Sarah Wasko / Media Matters

Update: This piece has been updated to include additional examples.

The proposed Title X rule change would impact clinics that offer or refer for abortions

The Trump administration announced that clinics performing or referring for abortions would lose family planning funding. On May 18, the White House released a statement saying that President Donald Trump would propose a new rule that would eliminate Title X family planning funding from clinics that perform or refer for abortions. This rule is similar to the “global gag rule” that Trump re-implemented early in his term that stripped funding from international clinics performing or referring for abortions. While the full impact of that decision isn’t yet known, Bustle reported it has already caused a clinic in Kenya to lose “more than $2 million in funding.” While abortion opponents claim that the rule is necessary to ensure the separation of federal family planning funds and abortion services, the Hyde Amendment already prohibits federal funding for abortion services. [The White House, 5/18/18; Care2, 5/22/18; Kaiser Family Foundation, 5/15/18; Bustle, 5/2/18; Planned Parenthood, accessed May 2018]

The proposed rule will impact low-income communities, Planned Parenthood, and other Title X clinics. As Julie Rovner of Kaiser Health News reported, 4 million patients rely on Title X funding, and these “patients are overwhelmingly young, female and low-income.” While Planned Parenthood clinics are only 13 percent of the Title X clinics, they “serve an estimated 40 percent of its patients.” In addition, “several studies have suggested that in many remote areas Planned Parenthood is the only provider of family planning services.” According to Ally Boguhn at Rewire.News, research by the Guttmacher Institute indicates that “other Title X sites would have to increase their client caseloads by an average of 70 percent to accommodate the change” and would likely be unable to absorb Planned Parenthood’s Title X patients. [Kaiser Health News, 5/18/18; Rewire.News, 5/18/18]

The Trump administration announced the language of the proposed rule before a speech at an anti-abortion group’s gala. The Trump administration revealed the actual language of the proposed rule May 22 before his keynote at the annual “Campaign for Life” gala held by the anti-abortion group Susan B. Anthony List. Media Matters found that in the weeks before the announcement of Trump’s speech, the Susan B. Anthony List had been promoting official room blocks for the event at the Trump International Hotel in Washington, D.C., although this listing was later deleted. [Axios, 5/23/18; Rewire.News, 5/23/18; Media Matters, 5/15/18]

Local outlets show the impact of the Title X defunding on their communities

St. Cloud Times: Minnesota’s other Title X clinics may not be able to absorb Planned Parenthood’s patients. Minnesota’s St. Cloud Times reported that Planned Parenthood clinics in the state “received $2.6 million in Title X funds last year to provide family planning services, including exams, contraception and screenings for sexually transmitted diseases,” and “serve 90 percent of patients who rely on Title X funding in the state.” The CEO of the Minnesota Association of Community Health Centers (community health centers can also receive Title X funding) said, “The demand for our services is well beyond our means to provide it.” The paper reported that according to a spokesperson for Planned Parenthood Minnesota, North Dakota, and South Dakota, “it's unclear if other Minnesota clinics will be able to absorb new patients, meaning many could go without care.” From St. Cloud Times:

In Minnesota, Planned Parenthood received $2.6 million in Title X funds last year to provide family planning services, including exams, contraception and screenings for sexually transmitted diseases. The group, which has 18 clinics in Minnesota, only one of which provides abortions, said its clinics serve 90 percent of patients who rely on Title X funding in the state.

It's unclear if other Minnesota clinics will be able to absorb new patients, meaning many could go without care, said Jennifer Aulwes, spokeswoman for Planned Parenthood Minnesota, North Dakota, South Dakota.

...

“This will protect taxpayer dollars from funding the abortion industry,” said Scott Fischbach, executive director of Minnesota Citizens Concerned for Life. “Abortion is not family planning. Abortion is not contraception.”

The state's network of federally qualified health centers will be able to pick up some of the slack, Fischbach said.

But a representative for the state's 17 federally qualified health centers, which operate 72 clinics, said it's unlikely they could absorb 25,000 new clients seeking family planning services.

“It's not as easy as simply flipping over the switch to the federally qualified health centers,” said Jonathan Watson, CEO of the Minnesota Association of Community Health Centers. “The demand for our services is well beyond our means to provide it.” [St. Cloud Times, 5/20/18, via Nexis]

California’s Times-Standard: Funding cuts to Planned Parenthood may “impact some of the most vulnerable people” in Northern California. Northern California’s Times-Standard reported that if the proposed rule change is enforced, “the loss of funding could lead to a cutback in the services offered at Planned Parenthood offices across the region” as Planned Parenthood of Northern California serves “more than 180,000 patients a year.” The chief of staff for Planned Parenthood of Northern California told Times-Standard that “even a small drop in the services Planned Parenthood can provide will impact some of the most vulnerable people in North Coast communities.” She explained that those most impacted are patients who “are uninsured or under-insured, or they don’t have easy access to health care services.” [Times-Standard, 5/18/18]

San Francisco Chronicle: Proposed rule could hurt “1 million low-income Californians” and negatively “affect teen pregnancy rates.” The San Francisco Chronicle noted that “more than 1 million low-income Californians” could be affected by the proposed restrictions on Title X funding, as the “federal program is particularly prominent in California, which accounts for more than 25 percent of all Title X patients nationwide.” The president and CEO of a nonprofit “that advocates for the expansion of family planning services” said “she is worried about how this rule would affect teen pregnancy rates.” [San Francisco Chronicle, 5/18/18]

Las Vegas Sun: Funding proposal would relegate women “to second-class status in terms of their health.” The editorial board of the Las Vegas Sun wrote that the proposed rule would bar the provision of family planning services by Planned Parenthood and other clinics providing or referring for abortions and “also would eliminate women’s Title X guarantee of receiving comprehensive and accurate information about their health care from their doctors, essentially reducing them to second-class status in terms of their health.” The proposed rule change could negatively affect the “14,000 to 19,000 patients a year” who go to Planned Parenthood clinics in Las Vegas and Reno. [Las Vegas Sun, 5/20/18]

The Boston Globe: The new rule change “sets off alarms” in Massachusetts. The Boston Globe talked to a Planned Parenthood patient who “pointed to the importance of Title X funding to her life.” The patient “said she was a 24-year-old making minimum wage when she discovered her partner had given her human papillomavirus.” The Planned Parenthood she went to at the time “diagnosed, treated, and [gave her] regular Pap smears and biopsies.” As she explained to the Globe, “Planned Parenthood was the only place that I could afford that.” From The Boston Globe:

One patient pointed to the importance of Title X funding to her life. Makenzie Peterson, now 37, of Amherst, said she was a 24-year-old making minimum wage when she discovered her partner had given her human papillomavirus.

At a Planned Parenthood in Utah, where she was then living, she was able to be diagnosed, treated, and given regular Pap smears and biopsies.

“Planned Parenthood was the only place that I could afford that,” she said.

To be eligible for free services from the health centers through Title X funds, a woman must make no more than the federal poverty level — $12,170. Individuals can get discounted services if they make less than 250 percent of the federal poverty level, or $30,350. [The Boston Globe, 5/19/18]

Portland Press Herald: Advocates in Maine are “angry” at the proposed changes. Maine’s Portland Press Herald noted that after the announcement, Planned Parenthood “patients already are concerned about what the administration’s move could mean.” The paper talked to a Planned Parenthood patient who was also an immigrant from the Ivory Coast who said that “she sought health care from the organization and was amazed how empathetic staff was.” According to the report, the patient said that “she and others within the immigrant community don’t have a lot of places they can go where they aren’t judged or shamed,” making access to Planned Parenthood essential. [Portland Press Herald, 5/18/18]

WOSU: Title X restriction happening as Ohio attempts to block other funding to Planned Parenthood. Public radio station WOSU-FM in Columbus, OH, spoke to a representative of NARAL Pro-Choice Ohio who noted that the proposed Title X rule “comes on top of Ohio’s plan to strip $1.4 million in funding for Planned Parenthood, which was blocked by a federal court last month.” He told WOSU that in addition to the state “wasting countless tax dollars fighting in court,” the proposed rule “would have a severe impact on Ohio patients” by further denying them access to necessary health care services. [WOSU, 5/18/18]

The Seattle Times: This policy “is likely to backfire” and lead to “higher rates of unwanted pregnancies and more abortions.” The editorial board of The Seattle Times said that in Washington, almost 40,000 Planned Parenthood patients use Title X funding “to stay healthy, as well as avoid getting pregnant with children they are unprepared to care for or don’t want.” The editorial board also argued that “the federal government should abandon its anti-abortion crusade” because such an effort “is likely to backfire, leading to higher rates of unwanted pregnancies and more abortions rather than fewer.” [The Seattle Times, 5/21/18]

UPDATE: Local outlets continue to highlight the potential impacts of proposed Title X rule

Pacific Standard: “Texas may offer a preview of the effects” of the Title X proposed rule “on reproductive health-care centers and their patients, nationwide.” Looking at research conducted by the Texas Policy Evaluation Project (TxPEP), Pacific Standard’s Francie Diep stated that “Texas may offer a preview of the effects of the Trump administration's policies on reproductive health-care centers and their patients, nationwide.” TxPEP’s research showed that after Texas’ funding cuts, “fewer clinics were able to offer their patients the most effective, long-acting, but more-expensive birth control options, such as intrauterine devices and contraceptive implants.” In addition, “birth control and exams that used to be free now cost, say, $50, or $70. Some said they forewent these services in favor of other needs.” TxPEP also “found clinics that weren't used to offering reproductive care often had a hard time performing their new duties.” From Pacific Standard:

But what does the rule actually mean to the four million Americans—most of them young women living under the poverty line—who receive health care at the clinics that would be affected?

To find out, Pacific Standard combed through the work of a group of researchers at the Texas Policy Evaluation Project, who have spent seven years tracking the family-planning policies in their state. … Texas may offer a preview of the effects of the Trump administration's policies on reproductive health-care centers and their patients, nationwide.

The policies Texas passed in 2011 are a bit different from what the Trump administration has proposed. The Texas legislature cut its family planning budget by two-thirds and de-prioritized specialized family-planning clinics, such as Planned Parenthood, from getting the remaining money. The effect of Trump's rule could be similar, however, if Title X clinics that provide or refer for abortions don't change their practices and take the financial hit instead, says Kari White, a sociologist with the Texas Policy Evaluation Project.

Not long after Texas cut its family planning budget, fewer clinics were able to offer their patients the most effective, long-acting, but more-expensive birth control options, such as intrauterine devices and contraceptive implants. Before the 2011 legislation took effect, 71 percent of Texas organizations that received federal money for family-planning purposes offered IUDs and implants to their patients, White and her colleagues found. In 2013, only 46 percent did so. Overall, the organizations saw less than half as many patients after the cuts, compared to before.

The women and teenage girls the researchers talked to in 2012 generally didn't know that the law had been changed in their state. But they felt very acutely the effects of that change: Birth control and exams that used to be free now cost, say, $50, or $70. Some said they forewent these services in favor of other needs. “That's hard when you're a single parent and have kids. That's expensive,” one woman said. “With the $50, we pay [for] gas, we buy the Pampers,” said another.

…

The researchers found clinics that weren't used to offering reproductive care often had a hard time performing their new duties.

Some clinics were slow in figuring out how to order the devices and medicines they needed. Others didn't have doctors or nurses who were trained to insert IUDs and birth-control implants. They had to either hire new staff or train their workforce. Some implemented protocols that aren't medically necessary, such as not offering IUDs and implants to teens and women who didn't already have children, or requiring STD results to come in before inserting implants. Leaders at several clinics that were located near now-closed Planned Parenthoods said they didn't see Planned Parenthood's old patients come into their facility because they didn't have the money to advertise to the community that they now offered reproductive services. [Pacific Standard, 5/24/18]

The Austin Chronicle: On top of previous funding cuts to Planned Parenthood, the new rule “could place more than 6,000 Austin residents in jeopardy of losing critical health care.” The Austin Chronicle’s Mary Tuma wrote that although Texas has already restricted funding to Planned Parenthood clinics, the proposed federal rule could have a negative impact on other family planning clinics in Texas. As Tuma explained, the federal rule “could place more than 6,000 Austin residents in jeopardy of losing critical health care.” The CEO of an Austin family planning clinic, El Buen Samaritano, “said Title X funds are critical to its operation; without them patients could lose access to long-acting contraceptive care, breast and cervical cancer screenings, STD and pregnancy tests, prenatal care, and annual exams.” In addition, their “patients, none of whom are above 200% of the federal poverty line, would be cut off from critical and affordable access.” Tuma also explained that the proposed rule currently means that “any woman who explicitly vocalizes her desire to terminate a pregnancy will be given a list that includes not only abortion clinics but also adoption agencies and postnatal care – and providers are not required to distinguish what's on the muddled list.” [The Austin Chronicle, 6/8/18]

Chicago Sun-Times: “In six Illinois counties, Planned Parenthood is the only Title X provider.” The editorial board of the Chicago Sun-Times noted that the proposed Title X rule “would force 50,340 women in Illinois who currently get birth control there, thanks to Title X funding, to find new clinics.” The editorial board explained how the federal rule would have a large impact in the state as “in six Illinois counties, Planned Parenthood is the only Title X provider” and that “Planned Parenthood serves 42 percent of the nearly 120,000 Illinois patients who receive care under Title X.” [Chicago Sun-Times, 5/24/18]

The Salt Lake Tribune published one person’s story of utilizing Planned Parenthood’s services. The Salt Lake Tribune published Utah educator Tory January’s commentary piece which talked about how valuable Planned Parenthood has been in her life and that the new proposed rule was an attempt “to stop people from going to Planned Parenthood.” January wrote that Planned Parenthood helped her when she had “a full-time and a part-time job” and “couldn’t afford to pay for health insurance.” January continued that the organization had also provided advice “ regarding conception and creating conditions for an ideal pregnancy” and that with their guidance “and a lot of luck” she was “able to conceive easily and experienced healthy pregnancies without complications.” January concluded, “Planned Parenthood trusts women to make decisions and gives them the resources to support those decisions.” [The Salt Lake Tribune, 5/28/18]

The Boston Globe highlighted the experiences of patients who benefited from Planned Parenthood’s services. Margery Eagan, co-host of WGBH’s Boston Public Radio, wrote in an opinion piece for The Boston Globe that “President Trump is trying to turn family planning — what most of us consider good for mothers, fathers, children, and families — into something bad, even shameful.” To illustrate her argument about the necessity of Planned Parenthood, Eagan spoke with several patients who had benefited from the organization's services. One woman -- a “Planned Parenthood patient for 15 years” -- said that Planned Parenthood “diagnosed her diabetes.” Another woman talked to Eagan about being “a lesbian grateful both for Planned Parenthood’s emphasis on inclusion and for the diagnosis of a kidney disorder that had been missed elsewhere.” [The Boston Globe, 5/28/18]

VTDigger: Twelve organizations, including healthcare advocates, providers, and insurers have formed a coalition in Vermont to oppose the Title X changes. Mike Faher of the online Vermont news site VTDigger wrote about a coalition formed by “twelve organizations — including the state Health Care Advocate, University of Vermont Medical Center and two insurers” which “ ‘strongly opposes’” the proposed rule. Faher explained that “members of the Vermont coalition are concerned about [the rule] limiting access to basic health care services for low-income residents.” In Vermont, “Planned Parenthood gets nearly all of Vermont’s Title X funding allocation, which falls between $775,000 and $781,000 annually.” The coalition is focused on how the “the Trump administration’s proposal violates medical ethics and will reduce health care services for Vermonters.” [VTDigger, 6/12/18]

The Columbus Dispatch: “More than 10,000 Columbus-area women could lose their access to affordable reproductive health care” under the proposed Title X rule. The Columbus Dispatch’s Rita Price talked about “a new analysis” conducted by members of government of Columbus that showed “more than 10,000 Columbus-area women could lose their access to affordable reproductive health care under” the proposed rule. As Price explained, “The report said reproductive health investments save seven times as much in future public spending by helping to prevent unintended pregnancies, increasing women’s labor-force participation and improving their families’ financial situation.” In addition, Price noted that Planned Parenthood “serves the majority of the state’s Title X patients — about 63 percent, or 59,000 patients” and “in nine Ohio counties” was the only Title X provider. [The Columbus Dispatch, 6/15/18]