The House on Thursday voted to overturn an Obama-era rule that sought to protect providers such as Planned Parenthood from losing state funding. Abortion rights activists are revving for a fight.
The House voted 230-188 in a vote the fell largely along party lines in favor of a resolution to rescind the rule using an obscure move called the Congressional Review Act. That gives Congress the authority to review and disapprove an agency regulation within 60 days after it goes into effect. The Senate now needs a simple majority to pass. President Donald Trump is expected to sign the measure.
The HHS rule, which came out in December, prohibited states from withholding Title X grant funding from a health provider for reasons other than their ability to provide family planning services. It went into effect two days before Trump's inauguration.
“It's a concern for us that we could see some damaging proposals coming down the pike that target Title X funding,” said Audrey Sandusky, director of advocacy for the National Family Planning and Reproductive Health Association.
Last month, House Speaker Paul Ryan announced plans to include a provision that would prohibit federal funding from going to Planned Parenthood as part of a bill to repeal the Affordable Care Act. Those efforts would not only restrict organizations such as Planned Parenthood from receiving Title X funding, but would also prohibit them from participating in the Medicaid program, which accounted for 40% of Title X providers' total revenue in 2015, according to a 2016 HHS report. Combined, Title X grants and Medicaid made up nearly 60% of all revenue for Title X providers.
“One attack on one aspect of the network is seen as an attack on the entire network,” said Sandusky, adding that the integrity of the entire Title X program is at stake.
More than 4 million people in 2015 received family planning services from nearly 4,000 Title X provider sites, according to 2016 HHS report. The program received $286 million in funding, which goes to states and is then distributed to clinics by state and local public health departments, or by not-for profit agencies on their behalf.
Title X clinics serve patients who are poor or low income, with 7 out of 10 receiving health coverage through Medicaid. In fact, 2015 marked the first year Title X providers saw more patients who had some form of health insurance, which accounted for 50% of their patients, versus those who were uninsured, which was 48% of patients. Like federally qualified health centers, Title X grantees are required to provide care to low-income patients for free or at a reduced cost.
Title X clinics provide breast and cervical cancer screenings, testing and treatment for sexually transmitted infections, and birth control.
Supporters of overturning the rule say states, rather than the federal government, should be able to determine which providers to fund based on whether they can effectively provide services. According to HHS, since 2011, as many as 13 states restricted access to Title X funds to certain providers based on “reasons other than their ability to provide Title X services.”
The Obama administration passed the rule after finding a number of states gave Title X funds to “comprehensive primary-care providers, state health departments, or community health centers” and effectively shut out some providers that specialize in reproductive health from receiving funding.
In Texas, which has long tried to restrict abortion access, state officials gave preferential treatment to certain providers as well as reduced funding to family planning services. Those actions dropped the number of patients Title X providers served from 259,000 in 2011 to 166,000 by 2015. The same practice in Kansas caused a 37% decline in the number of patients visiting clinics between 2011 and 2015.
Melanie Israel, research associate at the conservative Heritage Foundation's DeVos Center for Religion and Civil Society, said Title X funding could be diverted to such providers as the nation's network of federally qualified health centers, which could serve as many as eight times the number of patients cared for by Planned Parenthood clinics.
But Sandusky said the assertion that community health centers could somehow fill any gap created by a loss of family planning sites is unfounded. “You just can't simply assume that other providers that haven't been in the business of providing high quality family planning care will be up and ready to do so,” Sandusky said.
Israel said that anti-abortion supporters see GOP majorities in Congress and a Republican White House as their best chance in years to roll back access to abortion services. “Pro-life Americans have the opportunity of a generation,” she said.