October 17, 2021 Liz Borkowski, MPH 0Comment

On October 4, HHS announced a final rule to undo a horrible Trump administration action that resulted in the Title X family planning program’s capacity being cut in half. The 2019 Trump administration rule was referred to as the “domestic gag rule” because it prohibited providers that receive federal Title X funds from discussing abortion as an option with pregnant patients. Rather than accept these unethical restrictions on providing evidence-based care, as well as new onerous requirements for physical separation of abortion care from Title X-funded services, seven state governments and many providers dropped out of the network. Their departures slashed the options that low-income clients had for receiving affordable, high-quality family planning care. The most recent analysis of data submitted by Title X grantees found that “Title X served 1.6 million fewer family planning users in 2020 than in 2019 (1.5 million vs. 3.1 million).”

The Biden administration rule undoes the destructive changes the Trump administration imposed; it does this by reverting to the Title X regulations published in 2000, but with some additional revisions for equitable care. The updates to the 2000 rule include “requiring that family planning services be client-centered, culturally and linguistically appropriate, inclusive, trauma-informed, and capable of ensuring equitable and quality service delivery.”

The new rule is welcome news, and fulfills a commitment President Biden made a week after his inauguration. His memorandum stated, “Women should have access to the healthcare they need,” and it directed the HHS Secretary to review the Title X rule and “consider, as soon as practicable, whether to suspend, revise, or rescind, or publish for notice and comment proposed rules suspending, revising, or rescinding, those regulations.” Under Secretary Xavier Becerra, the agency soon initiated a notice-and-comment rulemaking process. Although it took several months, the process moved quickly for something that involved more than 180,000 public comments, and the use of the rulemaking process, rather than an executive order or other faster route, should make it more likely to withstand the inevitable court challenges.

In the meantime, many providers have suffered. Those who remained in the program were forced to difficult choices about providing care under unethical restrictions, and those who dropped out of the program have struggled to provide the same kind of service they could before the gag rule took effect. The 19th’s Jennifer Gerson spoke about the impacts with several experts, including Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, the national association for publicly funded family planning providers. Gerson writes:

Any provider or clinic that left the program outright can’t come back in until the government runs a new competition for grant administration.

Coleman explained that it is expected that the Biden administration will hold such a competition this month that would give any applicant in the country — nonprofit or governmental health care providers such as a federally qualified health center or county health department – the chance to apply for Title X funding. These applications would, in theory, be due sometime in early to mid-January, and funding would be dispensed for new grantees in April.

The one possible workaround to this timeline is the “dire needs” grants that HHS announced in response to Texas’ Senate Bill 8, the new law that effectively bans abortion after six weeks. Providers who had left the network under the Trump administration — both in Texas and elsewhere in the country — could potentially apply for one of those grants and get funding before the end of 2021.

“Once the funding and support of the Title X program was taken away from a really large number of important providers across the country, it will take a real investment to build back the program to where it used to be and where it should be, which is even stronger than that,” Coleman said.

Rebuilding and strengthening will also require a commitment from Congress. The FY 2022 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill passed by the House includes $400 million for the Title X program — a welcome increase of $113.5 million after seven years of flat funding. I hope the Senate will agree that the investment is worthwhile to ensure everyone, regardless of income, can access high-quality family planning care without financial barriers.

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