Trump administration officially releases plans to block Title X providers from abortion referrals

Pregnant woman getting checkup
Health and Human Services released the text of its proposed rule for family planning providers that would block them from sharing space with abortion providers if they receive Title X funding. (Getty/byryo)

A proposed rule from the Trump administration to block family planning providers who receive Title X funding from making abortion referrals would still allow those providers to discuss information about abortions with patients who request information.

Providers would not be allowed to share physical space or other resources, such as office staff, with an abortion provider. But they would be permitted—although not required—to provide "non-directive counseling" about abortion and provide a list of providers who offer comprehensive health services, including some which provide abortion services.

It's all part of the proposed rule change to Title X funding (PDF) rules, which were officially announced by President Donald Trump at the Susan B. Anthony List's 11th annual Campaign for Life Gala on Tuesday evening.

Sent to the Office of Management and Budget for review last week—but not actually released until Tuesday night—news of the proposed rule change was quickly lauded by anti-abortion groups as an effective attack against Planned Parenthood and decried by critics as a "gag rule" on health information.
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"I think what we’re seeing is a sustained and pretty unconscionable attack on federally funded family planning programs," said Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health. "I understand the Administration is trying to assert that there is no gag, but from what I understand, the administration is seeking to advance a change that would stop clinicians from referring patients who would like abortion services for that care which in and of itself constitutes a kind of gag."

The rule change would hit providers far beyond Planned Parenthood, she said. "There are other providers within the Title X network who offer abortion services in addition to Title X supported family planning care. There are sites operated by hospitals or other independent agencies so they would obviously be directly affected by the requirement for physical separation."

Beyond that, the Guttmacher Institute estimates other providers would have to increase their caseloads by 70% on average to serve the women who currently receive contraceptive care at Title X-supported Planned Parenthood centers.

The restrictions on offering referrals and removing the guarantee of nondirective information and counseling on abortion are also problematic, she said. "Some people who get Title X supported services may well not receive full information and referral," Hasstedt said.

HHS officials said the changes would increase the number of patients served by the Title X program, which serves about 4 million people a year.

The proposed rule change was applauded by groups such as the Christian Medical & Dental Associations. Chief Executive Officer David Stevens, M.D., said the rule would remove requirements that providers give patients information about abortions despite their objections.

He said he expects it would also spread Title X funding more widely to community health centers that provide comprehensive health and family planning services besides Planned Parenthood. He pointed to data from the national organization's annual report (PDF) which showed it had $73.4 million in excess revenue over expenses in 2017 while the percentage of its nonabortion services dropped. 

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He said the Title X funding could be put to better use being spread across other providers to advance the program's original goals of family planning. "The bottom line is it could have a much broader impact," he said.

What the proposed rule says

The language of the proposed rule focuses on Congress' intent for Title X since it first passed in 1970, as well as examples of its directives that the funding be kept from being spent on abortion services. Among the issues raised was what the term "family planning" means.

Among other pieces of language from the rule: 

  • Title X would require clear financial and physical separation between Title X-funded projects and facilities that provide abortion. This would require more reporting from grantees about subrecipients and program partners and their Title X-funded activities.
  • It would require training for proper response and reporting of women and children who are victims of trafficking or abuse.

  • It would permit individuals to qualify for Title X services if they are unable to obtain employer-sponsored insurance coverage for certain contraceptive services.