Planned Parenthood Withdraws From Title X Funding

By | August 19, 2019

Planned Parenthood will withdraw from Title X, the federal family planning program, rather than comply with a new Trump administration rule that restricts what health providers can say about abortion, the organization said on Monday.

The move could affect more than 1.5 million low-income women who rely on Planned Parenthood for services like birth control, pregnancy tests and screening for sexually transmitted diseases. Planned Parenthood serves about 40 percent of the four million patients under Title X. In some rural communities, Planned Parenthood is the only provider of such services.

The Trump administration’s rule says that while clinics accepting Title X funds may continue to talk to patients about abortion, they may not refer women to an abortion provider or suggest where to obtain an abortion.

That distinction might seem like a subtle one, but Planned Parenthood and many other organizations, including the American Medical Association, say the restriction would force them to withhold medical information from patients, interferes with the doctor-patient relationship, and could deny pregnant women the range of options available to them.

“When you have an unethical rule that will limit what providers can tell our patients, it becomes really important that we not agree to be in the program,” Alexis McGill Johnson, acting president of Planned Parenthood, said on Monday. She accused the Trump administration of forcing Planned Parenthood out of the Title X program.

The Department of Health and Human Services issued a statement on Monday, and without naming Planned Parenthood, said groups that refused to comply with the rule “are now blaming the government for their own actions.” The agency added: “They are abandoning their obligations to serve their patients under the program.”

The decision by Planned Parenthood is the latest step in the face-off between those who oppose restricting women’s reproductive health choices and the Trump administration, which has been steadily shifting federal health programs toward conservative preferences like promoting abstinence and allowing exemptions to insurance coverage of birth control.

The immediate effect of a Planned Parenthood withdrawal is unclear and likely to vary by state. The group on Monday declined to say how much in federal funding it would lose.

As the divisive issue of abortion becomes even more pitched with two new conservative Supreme Court justices and a presidential election looming, both sides appear to be attempting to shore up support from voters who feel passionately about preserving or restricting abortion rights.

Withdrawing from Title X will not deprive Planned Parenthood of all government funding, a longtime goal of many conservatives. Figures from Planned Parenthood’s 2017-18 annual report showed that the organization received about $ 500 million from Medicaid, the joint federal and state health care program for low income people. Federal funds cover most of that spending.

Planned Parenthood receives about $ 60 million of the $ 286 million given annually by Title X to about 4,000 health centers providing reproductive health care, as well as screenings for breast cancer and cervical cancer, to about four million patients.

The Trump administration rule, announced in February, is being challenged in court by Planned Parenthood, other organizations and more than 20 states, but a federal appeals court in July said the policy change could take effect while the legal cases were pending.

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Planned Parenthood and some other organizations that receive Title X funds had decided to stop using the money until the legal challenges were resolved, although they had not officially withdrawn from the program.

The Department of Health and Human Services said that such an intermediate status would not be acceptable. It said that organizations had until Aug. 19 to submit an “assurance and action plan” showing they intend to make “good faith efforts” to comply with the new rule.

Last week, Planned Parenthood sent a letter to the United States Court of Appeals for the Ninth Circuit, asking a panel of judges to stay the deadline until the legal cases could be decided. On Friday, the court declined to do so.

Planned Parenthood has said many clinics would feel pressure from the cuts.

The organization said that at least one program — a mobile health center in Cleveland that provides H.I.V. testing, pregnancy tests and other services — would have to close. It said that in states like Utah, where Planned Parenthood is the only organization receiving Title X funds, and Minnesota, where Planned Parenthood serves 90 percent of the Title X patients, those seeking care may face long waits for appointments. Some patients may delay care or go without, Planned Parenthood said.

Some state governments have promised to make up the lost federal funding. Governors in Hawaii, Illinois, New York, Oregon and Washington have said their states would not participate in Title X under the new rule. Legislatures in Massachusetts and Maryland have passed laws that essentially have the same effect.

Earlier this month, the Department of Health and Human Services posted an explanation of the timeline and details of the new policy, saying that it is “not a gag rule.”

“Health professionals are free to provide nondirective pregnancy counseling, including counseling on abortion, and are not prohibited in any way from providing medically necessary information to clients,” the department said. “The Final Rule does NOT include the 1988 Regulation’s prohibition on counseling on abortion — characterized by some as a ‘gag rule’ — but neither does it retain the mandate that all grantees MUST counsel on, and refer for, abortion.”

The department said that “while Title X providers are prohibited from referring for abortion as a method of family planning, referral for abortion because of an emergency medical situation is not prohibited.”

It said providers may give pregnant women “a list of comprehensive health care providers (including prenatal care providers), including some (but not the majority) who perform abortion as part of a comprehensive health care practice. However, this list cannot serve as a referral for, nor identify those who provide abortion — and Title X providers cannot indicate those on the list who provide abortion.”

Because clinics receiving Title X money will no longer have to counsel women on all reproductive options, including abortion, the new rule may make faith-based providers and others that oppose abortion eligible for funding — a change that could significantly alter the guidance patients receive.

Organizations receiving Title X funds will still be able to perform abortions but will have to do so in a separate facility from their other operations and adhere to the new requirement that they not refer patients to it. Clinics have been prohibited for years from using federal money to finance abortion services. The new rule goes a step further by ordering them to keep separate books for their abortion operations. Those changes are expected to take effect in 2020.

Planned Parenthood is not the only provider that has bridled at the new rule. In Maine, the only Title X recipient, Maine Family Planning, has decided to withdraw from the program, but has said that, for now, it will not close any of its 18 clinics.