ICYMI: States Struggle to Serve Patients As Trump Administration Attacks Title X, Planned Parenthood
03.29.19 — Yesterday evening, Politico (story below) reported on how states like Utah, Missouri and Arizona will struggle to serve millions of patients if legitimate providers like Planned Parenthood are forced to stop providing health care due to politically motivated changes to Title X, the nation’s family planning program, implemented by the Trump administration.
Specifically, Trump’s domestic gag rule — which prohibits health care providers who receive Title X funding from referring patients to safe and legal abortion services — would jeopardize the ability of many health centers to provide basic health care services like cancer screenings, birth control and HIV/STI testing to millions of people.
Equity Forward has long been tracking the Trump administration's efforts to dismantle Title X, including ways in which the administration rigged the grants process. Earlier this year, Equity Forward issued an original report detailing the sabotage of our nation’s family planning program, and its extensive HHS Watch campaign provides comprehensive information on the officials most hostile to Title X, including Valerie Huber, Diane Foley and Steven Valentine.
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States struggle to replace Planned Parenthood as Trump rules loom | By Alice Miranda Ollstein and Rachel Roubein
President Donald Trump's sweeping changes to federal family planning policy may not hit anywhere harder than Utah, which has $2 million at stake and would be hard pressed to Planned Parenthood if the organization makes good on a threat to pull out of the state rather than operate under the new rules.
"We're the only game in town," said Planned Parenthood Association of Utah President and CEO Karrie Galloway. "We're a unique and challenging state, and people don't have a lot of options for comprehensive, non-judgmental reproductive health care."
The situation illustrates how conservative-driven changes that would ban federal funding for clinics that provide abortion referrals could hurt even deep red states that have themselves been at odds with Planned Parenthood.
Trump administration officials and anti-abortion advocacy groups insist that Planned Parenthood can easily be replaced with providers that don't offer abortions or abortion referrals, and they say the new rules are needed to ensure tax dollars aren't inadvertently subsidizing abortion providers.
But Planned Parenthood serves an estimated 40 percent of the more than four million patients nationwide who receive care under the Title X program — and more than half of those in states such as Utah, Wisconsin and Ohio. It is a primary recipient of Title X grants in a dozen states and receives Title X money from grantees in many others, collecting as much as $60 million a year from the program.
The administration is set to award a new round of grants as soon as Friday. But uncertainty over whether federal courts will freeze the new rules isrippling down to community health centers and other local providers that rely on Planned Parenthood to allocate a portion of the Title X money it receives. Trump's changes to the program are due to take effect May 3, and Planned Parenthood has already announced it will withdraw from theprogram if the rules take effect, arguing that the ban on referring patients to an abortion provider amounts to a "gag rule" on its physicians.
Blue states, Planned Parenthood and other patient advocacy groups have filed a series of lawsuits seeking to halt the changes.
The situation in Utah is particularly acute. Planned Parenthood has been the state's only Title X grantee since the early 1980s, and currently serves about 37,000 low-income patients who depend on its clinics to get free and subsidized birth control, testing for sexually transmitted infections and other reproductive care. Low-income women in Utah rely even more heavily on Title X because the state has not yet implemented the Medicaid expansion that voters approved in November and that state Republicans are working to curtail.
Planned Parenthood's Utah affiliate says it will keep clinics open even if it drops out of the program, but that the loss of Title X dollars would reduce the availability of free and subsidized health services in the state.
Utah's health department would have seemed to be a logical successor; state agencies in about three dozen states are in charge of distributing Title X funds to community health centers, school-based organizations, Planned Parenthood affiliates and other providers.
But Utah's health department has long been ineligible for Title X money because of a state law requiring unmarried minors to get parental consent before obtaining any family planning services — a policy that clashes with the program's federal mandate to provide confidential reproductive care to people of all ages.
Utah officials told POLITICO they applied for a Title X grant in 2018 despite this conflict, hoping that Trump's HHS would look more favorably on their conservative restrictions. "We were essentially testing the waters to see if there may be some flexibility," spokesperson Tom Hudachko wrote in an email.
But the application was still rejected last year. The state consulted with HHS political staff nearly two months later, documents provided by the progressive advocacy group Equity Forward show. An HHS spokesperson said it's customary for staff to walk unsuccessful applicants through feedback. The discussion centered on Title X's technical requirements. Officials also spent time talking about "potential strategies for writing the application," according to Hudachko, but the state didn't apply for 2019.
The state's community health center association told POLITICO its members can't jump into any void Planned Parenthood leaves because they don't have the capacity to serve bigger caseloads. The clinics had conversations with the Utah health department about partnering on Title X services when the state applied in 2018, but ultimately felt they couldn't take on the more patients.
"Our health centers are fiscally fragile," said Alan Pruhs, the Association for Utah Community Health's executive director. "They stretch the dollar and do great work and provide good, quality care. But this idea, of the ability to take on more uninsured patients, doesn't really work, and the grants don't quite cover the cost of providing the care."
Finding a replacement for Planned Parenthood could be challenging in other states as well.
Missouri's Department of Health and Senior Services applied for a Title X grant in 2018 — the first time it ever applied as far as anyone at the department knows — but was rejected. The state confirmed it filed another one for the new funding cycle that begins April 1.
The Missouri Family Health Council, which has been serving as the sole administer of Title X dollars in the state, says it's waiting to learn its funding award for the new grant cycle set to begin April 1 and to see whether the courts block the new rules before deciding if it will stay in the family planning program. It currently distributes money to Planned Parenthood clinics that serve about 34 percent of the state's Title X patients, meaning either entity's exit could dramatically affect care in a state where family planning clinics can have a wait list of four to six weeks for new patients, according to Michelle Trupiano, the council's executive director.
"When we say the safety net is already stretched to the brim, that is what we mean," Trupiano said. She added: "When you take out a large provider from that safety network, the entire net is going to break."
In Arizona, the nonprofit Arizona Family Health Partnership receives most of the state's Title X money and distributes it to several different providers. Though Planned Parenthood only runs 17 percent of the Title X-funded clinics, it served 53 percent of the program's patients in 2015, according to the pro-abortion rights Guttmacher Institute.
"They're one of our more efficient and effective delegates in terms of the number of clients they are able to see and the cost per client," Bré Thomas, the partnership's CEO, said.
Thomas said the group hasn't begun looking for prospective replacements, but that it might be difficult to find ones that meet the new Trump rule's requirements.
The state health department got a Title X grant for the first time last year, after Arizona lawmakers passed a law requiring the government to apply — a move opponents viewed as a tactic to direct fewer dollars to Planned Parenthood. Arizona hasn't contracted with any other providers to receive the dollars yet, according to the state health department, which didn't responded to questions on how it's using the $1 million in grant funds and if any patients had received Title X services from the state grant.
As multiple federal courts weigh the fate of the new rule, progressive advocates and women's health experts warn that cutting Planned Parenthood out of Title X will create on a national level the kind of upheaval playing out in Texas, where the state pushed Planned Parenthood out of the program in 2011 and gave contracts to an anti-abortion group that previously ran crisis pregnancy centers and did not offer all forms of contraception.
The Heidi Group lost that multi-million dollar contract last year after mismanaging state funds and only serving 5 percent of the patients it promised to in its application. Texas has applied to win back its Title X grant and once again cut out Planned Parenthood. In that application, state officials promised to serve 53,000 residents compared to the 200,000 people the independent nonprofit currently holding the Title X grant serves today — a 277 percent decrease.
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