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Health Care Funding: Federal Obligations to and Expenditures by Selected Organizations Involved in Health-Related Activities, Fiscal Years 2013-2015

GAO-18-204R Published: Mar 06, 2018. Publicly Released: Mar 08, 2018.
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Fast Facts

In the 3-year period we examined, federal agencies obligated about $27 billion in funding to organizations that provide preventive, reproductive, and diagnostic health care services in the United States or abroad. These include:

federally qualified health centers,

International Planned Parenthood Federation,

Marie Stopes International, and

Planned Parenthood Federation of America.

Most of the funding came from two agencies: the Department of Health and Human Services (about $20 billion) and the U.S. Agency for International Development (about $76 million).

This is an update to our 2015 report.


Photo of a female patient completing a form in a health center.

Photo of a female patient completing a form in a health center.

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What GAO Found

From fiscal years 2013 through 2015, federal agencies reported obligating about $26.5 billion to federally qualified health centers (FQHC), International Planned Parenthood Federation (IPPF), Marie Stopes International (MSI), and Planned Parenthood Federation of America (PPFA), including these organizations' affiliates and member associations. (For the purposes of this report, GAO discusses FQHCs collectively as one "organization.") These organizations provide a range of health care services, including preventive care, reproductive health, and diagnostics. The Department of Health and Human Services (HHS) and the U.S. Agency for International Development (USAID) were the primary federal agencies that obligated funding to the four organizations. HHS obligated about $19.6 billion, mostly to FQHCs, though HHS also obligated funds to IPPF and PPFA. USAID obligated about $76 million to IPPF and MSI. (See table 1.)

Table 1: Reported Federal Obligations to the Four Organizations, Fiscal Years 2013 through 2015

Dollars in millions
Federal agency 2013 2014 2015 Total
Department of Health and Human Services (HHS)
Federally qualified health centers 5,687.69 6,289.14 7,514.91 19,491.74
International Planned Parenthood Federation 0.72 0.73 0.76 2.21
Marie Stopes International 0.00 0.00 30.00 0.00
Planned Parenthood Federation of America 28.86 29.70 31.13 89.69
Total HHS  5,717.27 6,319.57 7,546.79 19,583.64
U.S. Agency for International Development (USAID)
Federally qualified health centers 0.00 0.00 0.00 0.00
International Planned Parenthood Federation 2.49 3.78 5.32 11.59
Marie Stopes International 8.18 34.17 21.58 63.93
Planned Parenthood Federation of America 0.00 0.00 0.00 0.00
Total USAID  10.67 37.94 26.91 75.52
Total (HHS and USAID)  5,727.94 6,357.52 7,573.70 19,659.16
Other federal agencies 2,179.34 2,308.24 2,398.27 6,885.86
Total (HHS, USAID, and other federal agencies)  7,907.28 8,665.76 9,9971.97 26,545.01

Source: GAO analysis of HHS, USAID, and data. | GAO-18-204R

From years 2013 through 2015, the four organizations reported expending over $11.6 billion in federal funding. (In this report, the term expenditures refers to the actual spending of money by organizations that receive federal funds. Federal funds obligated in one year may be expended by an organization in a different year from when the funds were obligated or across multiple years.) FQHCs reported expending approximately $11.2 billion in direct grants. IPPF, MSI, and PPFA reported expending about $377 million in funding they received directly and indirectly--that is, funding passed through a nonfederal entity--from HHS and USAID. For example, HHS awarded funding to a state, which in turn made a sub-award, passing that funding on to PPFA. PPFA also reported expending nearly $16.4 million in funding from other federal agencies, including the departments of Agriculture, Education, Homeland Security, Housing and Urban Development, and Justice. In addition to expenditures, FQHCs and PPFA reported receiving federal reimbursements totaling about $27.8 billion and $1.2 billion, respectively, for services the organizations provided under the Children's Health Insurance Program, Medicaid, and Medicare.

Why GAO Did This Study

In order to achieve their programmatic goals, federal agencies obligate funding to various organizations, which, in turn, expend that funding on a range of activities and services. FQHCs, IPPF, MSI, and PPFA operate within the United States or internationally; provide health care services, including those related to preventive care, reproductive health, and diagnostics; and receive and expend federal funding.

GAO was asked to update its 2015 work on federal funding obligated to and expended by FQHCs, IPPF, and PPFA, as well as another health-related organization not included in its prior work, MSI. This report describes (1) federal agencies' reported obligations to the four organizations, and (2) the four organizations' reported expenditures of federal funding. GAO obtained detailed data from HHS and USAID on federal funding obligated to the four organizations. GAO reviewed expenditure data in annual reports, including audit reports submitted by the four organizations, as well as reviewed expenditure data provided directly from the organizations. Data on federal obligations are not comparable to, and cannot be reconciled with, the organizations' expenditure data. For example, federal agencies reported obligations by federal fiscal year, while the four organizations reported expenditures by their varying fiscal years; therefore, these amounts are not comparable for specific time periods. Additionally, obligations and expenditures should not be added together.

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GAO is not making any recommendations. HHS and USAID reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.

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