This article originally appeared on VICE US.
Two reproductive health clinics in New York City are preparing for the possibility that they will have to close after withdrawing from Title X, the country’s family planning program.
The clinics, both located in Brooklyn, are two of six operated by Public Health Solutions, a nonprofit organization that is no longer eligible to receive Title X funds because of a recent Trump administration policy. The change prohibits federal dollars from going to abortion providers or to health centers that provide abortion referrals to their patients. PHS provides referral services—not abortions—as well as gynecological exams, prenatal care, birth control, STI testing, and other reproductive health care.
The policy, which was handed down in July, has given the roughly 4,000 clinics that currently receive Title X funds an ultimatum: Stop providing abortions—or referring people to clinics where they can obtain abortions—or give up millions of dollars in funding. Clinics have until September to make their choice, but, like many others, PHS has already announced that it will forego the Title X money in order to continue providing the same standard of care it did before.
“We are unwilling to compromise those beliefs by replacing our services with inadequate and incomplete health care,” PHS President and CEO Lisa David said in a statement earlier this month. The network of clinics, she continued, would reject a total of $4.6 million in funding.
Turning down the funds has put PHS’s clinics—which primarily serve low-income New Yorkers—in a precarious position. With funds rapidly dwindling, the Brooklyn Eagle reports that the two clinics, located in the Brooklyn neighborhoods Fort Greene and Crown Heights, may be forced to close in a matter of weeks, unless PHS receives an infusion of cash. If the clinics close, they could be the first to do so as a result of the Trump administration changes.
New York state has prepared for this exact scenario by establishing a $16 million emergency fund for abortion clinics to dip into as a substitute for Title X. But as of this writing, neither PHS nor any other New York clinics have been able to access those funds as they have not been released by the governor's office. On Tuesday, a spokesperson for PHS told VICE that the organization was still in conversation with the state about securing the funding and directed VICE to the governor's office for comment. A spokesperson for Gov. Andrew Cuomo’s office declined to comment on the record.
Some advocates say the fact that two New York clinics have already been brought this close to shutting down highlights that even providers in progressive states are feeling the impact of the Trump administration’s mounting attacks on abortion.
“Roe v. Wade stands for the principle that abortion is a fundamental right, but that’s far from people’s reality across this country, even in blue states,” said Katharine Bodde, the senior policy council at the New York Civil Liberties Union. “Federal policy can impact abortion access even in states with supportive laws and policies, as we’re seeing here.”
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PHS’s struggles to secure funding in the absence of Title X is mainly logistical: Since the network of health centers was a direct grantee of Title X—that is, its funds were paid directly by the federal government—the bureaucracy involved in connecting the organization to the state pipeline for funding has caused a lapse in cash flow.
But the logistical issues involved in getting former Title X beneficiaries access to state funds aren’t the only obstacle to New York clinics staying open. In July, David told AMNY she had concerns that the $16 million set aside by the state could run out. “$16 million in the state budget…is not a lot of money," she said at the time. " …What I worry about is disruption in services, not that it won't ultimately be funded.” A PHS spokesperson told VICE that David was unavailable for comment.
History shows that even a temporary disruption in services can be dire for both patients and providers. Amy Hagstrom Miller, president and CEO of the clinic network Whole Women’s Health, remembers well what it was like to cease operations at multiple Texas clinics as the result of the 2013 state law requiring abortion clinics to obtain hospital admitting privileges.
“Laying off a fabulous nurse, telling them they no longer have a job because of political interference is one of the hardest things we’ve ever done,” Hagstrom Miller said in a June interview about the looming closure of Missouri’s last abortion clinic. If staff members get laid off, “they’ll have to get other jobs, making it very difficult to reopen and rebuild [later on],” she continued. “It might not be something you can afford to do.”
Layoffs are also a concern at PHS—the two clinics in question employ 30 people, according to NY1—though a statement from senior adviser Rich Azzopardi on behalf of New York Governor Andrew Cuomo reassures that the “threats of layoffs are 100 percent avoidable.” Azzopardi also said the administration has been in “constant contact” with PHS to help them access the state funds.
Blue states have ramped up their efforts to fund and protect abortion providers over the last year, in the face of both federal attacks on abortion rights and the increasingly extreme state laws threatening to ban abortion for millions. Multiple states, including New York, have passed legislation enshrining abortion protections into state law. Others have signed laws requiring public and private insurance to cover abortion, and pledged to fund abortion providers through their state’s public health departments instead of through Title X.
But even if providers may be in a slightly better position to continue services in progressive states, Robin Chapelle Golston, the president of Planned Parenthood Empire State Acts, said Wednesday it’s important to remember that nothing about the current environment of abortion access is ideal.
Replacing Title X funds is a “burden on the state,” she said, that forces state officials to “come up with this money that would normally come from the federal government.”
“Title X covers basic health care that most people support,” Golston continued. “These services are not controversial. There’s nothing about this [new Title X policy] that is about keeping women healthy and safe.”