Washington • The Trump administration is preparing to announce Friday a far-reaching change in how Title X family-planning funds may be distributed. The move would make clinics that provide abortion services or referrals ineligible for the federal funding, a change that would defund Planned Parenthood by millions of dollars.
Under the proposal to be filed by the Department of Health and Human Services, the $260 million program would require a “bright line” of physical and financial separation between Title X services and providers that perform or support abortion services or refer to abortion as a method of family planning.
These requirements are similar to those that were in place, although not enforced, during Ronald Reagan’s presidency. Unlike the Reagan regulation, the proposal will not prohibit counseling for clients about abortion. It does, however, take away the requirement that providers must offer pregnant women the opportunity for “neutral” and fact-based counseling regarding pregnancy termination unless she indicates she does not wish to receive such information.
The changes, the official said, reflect the view that Title X funds are for family-planning services and that abortion is not family planning. The updates also are designed to establish more transparency about the activities of grantees and their sub-grantees.
Jeanne Mancini, president of the antiabortion group March for Life, praised the administration in a statement Friday for taking action to direct taxpayer dollars to centers that do not promote or perform abortions.
“This money will now be redirected to comprehensive family health and planning centers that don’t perform abortions and understand that abortion is not healthcare,” she said. “The pro-life grassroots will be pleased to see President Trump deliver on yet another pro-life promise, and we look forward to continued progress is restoring a culture of life here in the United States.”
Trump has delivered on several top priorities for abortion foes since taking office. He has appointed several judges with a history of opposition to abortion to federal appellate courts, including Supreme Court Justice Neil Gorsuch. He reimposed a provision that bars federal funds from going to groups overseas that provide abortion referrals, which is known as the Mexico City policy. He signed legislation that allows states to withhold federal Title X funds from facilities that provide abortion services. And his administration has attempted to curtail the Teen Pregnancy Prevention Program, which funds comprehensive sex education programs that can include information about abortion.
Title X-funded health centers provide several basic services such as cancer screenings, birth control, sexually-transmitted-infection screenings, pregnancy testing and well-woman exams. While the changes do not affect the level of funding the government is providing, there has been a lot of alarm about how difficult it would be for smaller, community-based providers to absorb the vast number of patients served by Planned Parenthood. The organization — which receives $50 million to $60 million in Title X funds and serves an estimated 41 percent of the 4 million patients who receive care through the program — is by far the largest recipient of the grants.
This week, more than 200 members of Congress — including Sens. Elizabeth Warren, D-Mass., and Patty Murray, D-Wash., and Rep. Joseph Crowley, D-N.Y. — expressed their opposition to the change in a letter to Secretary of Health and Human Services Alex Azar. “The move would disproportionately impact communities of color, the uninsured, and low-income individuals, and could reverse progress made in critical areas,” they wrote.
In a conference call with reporters Friday, Planned Parenthood’s leaders characterized the new rules as “draconian” and “an attack” on women’s basic rights and safe, legal abortion.
“It’s completely outrageous that a small group of people’s ideological views are being pressed through these government agencies onto women’s health care across the country,” said Dawn Laguens, executive vice president of the organization.
Laguens said Planned Parenthood is working with medical groups and others to mount a challenge. It may be three to six months before the rules are in place at the earliest. HHS must first post the rules for public comment, review and incorporate that feedback, and issue a final version along with a date for them to go into effect.
The American College of Obstetricians and Gynecologists expressed deep concern about the anticipated changes, which the group says go far beyond the abortion debate.
“Anticipated changes to Title X pose an egregious intrusion in the patient-provider relationship and may force physicians to omit essential, medically accurate information from their patient counseling,” Hal Lawrence, the group’s executive vice president and chief executive, said in a statement.
The administration official said that the changes would not necessarily result in the defunding of Planned Parenthood as long as the group is willing to “disentangle” their abortion-related services from family-planning services. However, Planned Parenthood officials have argued that informing women of all their choices — including abortion — is an integral part of the family-planning discussion, and on Friday, its leaders reiterated that they would not waver from that commitment.
Conservatives are confident that the new rules will withstand a legal challenge because similar Reagan-era requirements overcame a Supreme Court challenge.
David Christensen, vice president of government affairs for the Family Research Council, said in an interview that those standards required operations receiving Title X funds to be physically and financially separate from those performing abortions.
“Under Reagan, they could not be co-located, they couldn’t refer for abortion,” Christensen said.
In an interview before the new policy was announced, the heads of several family-planning clinics across the country said that imposing the kinds of restrictions that were proposed decades ago would have an enormous impact on their operations.
Susan Buchanan, chief executive of the Boulder Valley Women’s Health Center, said the proposal “undermines our ability to provide health-care services to low-income women and other women who face barriers.”
Buchanan noted that the state had made major strides between 2009 and 2014 through the Colorado Family Planning Initiative, which focused on providing women with long-acting reversible contraceptives. The state’s teen birthrate dropped 50 percent during that five-year period, she said, avoiding at least $66 million in spending on entitlement programs such as food stamps.
“They’re shooting themselves in the foot, really,” she said.
The Boulder Valley Women’s Health Center is the only Title X recipient in Colorado that provides abortions: Several years ago, it separated its family planning and abortion provider operations to comply with requirements imposed by then-Gov. Bill Owen, R, but was told these measures were insufficient.
“We separated into two different corporate structures. We had separate books, insurance, separate boards, separate everything,” she said. “And it didn’t work. It didn’t satisfy them, If they truly believe in the fungibility of money, nothing that we do is going to convince them that we’re going to have adequate separation.”