The Trump Pence Administration has Forced Planned Parenthood Out of Title X

The Trump-Pence administration has been attacking reproductive health and rights since taking office, but the most recent assault has been on the nation’s Title X program. In fact, Planned Parenthood (which provides care to about 40 percent of the country’s 4 million Title X patients) has been forced to withdraw from the program. Jack Rayburn with the Planned Parenthood Federation of America talks to us about Planned Parenthood, Title X, and what we can do to fight back against these attacks on funding for reproductive health care.

Title X is the nation’s only dedicated family planning program that provides free or low-cost birth control and other sexual and reproductive healthcare for low-income women across the U.S. It includes birth control, STI screenings, cancer screenings, HIV testing, and other basic healthcare. For many, it’s one of the only ways to access affordable healthcare.

In early 2017, a proposed rule which fundamentally changed the way Title X works was met with intense backlash. Thousands of comments were submitted to the Department of Health and Human services, but the rule was unfortunately finalized. The rule gags providers who participate in the Title X program by prohibiting doctors from referring patients for abortion care. It also makes it difficult for many providers, including Planned Parenthood, to participate by requiring asinine financial and physical rules. The rule also loosens the requirement of quality for reproductive health care. This policy disproportionately impacts people of color, Latinx people, those living in a rural area, those in the LGBTQ community, and those who are low income.

Planned Parenthood treats a large proportion of those that rely on Title X in the United States, but they have been forced to leave the program because they could not ask their providers to violate their medical ethics by complying with the rule. Eight other states have also signaled that they are not complying with the changes to Title X.

links from this episode

Planned Parenthood Federation of America
Planned Parenthood Federation of America on Twitter
Planned Parenthood Federation of America on Facebook
Past episode Title X is Under Attack
Past episode Global Gag Rule Two Years In: What Are We Seeing?

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast on all things repro. I'm your host, Jennie Wetter, and each episode I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode I'll be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for RePROs to fight back.

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Jennie: Hi everyone and welcome to this week's episode of RePROs Fight Back. Before we get started, just a little bit of quick housekeeping. I know we had celebrated this on social media, but I don't think I said anything on the show on our last couple episodes, but we recently hit 50 episodes and it gave me a moment to just want to sit back and say thank you to everybody and just be so grateful to everybody who listens to the show. Thank you all for listening. I hope you enjoyed listening to the show as much as I enjoy putting it out. So with that, here's to 50 more episodes and thank you all for listening. So this week we are going to look at the Trump Pence administration attacking reproductive health and rights ever since they got into office and the most recent attacks that you've probably been hearing about in the news are related to the Title X program and the Trump Pence administration forcing Planned Parenthood out of Title X today we are going to dig into what is happening with Title X why Planned Parenthood was forced out and what that will mean for patients trying to access care. Helping me talk about all of this, I'm really excited to have with me today Jack Rayburn with the Planned Parenthood Federation of America. Hi Jack. Thanks so much for being here.

Jack: Hi Jennie. So delighted to be here talking with you today.

Jennie: So, uh, we're going to talk about why planned parenthood was forced out of Title X but before we get there we should probably do a little bit of scene setting and talk about what is Title X.

Jack: Set the table as we say. So Title X is the nation's only dedicated family planning program. It provides free or low-cost birth control and other reproductive preventive health services to low income women across the country. The program is, um, let me do my quick math here. Nearly 60 years old. It actually was enacted in 1970 on a bipartisan basis under President Richard Nixon…

Jennie:…blows people's mind now to think of like anything being bipartisan, but like family planning being bipartisan.

Jack: What a concept, right? It's just this idea that people should have access to healthcare. Seems shocking.

Jennie: Yeah. So want to talk a little bit about the program.?

Jack: So it was started and it's birth control and other sexual health services. Yeah. So again, access to reproductive and other preventive health services. So what does that mean? It's birth control. Um, so all forms of contraception. It's STI screenings, it's HIV screening, it's breast and cervical cancer screenings. It's a lot of really just basic health care. Um, and for a lot of patients it is either their, their primary point of accessing healthcare or even some cases their only source of healthcare. Yeah. And I think another thing that's really important and it impacts later when we talk about what's happened with Title X is it's really important counseling on healthcare and making sure you're getting full range of services available to you. And so, and of course the services I listed are what the federal program pays for, but because you're getting it at a Title X health center, um, which could include a Planned Parenthood health center, you are then, you know, provided that counseling and given all those options and then for example, were you to, you know, depending on the results of any of those screenings or tests, I, you know, just listed off, tou would be referred to health care either at that center or by another provider. Just the way any other kind of healthcare provider works.

Jennie: Now that we've talked about what Title X does, let's talk a little bit about what it doesn't do and that is provide funding for abortion.

Jack: Yeah, no, to make it absolutely clear, even though we think it should. Yes. Yes. I mean abortion is health care, abortion is reproductive health care. Um, hopefully by nature of listening to your podcast, all your listeners would agree. So, you know, we lament that we, you know, we can't use federal dollars for abortion, but that has been the case again unfortunately as a result of a completely different policy called the Hyde Amendment, which I'm sure listeners of your show are probably also familiar with. So Title X funds are not being used to provide abortion services. Um, I think really kind of interesting, over the summer there was a house oversight committee where Chairwoman DeGette of Colorado, um, was asking some pretty pointed questions of the witness from HHS asking the department to produce a single data point or example that would justify putting this rule into place. And they couldn't provide any, it's just not the case. What this rule is saying is that even by nature of you taking Title X dollars, which cannot fund abortion services, you are no longer allowed to refer your patients to abortion services.

Jennie: So things change with the new administration as unfortunately so many reproductive health things have changed with this administration. Do you want to talk a little bit about, so what happened?

Jack: Yeah, so unfortunately with this new administration, they decided to put forth a new set of regulations. So Congress put the law on place in the 70s it's been very little since then and there's total again for many, many years just bipartisan support for this concept that people should have access to these services. Unfortunately, this administration came along and has other ideas and they decided to put in new regulations in place that made a number of really dramatic and drastic changes to the program, but essentially are remaking how the program operates at a really fundamental level. So this started in early 2017 they put out a proposed rule and lots of people, politicians, provider organizations, et cetera, were really up in arms about the changes that were proposed. Thousands and thousands of comments went into HHS, essentially saying, this is a really bad idea and we'll get to like what that bad idea is in a second I suspect. But then unfortunately in early 2018 wait, February, if I'm remembering my dates correctly, they went ahead and finalize the rule over those objections. And what the rule does is it makes it, again, a number of really serious significant changes. So this administration has ultimately put out a gag rule because first and foremost what it does is it gags to providers who participate in the Title X program. What is essentially says is that if you are participating in the Title X program, you are prohibited from referring your patients to abortion. So it's essentially gagging doctors from giving their patients all of their options as it relates to their reproductive health care. In addition to that, it implements a number of really serious changes that make it very, very difficult for certain types of providers, including Planned Parenthood to participate. So for example, it imposes these really medically unnecessary physical and financial separation requirements on Title X recipients, which essentially say that if you are a provider participating, you have to provide abortion services in a completely financial and physically separate location from where you are providing Title X services. And again, there's no medical basis for this. They've also established a number of other provisions that kind of loosen the requirements around the quality of services that need to be provided. So I mentioned again it being a family planning program. I'm one of the most important components is that it provides birth control and all forms knowing, you know, so listeners of your podcast will know that patients need and deserve all the options available to them. And that includes all different sorts of birth control. But unfortunately the, this rule loosens that requirement around what providers have to provide. So at the same time they are trying to prohibit high quality providers like Planned Parenthood from participating, they are loosening the requirements and allowing, what we would argue are, you know, irresponsible forms of, of medical care, essentially folks that are taking federal family planning dollars, you know, to provide birth control but then not actually providing birth control. So we can point to a number of examples where this administration, even prior to this rule going fully into effect, has decided to make awards to providers that just frankly aren't providing that high quality care that patients deserve.

Jennie: Yeah, I think that always kind of blows my mind when they are giving funding to groups to provide services that the groups have no intention of providing it. We've seen that in things with trafficking victims, um, where groups are getting money to provide victim services but aren't providing the full range of services. And now we're seeing it with birth control and groups, um, that are now getting funding but have no intention of providing birth control. And they have even said as much.

Jack: It's wild. It's just, it's, it poor stewardship of taxpayer dollars, but I think it really just underscores what is the motivation here is that it's not about providing medically sound, medically accurate, high quality care. It's about advancing an ideology, right?

Jennie: Yeah. And some people, so maybe they don't know the Title X name, but they've seen maybe a list of providers that they can see that are friends services to low income people and they have come to trust that when they go get those services, they are going to get a high quality comprehensive services and now all of a sudden they're going to see these other groups on this list and go see them and not get the services they're going for.

Jack: Yeah, it's, it's absolutely true. And I think that's why, again, I mentioned very early on when this was in the initial stages of being proposed, you saw, you know, virtually unanimous opposition from the medical and public health community against this type, these types of regulations. You know, it's why the American Medical Association joined us in suing to block the administration from going forward with this rule. I mean, it is, it is gagging doctors. It is, it is a clear violation of the code of medical ethics, of the hippocratic oath, of what medical practice is supposed to be all about, which is giving patients all the information that they need and deserve that we have available so that they can in partnership with their doctor, make the choices that they want so that they, you know, they can have full autonomy of their bodies of their lives, their health.

Jennie: Yeah. And I think that, you know, we focused on birth control a bit, but you know, where the gag really applies is if a person were to test pregnant and they used to get non-directive counseling, that would give them all of their options and what they can do. And that would include abortion. It would include parenting, it would include adoption. But now they are prevented from doing that.

Jack: Yeah, it's, it's, uh, it's egregious. I, it's, it's funny. Well, it's not funny at all that you say that, but I, I blocked that part out a lot because it's just, it's one of the most egregious parts to my mind is that actually under the new rules, if a person has a positive pregnancy test, the provider is required to make a referral to prenatal care full stop. Full. Yeah. You know, it, it completely discounts the patients wills and wishes and their, their, their needs and their, you know, deserving the right to have the other options available to them, which includes abortion…

Jennie: …and these things all go together. Right. Like I could go to one of these providers that decides not to provide birth control, get pregnant, and then not be told about all of my options when my original goal was to not get pregnant.

Jack: Correct. Absolutely. It's hard to process, right. It's like up as down, right? Yeah. There's just so much and uh, it, it really is. Some of this stuff with the health care just makes me so angry because you don't know, you might not know. You're not getting your options.

Jennie: So you know, maybe you're not going to the provider who's going to do no birth control. Maybe you're going to provider who's decided, okay, I'm going to do pills and then the rhythm method, but nothing else. Everything else in my mind is abortion. Is the patient may not know they're not being counseled on a full range of birth control options and not getting the one that works best for them or is more effective?

Jack: Oh, absolutely. And I think it's important to remember who this program is designed to help. It is low income women and families who are otherwise I mentioned either less likely or unable to access care because they now have no other options are either under insured or uninsured. Um, you know, a lot of these, the folks that benefit from Title X are living in rural areas where there are very few other places you can actually physically access health care. Over 50% of the patients in the program identify as person of color or LatinX. Ultimately what this policy is, is this discriminatory, right? Because we know that people have means of high income. In this country will be able to continue access services, but the Trump administration is putting special rules on programs and it's essentially creating two systems of healthcare in this country where people have means have the ability to access high quality care and get all that information and people who do not are given subpar sub quality healthcare.

Jennie: Yeah, I mean, this is really what we've seen in so many things with, you know, when we have talked about over the course of this show, many times as you know, access to abortion and you know, I'm well off, I live in Washington D.C., I will always be able to get an abortion. I will always be able to get access to birth control. But there are so many people who live in a rural area who are poor, who are people of color, who may not have those same choices.

Jack: Yeah, no, absolutely. You know, I've got to mention my peeps, uh, you know, in the LGBTQ community, I mean, this program, uh, absolutely has a disproportionate impact on that population as well. I mean, one of the first things I mentioned was HIV screenings, STD screenings. These are things that disproportionately impact that community and there, you know, just a logical that they would stand to benefit from this program. So again, it's just, it really comes back to discrimination. It's extremely disheartening to think about.

Jennie: Thank you for bringing it up. I'm so sorry I forgot that.

Jack: Well, no, of course. There's just so much, there's so many things to talk about. Right. It's ridiculous.

Jennie: So then that turns us to Planned Parenthood. Do you want to talk a little bit about Planned Parenthood's role and Title X?

Jack: Yeah, I, we'll have to. So again, there are all sorts of different types of grantees in the program. There are community health centers that are standalone reproductive health clinics, including Planned Parenthood health centers. I should have said this from the beginning. The program nationwide serves about 4 million patients. We see about 40% of those patients nationwide. So we're not the only Title X provider, but we are a very, very significant chunk of the entire Title X network in this country. So because these new rules are going or have gone into effect, different parts of them have started. Some of them are haven't happened yet. Planned Parenthood has been forced to leave the Title X program. Um, so unfortunately we as we made very clear from day one when this proposal was put forward, we view this gag rule as medically unethical and it's not something we could ever ask the doctors and providers that work in our health centers to comply with. So we made it very clear from the get go that we had no intention of ever complying with this rule or to take effect. The good news at least, initially it was that, you know, I mentioned we sued with the American Medical Association. Uh, we were initially successful in securing a preliminary injunction in court that blocked this rule from taking effect. Um, while it continued to litigate. Unfortunately, the administration appealed as we, you know, kind of expected they would, they were successful in getting that injunction lifted. And after, you know, kind of a series of back and forth, the rule ultimately we were informed was taking effect as of July 15th. We were then asked as all other Title X grantees were to give notice by August 19th about our you know, our intentions to comply with the rule. As I said, we were never planning to comply and we made that very clear. So we ultimately announced, uh, earlier in August that all of our health centers were being forced out of the Title X program. And that is unfortunate. It's not just been us. There are eight other states that are direct grantees and or their political leadership slash governors have also signaled that same intention of not wanting to comply. What this has meant really, really profoundly is that kind of overnight, nearly 50% of all the patients in the Title X network suddenly were not in Title X…they were, you know, they're the providers that they see no longer participated.

Jennie: So now that Planned Parenthood and other providers are being forced out of this program, what is this gonna mean for patients?

Jack: Again, I want to assure patients and listeners that, you know, just as we've always done and again Planned Parenthood's, no stranger to a fight over funding. We've, we've done this, we continue to make every effort to keep our doors open, to make sure our health centers are able to provide the services that our patients deserve and we know that they need. So if you're a Planned Parenthood patient, if you're out there, please still come in. Please feel like you have a place to access care. That being said, this was a significant amount of money and so we will see impacts, not overnight. You know, we even as we were involved in litigation, which does still continue by the way, we were deploying a number of methods to um, using emergency funds, et cetera, to make sure we can keep our doors open and supply those services. But, you know, as time goes on, um, the fact that we are no longer participating won't mean that there will be changes in the way we are able to provide health care. So in some areas that might mean a reduction in the number of services we're able to provide in aggregate. It might mean increased costs over time to our patients who quite frankly, a lot of them, you know, I don't know about you when I go into a healthcare clinic or how my healthcare provider, I'm not necessarily aware of the various different kind of funding streams that are coming in. Um, so I think, you know, maybe the, the good news is that a lot of patients we see maybe not, maybe not even know what Title X is or whether or not they are a patient. So all the more reason to continue to come in and access care, but you need to, by nature of the fact that we don't participate anymore, it is, it does mean that there will be changes and there will be impact.

Jennie: Yeah. And I think, you know, one area that was always striking to me is seeing some of these people who live in rural areas or areas that just don't have a lot of other options where that could really have an impact on them.

Jack: Yeah. And it's, it's again, I think as we have heard the administration justify the reason for this. And you know, I think it's a really important point. As I mentioned, Title X is for many of our patients, you know, their only source of health care or is their entry point of accessing healthcare, particularly in rural areas. Um, the administration has declined, tried to claim that, oh don't worry, like Planned Parenthood shouldn't be in the program, but there's all these other kinds of providers and doctors waiting in the wings that are just desperate to get into the program. And as soon as we get Planned Parenthood out, the there'll be knocking on our door. That just doesn't, it doesn't bear out in reality, we have heard from, you know, national organizations but also a lot of local, for example, community health centers that have basically said we would not be able to provide the services to these patients. But when I think of where the rubber really hits the road is your point. But in some many counties in this country, there just aren't other options. And so, you know, it's gotten to the point where the administration has circulated certain types of lists of providers and, but when you actually like bear scrutiny and look at list, do you see things like the libraries or like I think there's like an example I think of like a, like a prison. I think in Florida or something.

Jennie: I just, it's, it's like a dentist.

Jack: Oh, right, right, right, right. Because we all go to our dentists for STI, breast cervical cancer screenings. Yeah, no, probably is. Yeah, I'm great. Um, it's, it, it would be funny if it wasn't so tragic cause this, you know, it will mean people having to drive further to access their healthcare. It will mean having to take time off their job, which may not be an option. It will mean trying to find daycare for the kids you do have so that you can go pick up your birth control so you can plan your family. What a concept.

Jennie: Yeah. And so to some of us that may ring like, okay is I have to drive 20 more minutes or you know, leave work early or whatever. But for some people, these are real hardship for sure. You know, if you, you have to take a day off, you have to deal with bus schedules. If you live in an area that has public transportation. I mean, I grew up in rural Wisconsin, so that's not always, that's not a thing where I live.

Jack: I didn’t know you were from Wisconsin. Yeah, yeah. Fellow Midwesterner-- Michigan. Yeah, yeah, you're right. But like the dot, dot, dot. There is that for many people, they just won't access health care. Yeah. And that's, that is the most tragic part of at all. It's one of those things that it's easier to do it when it's easy, but when I get tired, okay. So this'll fall further down my list of priorities and it makes everything harder.

Jennie: Yeah. Yeah. It's really, really unfortunate. Okay. So what can listeners do?

Jack: Um, it's a really good question. So I mentioned that our litigation is ongoing, but unfortunately we have been forced out of the Title X program. So in the meantime, we are left with very few options. But what I would encourage your listeners to do is to pick up that phone, find that number for your US senator and make a call and let them know, A, you know what Title X is and B, that you are seriously, seriously worried about what the Trump Pence gag rule will mean for 4 million people in this country. The ability to continue to access high quality healthcare, um, at the provider of their choice. So the House of Representatives in June as part of passing their Labor, HHS… it's wonky speak for their healthcare spending bill… which includes funding for the Title X program annually, they included protective language that would essentially block the Trump administration from moving forward with this role. The Senate would, they're coming back from August recess and we'll be hard at it September up against the September 30th deadline to complete those spending bills. Senate has yet to act on their bill. So now is the perfect time for your listeners to pick up that phone call both of their senators and just ask, where do you stand on Title X cusp? Unfortunately, many senators, they have yet to opine on where they even stand on this, let alone the necessity of taking action. So you know, where do you stand on Title X but most importantly, tell your leadership, tell your colleagues that you want a spending bill that protects it in the current network and access to care for 4 million patients. Yes. And that is absolutely, like you said, imperative right now because the finance or the fiscal year ends at the end of September. So make sure to call your senators right now about Title X--and just throwing on my international hat real quick-- also talking about the global gag rule and the importance of repealing the global gag rule. So that way they know we're still out there and we still care. We didn't even get into the global gag rule. Something I'm sure your listeners are very familiar with. I know they are. Um, but yeah, and I think the, the global gag rule, right kind of underscores the severity of Title X. So while we can't point to immediate impacts from this rule, and again that's kind of a product of the fact that we are making every effort to use emergency funds and use, you know, philanthropic dollars to kind of address the problem in the short term. We don't have to wait for those impacts domestically. We know what happens when you start gagging providers of care because we can look two decades of what the global gag rule has meant for the health of women and other people around the world and it's not good.

Jennie: You can definitely go back if you want to learn more about that and listen to an episode that I'll include in our show notes where we talk about what we're seeing from the current gag rule. And we talked a little bit about what we have seen in the past and it's less people getting access to family planning and an increase in abortions because people are not getting access to the services they want.

Jack: As your listeners also know. The, and I think you mentioned the House also put that global gag language in place. So they're all the more reason for the Senate to act. If the Goldstar homework for your listeners is to call their senators the, like, platinum bonus extra credit is for you to go ahead and call your um, member of the House of Representatives and Speaker Nancy Pelosi and thank them for doing the right thing and taking action early. So, you know, always a good thing to have to put pressure but always a really, really important thing to make sure you give that thank you to cause um, you know, they're putting their, they're putting their political capital into this and there is a cost to that. So it's always important to say thank you.

Jennie: Yes, thank you. Very important. So in that vein, Jack, thank you so much for doing this.

Jack: Thank you. I really, really enjoyed the conversation, and opportunity to talk about Title X.

Jennie: Hi everyone. Just a quick couple of notes for where you can get more information on these two things that we talked about in this episode. The global gag rule and more on Title X. So if you want to learn more about Title X you can check out our August, 2018 episode “Title X is Under Attack” where we do a deep dive into the history of the Title X program and learn more about Title X in general before we do a dive into the new um, attacks that the administration had taking place. And then also we touched very, very briefly on the global gag rule and I said that there was an episode you could go back and listen to, to learn more about what's happening on that. And that episode is from July of this year and it's “The Global Gag Rule Two Years In: What Are We Seeing.” And in that you can learn more about what it is and um, the harm is we're seeing right now. Okay. Thanks for listening. For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com you can also find us on Facebook and Twitter at RePROsFightBack. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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