Since 1970, federal funds from Title X have helped low-income women access family planning and reproductive health services through a range of organizations. But organizations that also perform abortions shouldn’t be eligible for these funds, some lawmakers suggest.
Last week, the Senate voted 51 to 50 to repeal Obama-era guidance that explicitly prevented states from denying Title X funds to clinics that also provide abortion services, like Planned Parenthood health centers. After two Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, sided with Democrats in voting to continue debate on the bill, Vice President Mike Pence cast a tie-breaking vote to end debate, and later voted again to repeal the rule. President Trump is expected to sign the repeal bill.
Repealing the rule means state governments that object to Planned Parenthood can try to prevent the group from receiving Title X funds, directing the federal money to health programs they prefer. But such differentiation remains illegal under the law, observers indicate. That could put the courts at the heart of the debate over family planning funding.
“Although repealing the regulation may well embolden states in thinking that they now have carte blanche to deny funds to Planned Parenthood and other organizations that provide abortions, that is not the case,” Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, a research and policy institute that focuses on reproductive rights based in Washington, D.C., tells The Christian Science Monitor in a phone interview.
The Hyde Amendment, a budget amendment passed every year since 1976, specifically bans directing federal funds to abortion. Groups like Planned Parenthood, which provide abortions with non-federal funds, can receive government money for their non-abortion-related services, including family planning and reproductive health. In the past five years, however, a number of groups have tried to cut funds to Planned Parenthood on the grounds that the group also provides abortions.
These so-called “defunding” efforts, which have tried to eliminate Medicaid reimbursements for Planned Parenthood services and Title X family planning grants to the organization, have met with court challenges.
“To date, every court to consider the issue on the merits has ruled that state politicians cannot block access to care at Planned Parenthood through the Title X family planning program,” the organization said in a statement.
With its rule, the Obama administration aimed to emphasize that discrimination was not permissible, observers suggest. But the repeal of the rule may have changed the game.
“Now that the rule is going to be rolled back – we’re pretty sure that the president will sign this – there’s nothing keeping them from being able to do that,” explains Jamila Taylor, a senior fellow at the Center for American Progress in Washington, D.C., who specializes in reproductive rights, in a phone interview with the Monitor.
To supporters, the repeal is a welcome step to give states greater control over how tax dollars are spent.
“[The Obama-era rule] is an unnecessary restriction on states that know their residents a lot better than the federal government,” Senate majority leader Mitch McConnell (R) of Kentucky said before the vote, The Hill reported.
Congressional Republicans would prefer to divert the funds currently going to Planned Parenthood and other groups that also provide abortions to organizations that do not, such as community health centers. But such an approach may end up depriving women of contraceptive care, some suggest.
“The bottom line is, it’s simply unrealistic to expect community health centers to step up and fill the void in the family planning safety nets” that would be left by shutting off access to Planned Parenthood clinics, Ms. Hasstedt says, noting that Planned Parenthood serves a disproportionate share of contraceptive clients and is the only option for care in some areas of the country.
And community health centers vary widely in their ability to meet additional demand, explains Sara Rosenbaum, a professor of health policy at George Washington University in Washington, D.C.
“Some health centers might be ready, over time, to pick up the slack,” she tells the Monitor. “A lot of health centers are far away from being able to even remotely absorb these kinds of costs.”
States that attempt to exclude Planned Parenthood from the group of care providers that are eligible for federal Title X funding may face legal opposition.
“If states do start to change and go back to a place where they are withholding Title X funds to Planned Parenthood, I think we could see more court cases come about,” says Dr. Taylor.
Professor Rosenbaum explains that the court could block a state from excluding Planned Parenthood, which she says remains illegal under the Title X statute.
At the same time as some states contemplate moving away from Planned Parenthood, however, others are enshrining support for the organization in state law. Maryland’s legislature passed a bill to provide Planned Parenthood funding from the state budget in case it is cut at the federal level, and Massachusetts Governor Charlie Baker likewise pledged to offset federal cuts with state money.
Though Hasstedt finds such responses “heartening,” she sees the variation in state policies as somewhat troubling.
“A woman’s access to contraceptive care and her health should not depend on the state she lives in,” she says.