EXECUTIVE SUMMARY

Essential Access Health and other family planning advocacy organizations petitioned the Supreme Court to review a Court of Appeals decision that upholds the Trump administration’s Title X regulations and gag rule.

  • Because of the changes, the number of Title X sites in California dropped from 366 to 238.
  • One in every four Title X providers has withdrawn from the program.
  • The number of patients seen at Title X clinics in California fell from nearly 1 million to about 225,000 patients between 2019 and 2020.

Since the Trump administration implemented new rules regarding Title X family planning centers that also offer abortion services, hundreds of family planning sites left the program, leaving hundreds of thousands of patients behind.

In California, the number of Title X sites fell from 366 in March 2019 to 238 in September 2020, says Julie Rabinovitz, MPH, president and chief executive officer of Essential Access Health in Berkeley, CA.

“We have new data showing what’s happening nationwide and also in California,” she says. “One in every four Title X providers has withdrawn from the program, and that has jeopardized access to time-sensitive services to 1.6 million patients nationwide.” (More information is available at: https://www.guttmacher.org/article/2020/02/trump-administrations-domestic-gag-rule-has-slashed-title-x-networks-capacity-half.)

In 2019, nearly 1 million patients were seen at Title X clinics in California. The next year, when the new rules were implemented, there were just over 600,000 patients seen in these clinics. There is expected to be an even greater decrease, to about 225,000 patients, Rabinovitz says, referring to internal data.

To stop the rules from continuing to damage the Title X program, reproductive health organizations have asked the Supreme Court to intervene.

“We’re planning to fight this until the end,” Rabinovitz says.

Essential Access Health and a group of family planning and reproductive health justice organizations petitioned the Supreme Court on Oct. 1. They asked the court to review a Court of Appeals decision that upholds the Trump administration’s Title X regulations that make it impossible for family planning clinics to provide abortion services — funded privately — and receive federal funding for their separate contraceptive and reproductive health services.

The groups include the American Medical Association, Planned Parenthood Federation of America, the National Family Planning & Reproductive Health Association, the American Civil Liberties Union, the Oregon Medical Association, and others. (More information is available at: https://www.essentialaccess.org/about/press-room/petition-supreme-court-sept-2020.)

“The 9th Circuit ruled to support the Title X regulations, and the 4th Circuit ruled that new regulations violated the Administrative Procedures Act (APA), which is what the original lawsuit was about,” Rabinovitz says. “We believe the 9th Circuit’s ruling was faulty. If it’s not reversed, it will have profound and long-lasting implications for Title X programs and the people who rely on them.”

The original lawsuit argued that the new regulations violated the APA. When any administration initiates regulations, they need to follow APA rules, including opening a comment period. They also should not issue regulations when there is no reason to do so and there is no evidence of an issue, Rabinovitz explains. “The APA is made to make sure the regulation is not arbitrary and capricious.”

In the case of the Trump administration’s requirement that abortion and non-abortion services be physically separated with different buildings, entrances, and finances, there was evidence of problems in Title X centers keeping these separate before the regulations were published. “The new regulations do violate the Administrative Procedures Act, and we need the Supreme Court to get involved in this. We need a decision based on facts and evidence,” Rabinovitz says. “It is our hope that the Supreme Court will consider this in light of their own recent decisions. We are hoping that politics will not interfere with a Title X mandate.”

For instance, in the Supreme Court case involving the Department of Homeland Security v. Regents of the University of California, the court ruled an agency must base its decision on a consideration of relevant factors and may not fail to consider important aspects of the problem. In that case, the court ruled that the Trump administration’s decision to end the Deferred Action for Childhood Arrivals program was “arbitrary and capricious in violation of the APA.” (For more information, visit: https://www.theusconstitution.org/litigation/department-of-homeland-security-v-regents-of-the-university-of-california-trump-v-naacp-and-mcaleenan-v-vidal/.)

When clinics pull out of Title X because of the rules making them choose between eliminating abortion services or finding alternative funding, low-income women are the hardest hit. “In California, we are lucky to have a family planning program called Family PAC with services to people up to 200% of the federal poverty level [FPL],” Rabinovitz says. “For those at 250% of the FPL, many of those patients may not be able to get comprehensive family planning services that they were getting before for a free or reduced rate.”

In many other states, the situation is more dire because they do not receive state funding to make up even part of the difference of what is lost with the Title X change. “They just rely on Medicaid or Title X, and many did not have the Medicaid expansion under the Affordable Care Act,” Rabinovitz says. “Arizona, Utah, and some other states do not even have Title X programs anymore, so those states are struggling to provide the same level of care for low-income individuals.”

Quality also is lost when Title X clinics close or pull out. “Several studies in California show that patients who go to Title X clinics in California are more likely to get high-quality services than are people who just go to a clinic that has the family PAC program,” Rabinovitz explains.

The Title X clinics offer educational outreach, extended clinic hours, and more birth control options, such as long-acting, reversible contraceptives. “Those studies have shown time and again that the quality of care is better at Title X clinics than non-Title X,” she adds.

The remaining Title X clinics are locations that never offered abortion services. But they also are being forced by the Trump administration’s rules to not provide abortion information to patients. “They can provide counseling around the options, but are not allowed to offer abortion referrals,” Rabinovitz says. “I think it’s incredibly difficult, especially for the clinicians and medical assistants. To not allow healthcare providers to offer full information to their patients is really asking them to compromise their medical ethics. It’s an outrageous and direct attack on women’s autonomy.”

It is like the federal government telling a doctor that he or she can only tell a patient with diabetes how to eat a healthier diet, but cannot mention the use of insulin to manage the disease, she says.

“If Vice President Joe Biden is elected, he could rescind the new regulations as soon as he takes office and restore the integrity of the Title X program, and it would make our appeal to the Supreme Court moot,” says Rabinovitz, speaking in a phone interview a few weeks before the Nov. 3 general election. “That’s what happened when President Clinton became president — he issued an executive order. That would be our hope in this situation, as well.”