The Trump administration wants to effectively pull Title X funding from family planning clinics that provide abortion services.
Under a proposed rule submitted to the Office of Management and Budget on Friday for review, clinics must draw a "bright line" to separate physical and financial ties between family planning programs and any program or facility where abortion is "performed, supported, or referred as a method of family planning", according to a White House official.
The rule appears to take direct aim at providers such as Planned Parenthood, which would be banned from providing abortion services within facilities that are supported by Title X funding.
The White House official said the new requirements were based on, but not identical to, regulations implemented in 1988 during the Reagan administration. That regulation banned family planning clinics receiving Title X funding from even mentioning abortion, which has since been referred to as the "domestic gag" rule.
The official said the proposed rule does not constitute a "domestic gag" rule in that it does not prohibit providers from counseling patients about abortion. But according to Dr. Jennifer Conti, clinical assistant professor of obstetrics and gynecology at Stanford University School of Medicine, such talk is a distinction without a difference in terms of the impact the rule will have on providers' ability to effectively counsel patients on all of their family planning options, which includes abortion.
"This administration is stopping short of the Reagan-era rule by saying you can still mention abortion, but you can't mention how to obtain one or where to obtain one," Conti said. "As an abortion provider myself - that is a gag rule.
"We can play semantics all we want and talk about what you can and can't say, but as a provider, if I cannot tell a patient how or where to obtain an abortion it's effectively the same thing as not being able to even discuss it as an option."
That means providers such as Planned Parenthood, despite offering other healthcare services, could not receive federal funding if they provided any abortion services or referred patients to other facilities that did perform abortions even if the patient request such information.
Federal funding is already prohibited from being used to pay for abortion. Providers like Planned Parenthood are paid for such services through private donations, or in the case of the California, are covered under that state's Medicaid program using only state funds.
"There is already a very clear line with regards to funding," Conti said. "With that in mind, I can only look at this as a complete and direct assault on Planned Parenthood."
The proposed rule has already received praise from conservatives who wanted to see the White House make good on campaign promises to defund Planned Parenthood. Last month, 149 Republican congressional members sent a letter to HHS Secretary Alex Azar asking for the department to quickly change make changes to the Title X program.
"President Trump's new Protect Life Rule at long last reinstates principles first put forward under the Reagan administration, and upheld by the Supreme Court nearly three decades ago," said Rep. Chris Smith (R-N.J.) in a statement released Friday. "Abortion is not family planning—in sharp contrast, the violence of abortion wounds families."
Sending the rule to OMB means it's possible the public will have a chance to comment on it, and comments would need to be reviewed before the rule could be finalized. Among those likely to voice opposition to the rule would be community clinics that would have to be available to provide any services no longer provided for free or on a sliding scale to patients. Abortion-rights advocates have argued taking federal funding away from providers such as Planned Parenthood would leave many low-income women in rural parts of country with limited access to family planning and reproductive health services.
Community health clinics are often touted by anti-abortion supporters as having the capacity to accommodate the health needs of those patients that currently use providers such as Planed Parenthood.
"By putting these dollars in the federal community health centers, which provide the same kinds of services — for every Planned Parenthood, there are 20 federal community health centers," said House Speaker Paul Ryan during a CNN town hall held in January 2017. "They're vastly bigger in network, there are so many more of them, and they provide these kinds of services without all of the controversy surrounding this [abortion] issue."
But a 2017 report by the Guttmacher Institute found only 60% of the more than 10,000 federally-qualified health center sites across the country reported offering contraceptive care to at least 10 women a year in 2015, and that no FQHC sites offered such services in 13% of the 415 counties where a Planned Parenthood facility was located.
"A large amount of counties in the US are serviced primarily through Planned Parenthood in terms of contraceptive care, STD screening, women's care, cancer screenings," Conti said. "In these counties where a lot of women get their care through Planned Parenthood, providers in the community have been very clear that if Planned Parenthood were to go away or not be able to provide such services there would certainly be a gap that they would not be able to fill."
The proposed rule change has also drawn instant criticism from a number of Democratic lawmakers, who accused the White House of engaging in government overreach for the sake of scoring political points.
"This policy has nothing to do with the health of America's families and everything to do with this White House's extremist policies that continue to put American lives at risk," said Rep. Robin Kelly (D-IL) in a statement. "It's past time for the government to get out of the doctor's office."
An edited version of this story can also be found in Modern Healthcare's May 21 print edition.
