 and 8% were age 65 years and over.
Locations: PPFA affiliates choose the location of their facilities. PPFA reports that the majority of PPAHCs are located in health professional shortage areas (HPSAs), medically underserved areas (MUAs), or rural areas. In contrast, FQHCs are required to be located in MUAs or to serve a medically underserved population; these areas are also automatically designated as HPSAs. There is some overlap in the location of PPAHCs and FQHCs, as 352 counties have both a PPAHC and an FQHC. Facility locations may be particularly important to evaluations of access because the availability of health services varies considerably across states and localities. In some areas, one facility may be as accessible as another and may provide (or may be able to begin to provide) the same set of services. In other areas, this may not occur because, for example, only one provider exists, either in general or for a particular service type. Moreover, facilities located in the same geographic area may not be equally accessible for patients, as one facility may be located near public transportation routes while another may not. Although this report presents maps of the locations of PPAHCs and FQHCs, these maps are not sufficient to infer meaningful information about the availability of health services in specific localities.