Proposed Rule Ensures States Can’t Discriminate Against Planned Parenthood When Distributing Title X Funds

NY Times: Proposed Title X Rule “Would Make Clear That State Governments” Must Allocate Funds Only “Based On A Provider’s Ability” And Not Based On Abortion Politics. In a September 9 editorial, The New York Times supported the proposed rule that would prevent states from denying Planned Parenthood access to funding given through “the Title X Family Planning Program, which provides federal money for services like contraception, testing for sexually transmitted infections and cancer screenings.” According to the Times, “The rule would make clear that state governments must apportion Title X funds based on a provider’s ability to perform family planning services effectively -- not on other factors like whether a provider also offers abortions.” From The New York Times:

Opponents of Planned Parenthood in recent years have cut funding to the organization that goes through the Title X Family Planning Program, which provides federal money for services like contraception, testing for sexually transmitted infections and cancer screenings. (Like all federal programs, it is largely barred from paying for abortions.) State and local governments distribute that money to health care providers, and at least 14 states took actions to cut the share they direct to Planned Parenthood.

This month, the Department of Health and Human Services proposed a rule that could stop states from doing this. The rule would make clear that state governments must apportion Title X funds based on a provider’s ability to perform family planning services effectively -- not on other factors like whether a provider also offers abortions.

State efforts to strip Planned Parenthood of Title X funds have hurt low-income residents, who are likely to depend on Planned Parenthood clinics for free or low-cost health services. In New Hampshire, for instance, the state’s Executive Council voted in 2011 not to renew Planned Parenthood’s contract under Title X, leaving parts of the state with no federally funded family planning services until the Department of Health and Human Services stepped in with an emergency grant three months later. Fortunately, the council voted in June to restore funding. [The New York Times, 9/9/16]

Administration Previously “Warned Officials In All 50 States” That The Politically Motivated Blocking Of Medicaid Funding Was “Out Of Compliance With Federal Law.” Before the Obama administration proposed the rule about Title X funding, it had in April “warned officials in all 50 states” that blocking Planned Parenthood’s Medicaid funding was likely “out of compliance with federal law,” according to The Washington Post. The paper reported on April 19 that the warning was sent to “all state Medicaid offices to clarify that terminating certain providers from Medicaid is only justifiable if those providers are unable to perform covered medical services” and further “that states cannot target providers for impermissible reasons.” A spokesperson for the Department of Health and Human Services explained that this guidance marked “the first time the agency has warned all the states collectively.” From The Washington Post:

The Obama administration on Tuesday warned officials in all 50 states that actions to end Medicaid funding of Planned Parenthood may be out of compliance with federal law.

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Federal health officials said the letter from the Centers for Medicare and Medicaid Services is being sent to all state Medicaid offices to clarify that terminating certain providers from Medicaid is only justifiable if those providers are unable to perform covered medical services or can’t bill for those services. The guidance emphasizes that states cannot target providers for impermissible reasons and are required to treat similar types of providers equitably.

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CMS has communicated with the individual state Medicaid offices in the past, but this is the first time the agency has warned all the states collectively, officials said. [The Washington Post, 4/19/16]

Right-Wing Media Attacked The Rule And Pushed Misinformation That Planned Parenthood Wasn’t An Essential Provider

The Daily Signal: Proposed Rule Ensures There Will Be “Millions More In Taxpayer Dollars For the Nation’s Abortion Market Leader At the Expense Of Women’s Health.” Casey Mattox, a lawyer for the extreme right-wing legal group Alliance Defending Freedom (ADF), claimed in a Daily Signal piece that the proposed rule would ensure that there are “millions more in taxpayer dollars for the nation’s abortion market leader at the expense of women’s health.” In the September 13 article, Mattox argued that this rule would be detrimental to women’s health because “Planned Parenthood is simply not equipped to provide [necessary] primary care services.” Because of this, he wrote, many states had already “wisely chosen to prioritize the funds to more comprehensive health care providers than Planned Parenthood,” claiming that those providers already “serve at least eight times as many patients than Planned Parenthood.” From The Daily Signal:

In his remaining few months in the Oval Office, President Barack Obama has found a new way to direct more taxpayer money to his friends at Planned Parenthood.

The Department of Health and Human Services has announced a new regulation that would force states to give federal family planning funds to Planned Parenthood and other abortionists. The move could mean millions more in taxpayer dollars for the nation’s abortion market leader at the expense of women’s health.

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Grants are available to both public entities (like state health departments) and private networks. Where a state health department chooses not to apply, private entities often receive and distribute Title X funds. Among states that receive Title X funds, some have wisely chosen to prioritize the funds to more comprehensive health care providers than Planned Parenthood, thereby avoiding state entanglement with abortion. That’s why the Obama administration is upset.

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Federally qualified health centers serve at least eight times as many patients than Planned Parenthood. Medicaid has expanded, and many states employ federally approved Medicaid waiver programs to provide the same services covered under Title X to many more people. And, of course, Obamacare now mandates coverage of contraceptives on virtually every health plan. [The Daily Signal, 9/13/16]

TheBlaze: Anti-Choice Lawmaker “Slammed The Proposed Rule” As A Waste Of Money Meant “To Protect Planned Parenthood And To Circumvent Congress.” In an exclusive interview with TheBlaze, Rep. Diane Black (R-TN) argued that the proposed rule is a waste of money that proves that Obama “has an unholy alliance with the big abortion industry.” Black is also a member of the Congressional Select Investigative Panel on Infant Lives, which is conducting a politically motivated investigation of abortion providers, Planned Parenthood, and fetal tissue research. Black “slammed the proposed rule” for “strip[ping] states of their ability to decide where their funds are best spent,” TheBlaze wrote, and argued that the rule was meant “to protect Planned Parenthood and to circumvent Congress.” TheBlaze quoted Black as saying that state legislators “know better than the federal government does about who in our state can provide the most comprehensive health care” and that federally qualified health centers (FQHCs) have “more comprehensive care than what Planned Parenthood does”:

In an interview with TheBlaze on Thursday, Rep. Diane Black (R-Tenn.), slammed the proposed rule, arguing that it would strip states of their ability to decide where their funds are best spent.

“The Department of Health and Human Services will strip us of our ability to be able to take the dollars that come from Title X family planning at the state level to fund where the state believes that the dollars would best be used,” Black said. “And to say now that Planned Parenthood would be one of those, because we would be prohibited from making that decision.”

“After all, these are taxpayer dollars,” Black continued. “These are dollars that are sent from our state to the federal government before they turn around and send them back, we should have some say in how those dollars are spent in our states. And we in our states know better than the federal government does about who in our state can provide the most comprehensive health care.”

Black called the proposed rule another example of the Obama administration’s efforts to protect Planned Parenthood and to circumvent Congress.

“They seem to take advantage of anything they can do by executive fiat rather than coming through Congress to do it and have a conversation with us,” Black said. “This administration has an unholy alliance with the big abortion industry, and over and over again, they do what they can to protect them, and this is just one more step before they leave office.”

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Black, who worked as a nurse prior to her time in Congress, said that in Tennessee, federally qualified community health centers vastly outnumber Planned Parenthood clinics. She argued that although Planned Parenthood has tried to portray itself as the only provider of women’s health services for low-income women, federally qualified health centers provide “more comprehensive care than what Planned Parenthood does.” [TheBlaze, 9/8/16]

Breitbart News: Proposed Rule Would “Override State Laws That Redirect” Funding From Planned Parenthood Because Of Alleged “Sale Of Body Parts Of Aborted Babies.” Breitbart News’ Dr. Susan Berry wrote that the proposed rule was intended to “override state laws that redirect[ed]” funding away from Planned Parenthood after the organization was allegedly involved in the “illegal sale of body parts of aborted babies.” These allegations stem from a series of deceptively edited videos released by the discredited anti-choice group Center for Medical Progress (CMP). Although multiple investigations have cleared Planned Parenthood, anti-choice lawmakers in several states attempted to defund the organization -- prompting the Obama administration to offer guidance and then updated rules governing the distribution of federal Medicaid funds as well as Title X funding. In the September 6 article, Berry rejected the HHS argument that states had “interfered with” the accessibility of medical care by diverting funds and asserted that many states had simply “redirect[ed] the federal funding to other [FQHCs] which provide more comprehensive medical services” than Planned Parenthood:

President Barack Obama’s administration is drafting a new regulation which would override state laws that redirect federal funding away from its political ally -- Planned Parenthood -- towards competing healthcare providers.

The federal rule is aimed at the laws passed by states to redirect Title X family planning funding away from Planned Parenthood, following the organization’s alleged involvement in the illegal sale of body parts of aborted babies.

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Several states now redirect the federal funding to other Federally Qualified Health Centers (FQHCs) which provide more comprehensive medical services, but which do not provide abortions. Nationally, there are 13,000 FQHCs – a figure that outnumbers Planned Parenthood facilities by 20 to 1.

Nevertheless, the Department of Health and Human Services (HHS) asserts that by redirecting Title X funding away Planned Parenthood, the states “have interfered with” low-income individuals’ ability to access federal assistance quickly. [Breitbart News, 9/6/16]

Wash. Times: Proposed Rule Meant To “Protect Planned Parenthood From Accountability At The Local Level.” In a September 7 article, The Washington Times reported that the proposed Title X rule was “countering gains” by the anti-choice movement “to defund the abortion provider at the local level.” According to the Times, the proposed rule represents another effort by the administration to “protect Planned Parenthood from accountability at the local level.” The Times claimed state lawmakers could not make funding decisions based on “whether a clinic performs abortions or traffics in fetal body parts from them.” From The Washington Times:

The Obama administration is proposing a new rule that would require states to continue to fund Planned Parenthood, countering gains by the pro-life movement to defund the abortion provider at the local level in the wake of the undercover video investigation alleging the clinic traffics in fetal body parts from abortions.

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Although new recipients meet Title X eligibility requirements, HHS says whether a clinic performs abortions or traffics in fetal body parts from them are not criteria by which determinations of funding can be made.

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The Obama administration previously has employed similar reasoning to protect Planned Parenthood from accountability at the local level.

In April the Centers for Medicare & Medicaid Services issued a directive to states informing them that providing “the full range of women’s health services” is not a legitimate reason to strip an entity of Medicaid funding.

The administration also has directly subsidized abortion providers in several states where federal dollars were redirected to other certified clinics that do not perform abortions. [The Washington Times, 9/6/16]

Planned Parenthood Is An Essential And Irreplaceable Health Care Provider

George Washington University Public Health Professor: Argument That FQHCs “Can Absorb The Loss Of Planned parenthood Clinics Amounts To A Gross Misrepresentation.” Experts have confirmed that even when FQHCs and community clinics do provide reproductive health services, they are not well-positioned to fill the gap left when Planned Parenthood is defunded. As Sara Rosenbaum, a professor at the George Washington University Milken Institute School of Public Health, wrote in an article for the Health Affairs Blog, the “claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do”:

I have worked with community health centers for nearly 40 years, and no one believes more strongly than I do in their ability to transform the primary health care landscape in medically underserved low-income communities. But a claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do were Planned Parenthood to lose over 40 percent of its operating revenues overnight as the result of a ban on federal funding.

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It is important to set the record straight about what it would mean to women were health centers suddenly to have to respond to a hole in care of this magnitude, especially given absurd claims about their financial ability to do so, such as assertions that community health centers could do so for $1.67 per patient. Community health centers are extremely efficient, but the cost of caring for their patients averages about $600 per person annually.

While community health centers constitute a vital component of the nation's primary care safety net, three reasons underscore why it's misguided to suggest community health centers could--overnight--compensate for the loss of affordable women's health services at Planned Parenthood clinics. [Health Affairs Blog, 9/2/15]

Guttmacher Institute: In 103 U.S. Counties, Planned Parenthood Is The Only “Safety-Net Health Center” With Accessible Contraception Services. In 2015, the Guttmacher Institute responded to a request from the Congressional Budget Office about the “geographic service availability from Planned Parenthood health centers.” The study found that in 103 U.S. counties, Planned Parenthood is the only “safety-net health center” able to provide publicly subsidized contraceptive services. The study also found that Planned Parenthood typically saw patients three to five days sooner than “other types of safety-net providers.” From the Guttmacher Institute (citations removed):

In 18 states, Planned Parenthood health centers serve more than 40% of women obtaining contraceptive care from a safety-net family planning health center .

In 11 of those 18 states, Planned Parenthood serves more than half the women obtaining contraceptive care from a safety-net health center.

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In 103 counties with a Planned Parenthood health center (21% of counties with a Planned Parenthood site), Planned Parenthood serves all of the women obtaining publicly supported contraceptive services from a safety-net health center. [Guttmacher Institute, 8/14/15]

NY Times: Planned Parenthood Serves More Patients And Has “Higher Quality Care Than Centers Without An Emphasis On Reproductive Health.” In a September 9 editorial, The New York Times refuted the argument that “community health centers can easily provide the same family planning services that Planned Parenthood offers.” As evidence, the Times noted that Planned Parenthood “serves an enormous number of patients” and despite running “only 10 percent of all health centers that receive Title X funds” regularly provides services to “about a third of all patients” receiving Title X services. The Times also pointed to a recent study which found that Planned Parenthood was able to offer “a wider range of family planning services and higher quality care than centers without an emphasis on reproductive health.” From The New York Times:

Some state lawmakers have argued that community health centers can easily provide the same family planning services that Planned Parenthood offers. But a study published this year found that providers focused on reproductive health care, like Planned Parenthood, offered a wider range of family planning services and higher quality care than centers without an emphasis on reproductive health.

Planned Parenthood also serves an enormous number of patients; though it operates only 10 percent of all health centers that receive Title X funds, it treats about a third of all patients receiving federally funded family planning services nationwide.

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If the rule takes effect, it will benefit people all over the country who need reliable reproductive health care. [The New York Times, 9/9/16]

State-Level Defunding Of Planned Parenthood Has Already Had Negative Impacts On Community Health

After State Funding Cuts Forced Rural Indiana Planned Parenthood Clinics To Close, Scott County Became Center Of “Exploding HIV Outbreak.” In 2011, Indiana’s anti-choice legislature cut state funding for Planned Parenthood -- forcing five Planned Parenthood clinics to close. These cuts left rural Scott County without an HIV testing center as it experienced a sharp increase in HIV infections. According to a 2015 article in The Huffington Post, the cuts made Scott County “the center of an exploding HIV outbreak” while the state was left “scrambling to erect pop-up clinics to combat an unprecedented HIV epidemic”:

Scott County, Indiana, the center of an exploding HIV outbreak, has been without an HIV testing center since early 2013, when the sole provider -- a Planned Parenthood clinic -- was forced to close its doors. The clinic did not offer abortion services.

The Scott County clinic and four other Planned Parenthood facilities in the state, all of which provided HIV testing and information, have shuttered since 2011, in large part due to funding cuts to the state's public health infrastructure. Those cuts came amid a national and local political campaign to demonize the health care provider. Now, the state is scrambling to erect pop-up clinics to combat an unprecedented HIV epidemic caused by intravenous drug use.

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Stauffer said if the Planned Parenthood facilities in Scottsburg and Madison, both in southwest rural Indiana, had received the funding they needed to stay open, they could have been a vital resource in preventing the current HIV outbreak. [The Huffington Post, 3/31/15]

Texas Defunded And Cancelled Contracts With Planned Parenthood To The Detriment Of Community Health. Joseph Potter, a professor of sociology and the principal investigator of the University of Texas at Austin's Texas Policy Evaluation Project (TxPEP), investigated the impact of the Texas legislature's decision to exclude Planned Parenthood from the state’s reproductive health safety-net program. According to a 2015 guest column in the San Antonio Express-News, Potter found “not all federally qualified health centers” or community clinics were interested in “becoming a family-planning provider.” Similarly, he found that “there have also been problems for the women faced with finding a new provider” once Planned Parenthood was no longer an option. A June 2016 report by the Texas Observer found that in Harris County, TX -- which had the highest number of new HIV diagnoses in the state in 2014 -- the county’s health department hadn’t conducted a single HIV test since the elimination of its contract with Planned Parenthood in December 2015. [San Antonio Express-News, 8/15/15; Texas Observer, 6/8/16]