The Biden administration is moving to reverse a Trump-era family planning policy that critics describe as a domestic "gag rule" for reproductive healthcare providers.
The proposal published on Wednesday would largely return the federal Title X family planning program to its status before Trump took office. The current rules, implemented in March 2019 under Trump, forbid any provider who provides or refers patients for abortions from receiving federal funding through Title X to cover services such as contraception and STD screenings for low-income people.
"As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings" for sexually transmitted infections, said the proposed rule published by the U.S. Department of Health and Human Services.
A 30-day public comment period for the proposed rules begins on the afternoon of April 15.
The Trump administration implemented the current rules in an effort to "defund Planned Parenthood," as he had promised supporters during both his campaign and his presidency. That prompted more than 1,000 health clinics in dozens of states, including but not limited to Planned Parenthood, to leave the program.
Planned Parenthood President Alexis McGill Johnson welcomed the policy reversal and said over the past two years, the Trump administration's approach "really did decimate access to affordable reproductive health care ... and it severely decreased the program's healthcare provider network, which puts more financial restraints on patients."
A report by the Guttmacher Institute, which supports abortion rights, estimated that the Trump rules reduced the capacity of the Title X network by 46% nationwide.
Under current law, federal funding for abortion is prohibited in most situations — although Biden and many other Democrats support ending that prohibition.
Polling by the Kaiser Family Foundation in 2019 found that 58 % of respondents opposed the Trump rules, and that Republicans were nearly evenly split in their opinion.
Abortion rights opponents argue that taxpayers who oppose abortion should not be compelled to support, through public funding, any organization involved in providing or referring patients for abortion. Many have advocated for shifting services to crisis pregnancy centers, which counsel patients against abortion, or public health clinics, which provide similar services but often struggle to meet patient demand.
Carol Tobias, President of the National Right to Life Committee, told NPR that she worries the Biden administration's proposal would make it "too easy" for providers to advise women to choose abortion.
"The agency that is getting the Title X funding can refer for abortion and tell them, 'Oh and by the way, we do abortions in this same facility if you want to set up the appointment,'" Tobias said.
Healthcare providers who've offered services through Title X say they are ethically obligated to offer pregnant patients a range of options based on their interest and need, which may include abortion or adoption.
"We are not coercing anyone into making the decision that's right for them," said Lisa David, President and CEO of Public Health Solutions in New York, which primarily serves low-income New Yorkers needing a range of healthcare services. "But we do want to provide information if they want it, and a referral if they want it."
David's organization, which does not provide abortions but refers patients for the procedure upon request, left the Title X program in response to the Trump administration rules. David said she's been able to temporarily cover costs through emergency state funding, and hopes to rejoin the program under new rules from the Biden administration.
MARY LOUISE KELLY, HOST:
For millions of low-income people, a program called Title X covers the cost of things like birth control and STD screenings. Under the Trump administration, clinics that provide abortions or abortion referrals were banned from the program, and many dropped out. Now the Biden administration is taking steps to undo that policy. NPR national correspondent Sarah McCammon is here to explain.
SARAH MCCAMMON, BYLINE: Hi there.
KELLY: Start with the backdrop. What has been happening with the Title X program, and what does the Biden administration want to change?
MCCAMMON: Yeah, a little background on Title X first. It pays for things like pregnancy tests, HIV tests, birth control at low or no cost for patients who are mostly at or below the federal poverty level. In 2019, the Trump administration changed the rules for Title X so that any health care provider that offers abortions or abortion referrals could not be part of it. That policy is still in effect, and the Biden administration wants to reverse it.
KELLY: What has been the impact of the Trump years on the program, on its patients?
MCCAMMON: Well, there's been a big contraction in Title X. Many providers said that the rule would interfere with their ability to counsel patients about a range of options. And as a result, more than 1,300 clinics nationwide, including most notably Planned Parenthood, pulled out of Title X. That's according to the National Family Planning & Reproductive Health Association. Now, I spoke to Julie Rabinovitz. She's the president of Essential Access Health, a group in California that receives those Title X funds and then distributes them to providers around the state.
JULIE RABINOVITZ: Many of these programs have had to reduce hours and reduce the type of services, reduce the number of staff that are providing family planning services at their clinics. And it also means that many patients have to drive much further to access these services.
MCCAMMON: Some organizations in other states that have pulled out of Title X have patched through with private funds or help from state governments, but they say they could not do that forever.
KELLY: Now, the Trump administration policy was a victory for opponents of abortion rights, which makes me curious how they are reacting to this move by the Biden team to overturn it.
MCCAMMON: Well, they're disappointed, but not surprised. I mean, this is a move that Biden has been expected to make, along with other steps to reverse Trump's abortion-related restrictions. Many of these groups oppose any public funding for organizations that are involved in any way in abortion, although we should say that federal funding for abortion is illegal in most cases. Carol Tobias is president of the National Right to Life Committee, and she worries that women will feel pressured to choose abortion if it's made available.
CAROL TOBIAS: The agency that is getting the Title X funding can refer for abortion and tell them - oh, and by the way, you know, we do abortions in this same facility if you want to, you know, set up the appointment.
MCCAMMON: And we should note, Mary Louise, that family planning providers tell me they are under an ethical obligation to counsel patients about all their options and not push in any direction.
KELLY: And quickly, what happens next? How long might it be before providers who lost funding get it back?
MCCAMMON: There's a rulemaking process to go through, all of which could take several months. And some health care providers have told me they would like to see the Biden administration move more quickly to expedite the process. But so far, there's no indication of that.
KELLY: That is NPR's Sarah McCammon.
MCCAMMON: Thank you. Transcript provided by NPR, Copyright NPR.