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UPDATE 7/18 4:56 p.m.: Democratic Illinois Gov. J.B. Pritzker announced that Illinois would “forgo Title X funding from the federal government while the gag rule remains in effect.” The state’s public health department will fund providers instead.
The Trump administration’s changes to a federal family planning program have put health care organizations in a bind: They can keep the program's grant money and deny people information about where they can get abortions — or pull out of the program and risk closing clinics where patients receive STI tests, cancer screenings, and birth control.
Planned Parenthood’s state affiliates are no longer taking funding from the $286 million program, Title X, in the wake of the administration’s Monday announcement that it would enforce its long-delayed rules barring program providers from referring people for abortions. And Maine Family Planning, the sole grantee in the state, announced that it will leave the program entirely, after almost half of a century of participating in Title X.
Instead, they’re all relying on rainy day funds, which will only last for so long. Not all clinics that receive Title X money offer abortions, and even those that don’t are now at risk of closing.
“The Title X program is a critical part of the public health system, and without it, the future could look pretty bleak for providers and patients alike,” said Audrey Sandusky, director of advocacy and communications for the National Family Planning and Reproductive Health Association, a membership group for family planning health care providers.
The writing had been on the wall for weeks, if not months. But when providers in the federal program opened their inboxes to find a message from a Trump administration official Monday evening, the news was still jarring.
“I was hoping for better angels to win out here and that an injunction would stick and that we’d be able to continue giving services as we had been,” said Evelyn Kieltyka, senior vice president of program services for Maine Family Planning, one of the many health care groups that sued in an attempt to stop the rules from taking effect.
“But when they actually decided to enforce and provide guidance, we had no choice but to withdraw from the program,” Kieltyka added.
While there are other avenues to find abortion providers, patients can often run into complex state restrictions on the procedure, pregnancy centers that may look like abortion providers but aren't, or inaccurate information online. For Kieltyka and other opponents of the new rules, the changes amount to a “gag rule” that muzzles health organizations from offering their patients information about a legal procedure.
“It was just unethical and, again, just not patient-centered to not be able to provide women with all of their choices when it comes to an unintended pregnancy,” she said.
"The future could look pretty bleak for providers and patients alike."
Though nobody knows how many clinics may shut down as the result of the Trump administration’s changes, which anti-abortion advocates have dubbed the “Protect Life Rule,” almost 4,000 clinics and about four million low-income people across the country participate in Title X. Maine Family Planning receives $1.8 million per year from Title X, which it doles out to 47 clinics throughout the state; in total, the organization serves more than 23,000 people annually through Title X.
Maine Family Planning has the “limited financial reserves” to keep its network funded through the end of July, Kieltyka said. Maine’s governor, Democrat Janet Mills, has pledged to help the network, if possible.
For now, Maine Family Planning officials are telling clinics to operate like it’s “business as usual.”
A long time coming
The rule changes have long been viewed as an attempt by the Trump administration to carve Planned Parenthood out of Title X. While it’s already illegal to use federal funds to pay for abortions — except in limited circumstances — proponents say the changes are necessary to ensure that no taxpayer-supplied funds intermingle.
“Planned Parenthood and others want to use public Title X funds to support their abortion services in blatant disregard of the fact that Congress explicitly and statutorily excluded abortion from the scope of Title X projects and funding,” Catherine Glenn Foster, president of the anti-abortion group Americans United for Life, said in a statement.
“In reality, no physician in America is being stopped from referring a patient for an abortion — they just can't demand taxpayer funding to do so," she continued.
Under the new rules, if a pregnant patient wants an abortion, a doctor can give them a list of health care providers. That list may include some, but not a majority, of clinics that perform abortions; physicians may not indicate which ones actually offer abortions.
Title X grantees must also now separate the finances of any abortion-related services they might have from any other services. Another requirement — that clinics must physically separate abortion services from other offerings — is expected to take effect next year.
"We will not comply with the Trump-Pence administration’s gag rule."
The governors of Washington, Oregon, and Hawaii have all previously promised to give up Title X dollars if the Trump administration's changes went through. In an email, Jaime Smith, executive director of communications for Washington Gov. Jay Inslee’s office, said that the state is still “reviewing our options.”
“Our state will continue to challenge this extremely harmful effort that places barriers to care for thousands of Washingtonians, particularly lower-income and vulnerable women,” Smith said. Neither Oregon nor Hawaii returned a request for comment on their states’ futures in the family planning program.
Planned Parenthood — whose leader was just ousted in what she called a "secret meeting" — has made its choice.
“As we have said before, we will not comply with the Trump-Pence administration’s gag rule and we will not compromise our patients’ ability to get the best care,” Jacqueline Ayers, Planned Parenthood Federation of America's vice president of government relations and public policy, told VICE News in a statement.
“During this period of limbo while we wait for the court to rule, our affiliates are not using federal Title X funds to provide care. We are continuing to fight this illegal rule in court and to provide care to all people — no matter what.”
A panel of judges from the U.S. 9th Circuit Court of Appeals is set to re-hear a legal challenge to the changes. Last week, they declined to keep the rules from going into effect while litigation continues.
“A lot of soul-searching”
Because Monday’s announcement arrived on the eve of a multi-day meeting for Title X grantees with the Office of Population Affairs in Washington, D.C., some may be waiting for the meeting to conclude before they make a decision about whether to keep the grant money or comply with the new rules. Officials at the meeting are widely expected to give grantees more guidance about what the new Title X should look like and how the changes will be enforced.
“A lot of these grantees are doing a lot of soul-searching, to figure out what comes next in this period of uncertainty and how to keep their network strong either in the program or out of the program, with funding or without funding,” said Sandusky, of the National Family Planning and Reproductive Health Association.
As for Maine Family Planning, Kieltyka said it’s “aggressively working on how we can continue to support the network we have.” As a nurse practitioner, she’s provided family planning services for more than four decades.
“As a provider, it’s unthinkable that you can’t actually give your patient what they want,” she said, her voice soft and pained. “And it’s incredibly safe, legal, available — and yet I can’t tell you where to go. There’s no other health care service where that kind of restriction is placed.”
Cover image: National Institute for Health and Care Excellence study. File photo dated 15/04/2009 of condoms. Issue date: Thursday April 6, 2017. See PA story HEALTH STIs. Photo credit: Niall Carson/PA Wire URN:30830144 (Press Association via AP Images)