Update: On Friday, a final rule on the long-expected changes to Title X funding were released by the Department of Health and Human Services (HHS). The changes appear to be nearly identical to the proposed policy (often referred to as a "domestic gag rule") from last year and are already receiving harsh criticism.
Currently, the Title X program provides federal funding for facilities that offer family planning and other preventive services, especially those that serve lower income patients. The new rules require "financial and physical separation" between facilities and programs that provide services funded via Title X and those providing abortions.
But, to be clear, Title X funding was never allowed to directly fund abortion services, and thanks to the controversial Hyde Amendment, federal Medicaid funding also does not cover abortion costs outside of very narrow exceptions.
The new rules also "prohibit referral for abortion as a method of family planning." And while the HHS says that the ruling "does not bar non-directive counseling on abortion," it does eliminate the requirement that providers and facilities receiving Title X funding offer abortion referral and counseling to patients if requested, so that providers "are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral."
These new rules theoretically leave facilities like Planned Parenthood and other clinics that provide abortions as well as other health services in a bind: Either they forgo the funding they receive through Title X (funds which help them provide comprehensive care to a wide range of patients) or they stop providing some information and services related to abortion. Again, the Title X funds themselves were never permitted to be used for abortion services.
Reproductive health advocates are, understandably, frustrated. "No health care provider should be forced to withhold or manipulate information that their patients request," Willie Parker, M.D., board chair of Physicians for Reproductive Health, said in a statement. "I am deeply alarmed by this change in longstanding policy and practice in the Title X program."
“The gag rule is unconscionable and unethical," Leana Wen, M.D., president of Planned Parenthood Federation of America, said in a statement. "This rule compromises the oath that I took to serve patients and help them with making the best decision for their own health. Patients expect their doctors to speak honestly with them, to answer their questions, to help them in their time of need."
As with so much that the Trump administration has put forth, we can expect this change to be legally challenged before it goes into effect. Previously, the administration's final rule that would have provided more exemptions from the Affordable Care Act's birth control mandate was blocked nationwide.
Update (May 22, 2018): On Tuesday, the U.S. Department of Health and Human Services (HHS) made an announcement about a proposed update to the Title X program. The announcement comes four days after multiple outlets reported on the rumored policy, what's being referred to as a "domestic gag rule" on abortion.
The proposed update prohibits health care providers that offer abortions (or abortion-related counseling or referrals to patients who are seeking an abortion) from receiving federal Title X grant funding. "The proposal would not bar non-directive counseling on abortion, but would prohibit referral for abortion as a method of family planning," the HHS statement reads.
President Donald Trump will reportedly speak about the proposal Tuesday night during a speech at a fundraising gala for the anti-abortion organization the Susan B. Anthony List.
The Trump administration reportedly proposed a new policy last Friday (a gag rule on abortion) that would cut funding to any health care provider who offers abortions—or even information about how and where to obtain one. An official White House announcement has not yet been released, but multiple outlets reported that the administration issued the proposal last Friday.
While there's still a lot we don't know regarding the new policy and what will actually come of it, here are the general implications and regulations behind gag rules on abortion and what this might mean for women's health care access.
The policy is being referred to as a domestic gag rule, as it would likely prevent federal funding from going to any U.S. health clinic that so much as mentions abortion as an option for women.
If this sounds familiar, it's because a policy like this already exists for U.S. funds going to international health organizations. You may remember that in 2017, President Trump reinstated the Mexico City Policy, often referred to as the global gag rule on abortion, which prevented U.S. money from funding international health organizations that offer abortions or even just information about abortions—even if U.S. dollars aren't paying for the actual abortion-related services. The ban was introduced by President Reagan in 1984, and it's been rescinded and reinstated many times since then.
While specific details about the new policy have not yet been made available from the Department of Health and Human Services (HHS), it would essentially mean the global gag rule is extended to the U.S., too.
Women’s health organizations, including Planned Parenthood (which would be directly affected by this ruling), the American College of Obstetricians and Gynecologists (ACOG), and Physicians for Reproductive Health, have spoken out against the policy.
The rule would take away the guarantee that patients receive complete information about their reproductive health care options, Dawn Laguens, executive vice president of the Planned Parenthood Federation of America, explained during a press conference call to address the news. For example, if a woman is pregnant and wants or needs an abortion, her provider would be prohibited from so much as telling her where she could go get one, Laguens further explained.
“This gag rule is not only unconscionable, but it undermines medical ethics by allowing health care professionals to withhold accurate and timely medical information from patients,” Jenn Conti, M.D., a fellow with Physicians for Reproductive Health, tells SELF in a statement. ACOG also said in a statement to SELF that the organization is “deeply concerned” about the gag rule.
This policy could prevent health clinics from receiving Title X funding, which makes family planning and other preventive health services more affordable and accessible.
Title X is a federal grant program dedicated to ensuring access to family planning and other preventive health services—primarily for low-income or underinsured and uninsured people.
In 2016, Title X funding went to 91 family planning service grantees, which included 48 state or local health departments and 43 nonprofit organizations (such as Planned Parenthood clinics). This funding goes towards things like birth control, STI screening, breast and cervical cancer screening, family planning counseling, and other reproductive health services. In 2016, Title X funding served more than 4 million clients.
It's important to note that federal law already prohibits the use of Title X federal funding for abortion services. A gag rule, however, could mean that a clinic can't even receive Title X funding for the other important health services they provide (like providing access to affordable birth control methods that would prevent unwanted pregnancies) if they also offer abortions or answer their patient's questions about abortion referrals.
Under this type of policy, health centers would have to either stop providing abortions and giving out any information about where to access a safe abortion or no longer receive the federal funding that allows them to care for a wide range of patients.
A domestic gag rule would prevent patients from talking to their doctors about abortion and keep doctors from making the full range of medical options known to patients who don’t want to continue with a pregnancy, George Hill, president and CEO of Maine Family Planning, which receives Title X funding, tells SELF.
While family planning groups that receive Title X funding aren’t allowed to use federal tax dollars toward abortion services, they currently may offer abortions and abortion-related guidance and services at the same location and through the same health care personnel. Under the new policy, that could be forbidden, Fabiola Carrion, senior staff attorney with the National Health Law Program, tells SELF.
“This rule is quite dangerous,” Carrion says. “It rolls back progress that is already in place to ensure that all women and people have access to quality care, including birth control and other reproductive healthcare.”
Things also get murky when it comes to cases where a pregnant woman has a serious health condition such as cancer or an ectopic pregnancy (when a fetus implants outside the uterus), Hill says. “There are a lot of questions about what you’re going to do in those cases,” he says.
If a domestic gag rule were to be put in place, women’s health care providers would either have to decide if they’re going to stop giving the full range of medical options to patients, find a workaround, or refuse to accept Title X funding in order to accommodate patients seeking abortion services, Hill says.
Clearly, this will have an impact on a woman’s ability to receive a safe and legal abortion. But the impact could go much deeper than that.
Given that clinics will have to decide whether they’re going to stop offering abortion services, try to find private funding to offer abortion services in another facility with a different set of medical providers, or comply and continue to receive Title X money, funds are going to be tight and care may be restricted as a result.
“Restricting the Title X program would limit access to preventive care for 4 million Americans annually,” Hal Lawrence, M.D., ACOG executive vice president and CEO, tells SELF in a statement. “Contraceptive care is not an insignificant or minor component to women’s health care. It’s routine and necessary preventive care.” In addition to birth control, preventive care offered by Title X–funded clinics can include cancer screenings, STD testing, and other general women’s health exams.
In the event that health care providers that would be affected by this ruling opt not to comply and therefore lose Title X funding, that lack of funds could mean that some clinics struggle to stay open or provide the range of care that many do, Dr. Lawrence says. “This endangers women’s health, leaving them with fewer options for safe, timely, and comprehensive preventive care, and is certain to delay provision of care or altogether deter women from seeking care at all,” he explains.
And, of course, if women can’t have easy access to birth control, it increases the odds that more will experience unintended pregnancies and births, as SELF previously reported.
It’s hard to say whether this domestic gag rule will actually be put into place and what the specific rules for compliance will be.
“This could go into effect, but it is also likely that it could be challenged in court, as it should be,” Carrion says, adding that, “We are all quite scared about the implications of this rule.”
Carrie Flaxman, deputy director of public policy litigation for Planned Parenthood, explained on the press call that the rule "as we understand it" is being submitted to the Office of Management and Budget, which is the routine process that all regulations have to go through before becoming a final law. "This process could take months," Flaxman said.
Flaxman also pointed out during the press call last week that we still don't know the details of this particular rule, and one of the big uncertainties is how the government would go about enforcing such a policy. Hill expects that several lawsuits will be brought against this new proposal. But while it can and likely will be challenged in court, it’s hard to predict what will happen until we have more information.
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