By Rebecca Bowers

EXECUTIVE SUMMARY

On March 4, the Trump administration published a final regulation that is a new version of the Reagan administration’s “domestic gag rule.” With the rule’s publication in the Federal Register, a 60-day clock is ticking until provisions of the rule start going into effect.

  • If implemented, the regulation will bar abortion referral, undermine patients’ rights to receive comprehensive counseling about pregnancy options, and exclude organizations from Title X if they provide abortion using non-federal funds. The rule also will change the services and providers that could receive support through Title X in ways that would shift the program away from its mission of providing high-quality and comprehensive family planning.
  • Groups, including 23 states, several family planning organizations, and the American Medical Association, have sued to block the new regulations from implementation.

Proposed changes to the federal regulations governing the Title X Family Planning program have mobilized reproductive health advocates to fight in court against the move.

On March 4, the Trump administration published a final regulation that is a new version of the Reagan administration’s “domestic gag rule.” With the rule’s publication in the Federal Register, a 60-day clock is ticking until provisions of the rule start going into effect.

If implemented, the regulation will bar abortion referral, undermine patients’ rights to comprehensive counseling about pregnancy options, and exclude from Title X organizations that provide abortion using non-federal funds. In addition, the rule also will change the services and providers that could receive support through Title X in ways that would shift the program away from its mission of providing high-quality and comprehensive family planning. (Read an analysis of the regulation: See the August 2018 Washington Watch column, “Trump Administration Revives Title X ‘Domestic Gag Rule,’” available at: https://bit.ly/2O2zJQh.)

“In every way, this rule attempts to shred the integrity of an evidence-based program with a nearly 50-year track record of public health success,” says Clare Coleman, president and chief executive officer of the National Family Planning & Reproductive Health Association. “The Trump administration’s rule not only contradicts medical ethics and healthcare quality standards, it defies widely shared, fundamental American values on the importance of confidentiality, dignity, and respect.”

Groups, including 23 states, several family planning organizations, and the American Medical Association (AMA), have sued to block the new regulations from implementation based on statutory and constitutional claims. The federal courts may consider the statutory claims and decide to block the regulations from going into effect until the cases can be heard. The courts will need to take action on the request for a stay before May 3, 2019.

If the regulation is enacted, physicians would be prohibited from having open, frank conversations with their patients about all of their healthcare options, a situation termed “untenable” by AMA President Barbara McAneny, MD.

“The new rule imposes a government gag rule on what information physicians can provide to their patients,” said McAneny in a statement. “The administration wants to allow Title X clinics not to provide full information to patients about all of their health care options and block physicians from providing appropriate referrals for care.”

Title X Funding Is Key to Family Planning

Since its enactment in 1970, Title X has served as the sole federal program dedicated to supporting family planning care delivery.

The program serves more than 4 million low-income, uninsured, and underserved patients and is administered by the federal Health and Human Services’ Office of Population Affairs. In Fiscal Year 2018, the program had a funding level of $286.5 million.1

In 2017, about 4,000 clinics across the country relied on Title X funding. These funds go to sites such as community health centers, state health departments, and Planned Parenthood centers, as well as to faith-based, school-based, and other nonprofit organizations. According to federal documents, in 2017 approximately 19% of revenue for family planning services for participating clinics involved Title X grants. These funds were used to pay for the direct costs of family planning services as well as to cover general operating costs, such as rent, staff salaries, health information technology, and staff training.1

The current Title X network provides the backbone of needed services for many at-risk women. According to the Guttmacher Institute, in 2015, 64% of U.S. counties had at least one family planning center supported by Title X. Ninety percent of women who needed publicly funded family planning care lived in those counties. Data indicate that in 21% of all counties, a Title X site was the only health center delivering publicly funded contraceptive care to at least 10 women annually.2

“The Title X rule is designed to destroy our nation’s family planning provider network and deprive millions of poor and low-income people of access to the contraception and other preventive healthcare they need,” said Coleman.

Legal Action Mounts

The new regulation comes during a funding cycle for Title X grantees due to end March 31. Applications for new grants have already been submitted and were expected to begin April 1, 2019, under the previous regulations. Those applicants selected for funding will need to choose between complying with the new regulations or withdrawing from the Title X program.

The new requirements are extensive, calling for entities supported by Title X to be separate both physically and financially from any entity that provides abortion using non-federal funds. That separation would include separate physical spaces, accounting records, patient health records, staff, phone numbers, email addresses, signage, and more.

Title X plays a “vital role” in the fabric of America’s family planning safety net, reads a statement issued by the American College of Obstetricians and Gynecologists and 18 other professional reproductive health societies.

“The final regulation is the latest of numerous recent decisions — from rolling back insurance coverage for contraceptives to attempting to eliminate funding for evidence-based teen pregnancy prevention programs — that unravel the threads of this safety net,” the statement reads. “Together, these decisions compound, leaving women and families with increasingly fewer options for obtaining medically accurate, affordable, and timely access to contraception and preventive care.”

Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta and chairman of the Contraceptive Technology Update Editorial Advisory Board, says, “Once again, efforts to decrease the delivery of contraceptives and abortion services will make the availability of contraception more difficult for less-advantaged women. But the needs of less-advantaged women are not really the concern of the Trump administration. These proposed Title X plans are, in my opinion, a disgrace.”

REFERENCES

  1. Sobel L, Salganicoff A, Frederiksen B. New Title X regulations: Implications for women and family planning providers. Kaiser Issue Brief. March 2019. Available at: https://bit.ly/2Je72RB. Accessed March 21, 2019.
  2. Hasstedt K. What the Trump Administration’s final regulatory changes mean for Title X. Health Affairs Blog, March 5, 2019. doi:10.1377/hblog20190304.267855.