WASHINGTON D.C. — Tonight, the Trump-Pence administration released a nationwide gag rule, marking a radical departure from how health care has operated in the United States up until this point.
The proposed rule, issued by the Department of Health and Human Services tonight but not yet posted to the Federal Register, would do three main things:
1. Make it illegal for doctors, nurses, hospitals, and community health centers across the country that participate in the Title X program to refer their patients for safe, legal abortion.
2. Impose new restrictions designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood.
3. Remove the guarantee that people are getting full and accurate information about their health care from their doctors. For nearly two decades, Title X law has been clear: Health care providers cannot withhold information from you about your pregnancy options. This rule means they can.
Additionally, the proposed rule includes a slew of additional changes designed to dismantle the program — including a new policy stipulating that Title X projects do not have to provide every effective and acceptable method of birth control. This is a sharp departure from the way the program has been operating, in which HHS put an emphasis on ensuring women have access to all 18 FDA-approved contraceptive methods. The rule also deletes the requirement that contraceptive methods provided by Title X projects be "medically approved."
The rule also re-defines what "low-income" means — expanding it to now include women whose employers no longer allow them to have their birth control covered by health insurance — in an apparent attempt to rectify the gap in care caused by the administration's previous rule on insurance coverage of birth control. However, the rule does not stipulate any additional resources or funding to help the program or providers meet this increased need.
The rule is expected to include a 60-day comment period after the yet to be determined date it is posted to the official federal register.
Statement from Dawn Laguens, Executive Vice President, Planned Parenthood Federation of America:
"This is the worst attack on women's health and rights we've seen from the Trump-Pence administration. No woman should be denied basic information about her health care — including safe and legal abortion. A president who doesn't know the difference between HPV and HIV should not be making reproductive health decisions for millions of Americans.
"The result of this rule is that people will not get the health care they need. They won't get birth control, cancer screenings, STD testing and treatment, or even general women's health exams. Everyone, regardless of their income or where they live, deserves the best medical care and information available. Under this rule, they won't get it. This is one of the largest-scale and most dangerous attacks we've seen on women's rights and reproductive health care in this country. This policy is straight out of the Handmaid's Tale — yet, it's taking effect in America in 2018."
The domestic gag rule has never gone into effect in the United States before. The Reagan administration did try to implement this in 1988, but the rule was held up in the courts and later retracted by the Clinton administration in 1993 after intense outcry from the medical community, including the American College of Physicians and the American College of Obstetricians and Gynecologists. Reinstating this rule would prevent millions of people from getting birth control and preventive care at Planned Parenthood health centers. At the same time, it would also force doctors and nurses to withhold information from patients across the country.
Although Planned Parenthood health centers make up only about 13 percent of the Title X health centers, they serve 41 percent of the patients who get care through Title X. Preventing those patients from coming to Planned Parenthood health centers would mean many are left with nowhere else to turn.
Title X is a decades-old popular and effective program designed to ensure that everyone, no matter where they live, how much money they make, and whether or not they have health insurance, has access to basic preventive reproductive health care like birth control, cancer screenings, STD testing and treatment, and well-woman exams. It has received bipartisan support from Congress since its inception. Every year it serves more than four million people, although many people who get care through the program may not even be aware that they are Title X patients.
The domestic gag rule wouldn't just affect Planned Parenthood. The rule "gags" any Title X provider from referring for abortion. It would affect every health care provider in the program, from community health centers to hospitals.
Title X serves a racially and ethnically diverse patient base: Out of the four million family planning clients served by Title X, more than one-third are Hispanic or Latino, 13 percent have limited proficiency in English, and at least a third are people of color. Racial or ethnic bias, along with language barriers, can already make health care difficult to access and an attack on Title X will limit health care options even further.
Key facts about Title X and Planned Parenthood:
According to latest estimates, Planned Parenthood health centers served four in 10 Title X patients ( 41 percent ) in 2015, despite only accounting for 13 percent of Title X centers.
In 14 states, Planned Parenthood serve more than 50 percent of the Title X patients in their states, including in Alaska, Arizona, California, Connecticut, Iowa, Michigan, Minnesota, New Jersey, New York, Ohio, Washington, Wisconsin, Utah, and Vermont.
More than half of Planned Parenthood's health centers are located in medically underserved areas.
Research has shown that Planned Parenthood consistently outperforms other publicly funded providers, including FQHCs, when it comes to meeting the family planning needs of people across the United States by:
Providing the full range of birth control methods on-site;
Filling longer-term contraceptive prescriptions; and
Offering shorter wait times and expanded health center hours.
Community health centers will not be able to fill the huge void if Planned Parenthood is blocked from Title X program, dealing a major blow to health care access for thousands of low-income people across the country.
Community health centers themselves say there is no way they could fill the gap if Planned Parenthood health centers were no longer allowed to serve these patients.
The idea that other providers could absorb Planned Parenthood's patients has been resoundingly dismissed by experts. In fact, Dr. Georges Benjamin, the executive director of the American Public Health Association, called the idea "ludicrous."
Across the entire community health center network, nearly half of sites served fewer than 10 contraceptive patients annually.
In fact, many of the lists of "replacement" providers don't even provide reproductive health care. In Louisiana, the state list of alternative providers included dentists and nursing homes. In Florida, it included school nurses. In Ohio, it included food banks.
Planned Parenthood is the nation's leading provider and advocate of high-quality, affordable health care for women, men, and young people, as well as the nation's largest provider of sex education. With more than 600 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect and without judgment. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable health information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.
