The Trump administration on Tuesday released a proposed rule to change federal requirements for health care providers that receive Title X family planning grants.
According to Modern Healthcare, the first round of the application cycle for Title X family planning funds begins this week.
Proposed rule details
The proposed rule would require recipients of Title X family planning funds "to separate their Title X project—physically and financially—from any abortion activities." As such, the proposed rule would prohibit the federal government from dispersing Title X family planning funds to health care providers that offer abortions and abortion referrals in the same locations that they offer family planning services.
The proposed rule also would eliminate a federal policy that requires health care providers to offer abortion counseling to qualify for Title X family planning funds. Under the proposed rule, Title X family planning grant recipients would be permitted—but not required—to give patients a list of "licensed, qualified, comprehensive health service providers, some (but not all) of wh[om] provide abortion in addition to comprehensive prenatal care." The proposed rule states that "providing such a list would be permitted only in cases where a program client who is currently pregnant clearly states that she has already decided to have an abortion."
In addition, the proposed rule would allow U.S. residents to sign up to receive services under Title X family planning grants if their employers do not offer health insurance coverage for contraceptives.
Further, the proposed rule would "encourage … family participation in the decision of minors to seek family planning services." According to the proposed rule, "unemancipated minors who wish to receive services on a confidential basis must be considered on the basis of their own resources, provided that the Title X provider has documented in the minor's medical records the specific actions taken by the provider to encourage the minor to involve … family." The proposed rule also would require that all employees who work for providers receiving Title X family planning funds complete annual training on how to work with patients who have experienced abuse.
According to the Wall Street Journal, the proposed rule also indicates that the administration plans to broaden the definition of "family planning" to include adoption, abstinence, infertility management, and natural family planning. Under the proposed rule, providers would not face penalties for choosing not to offer access to every medically approved form of contraception. Instead, grantees would be required to offer "a broad range of … methods and services," which do not all have to be medically approved.
According to the proposed rule, recipients of Title X family planning funds would have to show HHS that they are complying with the new regulations.
"Vitals" reports that the proposed rule will be subject to a public comment period and possible revisions before being finalized—and abortion-rights groups are likely to sue the administration over the proposed rule, starting a lengthy legal dispute.
The proposed rule could make providers such as Planned Parenthood and other women's health centers ineligible for Title X grants.
Under current regulations, such providers receive Title X funds to provide basic health services—such as contraceptives, pregnancy tests, and screenings for sexually transmitted infections—but also provide abortion services and referrals. Current regulations prohibit the use of federal funds for abortion services, but do not bar providers from using nonfederal funds for such services or make providers who offer abortion services ineligible for Title X grants.
According to the Washington Post's "To Your Health," the proposed rule could result in Planned Parenthood—which provides services to 41% of the four million people who receive care under Title X funds—losing up to $60 million a year.
Similarly, Susan Buchanan, CEO of the Boulder Valley Women's Health Center, said Title X grants represent about 20%—or $550,000—of the health center's budget. Buchanan said the proposed rule would place the health center "in the position of having to make a Hobbesian choice" between the 10% of the health center's patients who receive abortions and the remainder of patients who do not receive such services.
The majority of U.S. residents who could be affected by the proposed rule would be those who are uninsured, particularly in states where officials have not expanded Medicaid under the Affordable Care Act.
Critics of the proposed rule have said it essentially would act as a gag rule, restricting what health care providers are able to say to their patients.
For example, Planned Parenthood said the proposed rule is a "nationwide gage rule." The group also criticized the proposed rule for no longer requiring Title X recipients to provide all forms of medically approved contraception, and for eliminating a requirement that Title X recipients only provide medically approved contraceptives.
Rep. Frank Pallone (D-N.J.), the ranking member on the House Energy and Commerce Committee, said he believes "providers would be forced to choose between giving their patients complete medical information or complying with a restriction on speech" if the proposed rule is finalized as-is.
Ilyse Hogue, president of NARAL Pro-Choice America, said, "With this [proposed] rule, this administration is trying to instruct doctors about what they can or cannot say to their patients. That should alarm anyone who ever wanted to know the facts about their own health care or feel the doctor-patient relationship is sacred and should be protected."
Supporters of the proposed rule have said it would not implement a gag rule on Title X recipients because it allows providers to offer "non-directive" abortion counseling, the Wall Street Journal reports.
Jeanne Mancini, president of March for Life, said the proposed rule would "redirect[t]" Title X family planning funds "to comprehensive family health and planning centers that don't perform abortions."
Tony Perkins, president of the Family Research Council, said, "Planned Parenthood and other abortion centers will now have to choose between dropping their abortion services from any location that gets Title X dollars and moving those abortion operations off-site." He added, "Either way, this will loosen the group's hold on tens of millions of tax dollars" (Baker, "Vitals," Axios, 5/23; Radnofsky, Wall Street Journal, 5/22; Hellmann, The Hill, 5/22; Luthi, Modern Healthcare, 5/22; Hirschfeld/Shear, New York Times, 5/22; Eunjung Cha et al., "To Your Health," Washington Post, 5/18).
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