The Trump administration’s disdain for women’s reproductive rights and reproductive healthcare are well known. Shortly after taking office, President Trump reinstituted the “global gag rule” that forbids foreign aid for any overseas healthcare provider that offers abortions or abortion counseling — even if the federal funds are carefully spent only on nonabortion services. Since his election, Trump has regularly threatened to defund Planned Parenthood. He has appointed anti-abortion judges and cut federal grants for family planning research.
Now, he and the officials he has put in place at the Department of Health and Human Services are taking aim at the much-respected Title X Family Planning Program in an effort to further limit women’s access to safe and legal abortion.
This program has offered federal funding for family planning and related healthcare services for low-income Americans for 50 years. Clinics funded under Title X are a lifeline to millions of people in underserved urban and rural communities, providing contraception, breast exams, screening for sexually transmitted disease and some basic healthcare. Some of the providers that receive Title X funds — including Planned Parenthood, which provided healthcare to 40% of all patients in Title X programs in 2017 — offer abortions as well. But those abortions are never funded by Title X dollars, since Congress has barred federal money from being spent on abortions.
Now, the Trump administration has decided that Title X providers must go to new and ridiculous lengths to prove they are not spending the federal money on abortions. A rule issued recently by the Department of Health and Human Services requires Title X recipients who also provide abortion services to physically separate their abortion services from their other healthcare services. Previously, Title X providers were allowed to offer abortion and other healthcare services in the same location (even with the same staff and waiting room) as long as the Title X activities were distinguishable from the non-Title X activities and costs were properly pro-rated and allocated.
The new rule — parts of which go into effect in May — demands that providers have separate facilities. The rule is vague about exactly what that means but says compliance might include separate treating and waiting rooms, personnel, office entrances, phone numbers, and websites.
Worse, the new rule forbids Title X providers — in the course of administering other forms of healthcare — from referring patients to an abortion provider, even if one is requested. The administration says that doing so is tantamount to providing the abortion itself. That’s absurd.
The most that Title X providers are allowed to do for someone who asks for a referral to an abortion clinic is offer the patient a list of comprehensive primary healthcare providers. Some of the facilities on the list — “but not the majority,” according to the rule — can also provide abortions. But the provider can’t point out which facility on the list offers abortions. So the list becomes what a lawsuit filed by Planned Parenthood calls a “scavenger hunt” for anyone who wants an abortion. It’s egregious of the government to gag healthcare providers, and it’s unconscionable to enlist them in a ploy of obfuscation.
Lawsuits filed by Planned Parenthood with the American Medical Association, the Center for Reproductive Rights, the American Civil Liberties Union, the California attorney general, Essential Access Health (the state’s Title X grantee) and a coalition of nearly two dozen states argue that the rule prevents healthcare providers from offering the comprehensive counseling and information they have an ethical obligation to give patients. The lawsuits also contend that the rule violates federal statutes — including the Affordable Care Act, which prevents HHS from interfering with a provider telling patients about their full range of treatment options. They also argue it violates the 1st and 5th Amendments. and a coalition of nearly two dozen states argue that the rule prevents healthcare providers from offering the comprehensive counseling and information they have an ethical obligation to give patients. The lawsuits also contend that the rule violates federal statutes — including the Affordable Care Act, which prevents HHS from interfering with a provider telling patients about their full range of treatment options. They also argue it violates the 1st and 5th Amendments.
Planned Parenthood has made it clear that it would sooner figure out how to operate without Title X funds than be forced by the gag rule into an untenable practice of healthcare. Maine Family Planning, the sole recipient of Title X funds in that state, says in a lawsuit against the administration that if it has to give up Title X funds it will have to close clinics. If providers across the country are forced to do that, a vital source of healthcare will vanish in the places most desperate for it.