Today, President Trump’s Department of Health and Human Services is expected to announce a rule that will prohibit Title X recipients from providing abortion services entirely. The devil will be in the details about how far this rule will reach, as some reports indicate it will also prohibit Title X recipients from referring patients to abortion providers, and other reports indicate it will go so far as prohibiting them from even discussing abortion.
The effect of today’s rule will be that Title X recipients are likely going to face a terrible choice: Stop receiving vital Title X funding or stop providing/referring/counseling about abortion. Either way, recipients and their patients will be harmed. If healthcare providers choose to reject Title X funds, they won’t be able to serve low-income patients at the same level they did previously, undercutting the incredibly successful family planning program and increasing the unintended pregnancy rate and all of the health problems that accompany it. If they choose to stop being associated with abortion, they will be further depriving women of access to abortion, a constitutionally protected procedure that almost one million women per year access in this country.
Back when Republicans were a different species, a Texas Congressman named George H.W. Bush led the charge to create a national program that funded family planning services for low-income individuals. Signed into law by President Richard Nixon in 1970, Title X has proven to be an effective and low-cost way of delivering contraception and other family planning healthcare needs.
This is the kind of program that fiscal and social conservatives should love. For just under $300 million per year, over 800,000 unintended pregnancies were prevented in 2015, which means an estimated 278,000 abortions were averted according to the Guttmacher Institute. The program reduces the teen unintended pregnancy rate, which would be 44 percent higher without it. It also improves health for the people who use the services, preventing an estimated 87,000 preterm or low-birth-weight births, 63,000 sexually transmitted infections, and 2,000 cases of cervical cancer in 2010.
Overall, based on calculations by the Guttmacher Institute, Title X saves seven dollars for every one dollar spent on the program. That’s fiscal responsibility with proven results – everyone, Republicans in particular, should love this effective money-saving social program. Especially since it’s a legacy of the revered Republican names of Bush and Nixon.
And yet, we know that’s not the case. Because many Title X providers also provide abortions, social conservatives have been after the program for decades. Existing law already prohibits Title X recipients from using their federal dollars on abortion care, but these providers are able to separate their budgets and provide abortion and Title X family planning services at the same site, making it easy for patients to receive comprehensive health care at one facility.
News coverage this morning is highlighting the effect of this rule on Planned Parenthood, which will certainly feel a huge blow. However, others will also be harmed – independent abortion clinics that receive Title X funding will face the same choice, which will be challenging without a large national organization supporting them. Hospitals that provide abortion services will also be in a bind, as they will have to choose between providing comprehensive care to a broad swatch of their community and receiving federal money that would enable these services. And the thousands of community-based clinics that do not provide abortion will also be impacted because they will no longer be able to provide their patients comprehensive care, since the new rule will prohibit referring or maybe even counseling their patients about abortion.
No doubt this new rule will be fought in the courts and will take a while to take effect. President Reagan promulgated a similar rule in 1988 that was ultimately upheld by the Supreme Court – but a lengthy legal battle pushed implementation into the Clinton Presidency, and Bill Clinton rescinded the rule before it could take effect.
What’s certain is that today’s announcement is not the final say on the matter. But, it is yet another indication that President Trump, who used to describe himself as "very pro-choice," is once again using the presidency to kowtow to the anti-abortion crowd. And he’s doing so at the expense of the people who access Title X family planning and abortion services. In this country, those people are overwhelmingly low-income women, which means that, once again, social conservatives are using the bodies of poor people, most often poor women of color, to bolster their anti-abortion credentials.