Sen. Dean Heller (R-NV) has long misstated that Planned Parenthood uses taxpayer dollars for abortion care in defiance of federal law.

One of the most vulnerable Republicans in the U.S. Senate heading into the 2018 midterm elections, Heller now falsely claims that the health-care organization is funneling taxpayer dollars to campaign ads against “political enemies”—presumably including himself.

“They use those dollars for two purposes,” Heller said in a Tuesday interview on Live And Local With Kevin Hall, a radio show based in Nevada. “One is to perform abortions, and number two, they use it to run ads against people that are conservative. And I don’t think federal dollars should be used by Planned Parenthood to run ads against their political enemies.”

Heller also repeated another favorite, but categorically false, GOP talking point: Community health centers that don’t offer abortions could make up the gap in care that would result from “defunding” or cutting off Planned Parenthood from Medicaid reimbursements. Even community health centers have said that’s not possible.

Here, Rewire fact-checks Heller’s most recent false statements.

False: Taxpayer Dollars Fund Abortion Care

Heller’s claim that the federal funds Planned Parenthood receives in the form of Medicaid reimbursements go to abortion care plays into the GOP myth that taxpayer money is fungible. Writer Amanda Marcotte destroyed that myth in a 2015 article for Slate. Just because the federal government subsidizes some specific services at Planned Parenthood doesn’t mean it does the same for others, Marcotte wrote:

Imagine you are in line at the grocery store. The customer in front of you buys a can of beans with a SNAP card. You buy a bottle of wine and pay with cash. Then the next person in line angrily accuses you of wasting taxpayer money by buying alcohol with food stamps.

You’d probably be confused. The argument against you is that because the grocery store accepts food stamps from some customers, and because money is fungible, then you, by osmosis, have paid for your wine with food stamps.

Sounds stupid, but that’s the exact argument that Republicans are using against Planned Parenthood.

The Hyde Amendment, an appropriations rider enacted into law every year since 1976, prohibits most federal funds from going to abortion care except in rare circumstances. The discriminatory ban disproportionately affects people with low incomes and people of color.

Heller paid lip service to reproductive health care in April, saying he had “no problems with federal funding for Planned Parenthood” during a rowdy constituent town hall meeting with Rep. Mark Amodei (R-NV).

The next day, however, a Heller spokesperson walked backed that support while again indicating that Planned Parenthood breaks federal law.

“Senator Heller has worked hard to improve women’s access to health care and the quality of care they receive,” spokesperson Megan Taylor told Rewire in an email. “While he doesn’t have a problem with many of the health care services Planned Parenthood offers to women, he is opposed to providing federal funding to any organization that performs abortions and is supported by taxpayers’ dollars; he has a long record that reflects his position.”

Heller and Amodei subsequently voted for efforts to repeal the Affordable Care Act, commonly called Obamacare, coupled with defunding Planned Parenthood—Heller, for an unpopular failed Senate version, and Amodei, for the version that GOP leaders railroaded through the U.S. House of Representatives.

Earlier this year, both lawmakers had undermined federal protections for Title X family planning funds that go to Planned Parenthood affiliates and other clinics serving four million patients nationwide, the majority of whom have low incomes and are people of color, according to U.S. Department of Health and Human Services data from 2015.

Heller in March voted to shred the Obama-era protections that attempted to stop state-level interference with those funds. Amodei was absent from the House vote; a spokesperson, Logan Ramsey, did not provide clarification on his position.

False: Taxpayer Dollars Fund Negative Campaign Ads

Taxpayer dollars, again, are not fungible, parent organization Planned Parenthood Federation of America (PPFA) stressed in a statement.

“Planned Parenthood health centers operate just like other Medicaid providers—they are reimbursed when a patient comes in for cancer screenings, birth control, STD testing and treatment and annual exams,” the statement said. “Planned Parenthood is not a line item in the budget, nor does it get a blank check from the government. Federal funds do not go towards Planned Parenthood’s advocacy work.”

Heller’s characterization reveals a fundamental misunderstanding, deliberate or not, of how lobbying operates. PPFA is a 501(c)(3) organization that is prohibited from advocacy work; that work occurs under a separate entity, the 501(c)(4) Planned Parenthood Action Fund.

Elisa Cafferata, Nevada Advocates for Planned Parenthood Affiliates’ director of government relations, reiterated that Medicaid and Title X money are neither fungible nor free to use for lobbying.

“We use it for health care, and we get reimbursed for the specific services that we provide, just like the community health centers do,” Cafferata said in a phone interview.

Other advocacy groups have targeted Heller since he defied his pledge to reject the Senate’s initial Obamacare repeal draft. Heller’s “yea” vote on the “skinny repeal” bill flouted Nevada’s largely pro-choice Republican governor, Brian Sandoval, who had joined a bipartisan group of ten governors in urging Senate leaders to can it.

Politico‘s Seung Min Kim earlier this month wrote that Heller was “under fire over [his] Obamacare gymnastics.”

EMILY’s List, an organization that helps elect pro-choice Democratic women to office, greeted Heller’s return to Nevada for the August congressional recess with a digital ad buy and endorsement of Rep. Jacky Rosen (D-NV) for his seat:

Welcome home, Sen. Dean Heller! Time to face your constituents and own up to your votes: https://t.co/eV08EjCz1V

— EMILY’s List (@emilyslist) August 7, 2017

Heller “is showing his true Trump-like colors by peddling in right-wing lies to smear Planned Parenthood, which provides critical care to thousands of Nevadans every year,” EMILY’s List Executive Director Emily Cain told Rewire via email. “Whether it’s breaking his promises to protect their health care or bragging about defunding Planned Parenthood, Nevada women will hold Dean Heller accountable for his dishonesty by electing a true ally, Jacky Rosen, in his place.”

False: Community Health Centers Can Pick Up the Slack

Heller is the latest in a long line of anti-choice organizations and politicians to mislead the public about reproductive health-care access, specifically regarding community health centers’ ability to simply take over for Planned Parenthood.

When congressional Republicans talk about defunding Planned Parenthood and rerouting money to community health centers, they typically mean to federally qualified health centers—clinics that receive billions in public funding to provide a range of primary care services to medically underserved patients. Some community health centers restrict access to contraception or refuse to provide it altogether for religious reasons, according to a Rewire investigation. Together, the centers Rewire identified that restrict access to at least some forms of contraception operate health clinics in dozens of locations throughout the nation and collected $38 million in Affordable Care Act grants last year alone.

House Speaker Paul Ryan (R-WI) used a January CNN town hall meeting to claim, without any context or evidence, that the 20 community health centers for every Planned Parenthood affiliate “provide these kinds of services without all of the controversy surrounding this issue.”

“You believe in providing more choice for people when it comes to health insurance, except for Planned Parenthood?” moderator Jake Tapper countered in the exchange with Ryan.

Washington Post fact-checker Michelle Ye Hee Lee subsequently wrote that while the numbers themselves may be close to accurate, Ryan’s claim “is based on assumptions that are too uncertain, and lack context.”

The Susan B. Anthony List nevertheless advertised the 20:1 falsehood in Politico‘s widely read Huddle tipsheet, where it went unchecked for a week in February.

Heller took his turn in Tuesday’s interview.

“But why fund Planned Parenthood if there are only two clinics in the state of Nevada?” the radio show’s host, Kevin Wall, asked Heller. “How many community hospitals that deal with women’s issues—”

“There’s 40 clinics out there that specifically—” Heller said.

Wall spoke over him. “Versus two.”

“Versus two,” Heller confirmed.

Nevada is home to 35 community health centers, according to a map from the Nevada Primary Care Association. They generally provide the same services as Planned Parenthood but often “only offer a limited number of alternatives,” according to Nevada Advocates for Planned Parenthood Affiliates’ Cafferata. Despite Planned Parenthood having just two centers in Las Vegas and one in Reno, Cafferata said the organization serves “a disproportionate share of the people who need the safety-net family planning” in the state. The patient pools for Nevada’s Planned Parenthood affiliates and community health centers are comparable, each serving within a few thousand above and below 20,000.

“One of the advantages of having a Planned Parenthood out in a community is you’re more likely to have access to the complete range of family planning options,” Cafferata said. “So, women have a lot more options when they come to Planned Parenthood.”

Community Health Alliance runs six fixed community health centers and four mobile medical and dental vans considered community health centers in Washoe County, Nevada—Amodei’s district spanning the northwestern corner of the expansive state. The centers focus on a broad range of primary care services, such as vaccinations, preventive health, and diabetes management, that include, but are not exclusive to, reproductive health, according to CEO Chuck Duarte.

“We really count on Planned Parenthood as that community partner that provides women’s health services,” Duarte told Rewire by phone over the course of two interviews.

“We provide the same services as Planned Parenthood, with few exceptions,” Duarte said. “The big difference is that Planned Parenthood has dedicated capacity for that.”

Of Duarte’s approximately 22 primary care providers, two can perform colposcopies of the cervix, vagina, and vulva following irregular Pap smears to detect cervical cancer—“and of course, [those providers have] a full patient load, and so they’re not doing procedures all day.” Three or four of the providers can insert highly effective long-acting reversible contraceptives like intrauterine devices (IUDs).

“Losing Planned Parenthood means losing capacity for family-planning services in the community that I think community health centers would take a long time to develop and replace,” Duarte said.

Duarte first spoke with Rewire in June prior to testifying at a hearing held by Sen. Debbie Stabenow (D-MI) and other Senate Democrats about the consequences of GOP health-care efforts. Those consequences include limiting people’s access to reproductive health care and beyond.

Defunding Planned Parenthood would create a burden on Duarte’s community health centers and others forced to recruit, hire, train, and pay more providers. “It’s not easy to get providers, particularly those that specialize in women’s health,” he said.

“We’re so underserved in Nevada,” Cafferata said. “Everybody could triple their size and number of staff they have and number of patients they see, and there still would be waiting lists. So, it’s not like [community health centers are] just sitting around waiting for patients to show up. They’re booked full. We’re booked full. I always say, we already are in a health-care crisis situation in Nevada in terms of having so few providers. To take any providers out of the mix—like Planned Parenthood—would be devastating.”

The Congressional Budget Office, the nonpartisan number-crunchers for Congress, found that defunding Planned Parenthood would disproportionately hurt people with low incomes, especially those in rural areas. The Las Vegas Review-Journal in 2016 wrote about the state’s rural residents, calling them the health-care “have-nots.” News4Nevada, which bills itself as the premier “source for rural Nevada news,” in January reported on rural clinics losing out on family planning money.