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Health advocates raise concerns about possible cuts to funding for women's health initiatives

Funding for organizations such as Planned Parenthood that provide screenings and other services related to women’s health may be threatened by the incoming administration and Congress, according to health care advocates.

An HHS rule that is set to take effect Jan. 18 prohibits states from restricting federal Title X funding for any reason other than an organization’s ability to perform the services being funded, which would make it more difficult for states to direct funds away from Planned Parenthood.

Advocacy groups worry that the new law might not be effective for long once President-elect Donald J. Trump takes office. House Speaker Paul Ryan (R. - Wis.) also announced this week that budget reconciliation legislation to defund the Affordable Care Act would include Planned Parenthood funding.

“This rule could be changed by the next administration, which would open the door to more state legislatures interfering in the provision of evidence-based family planning,” Daniel Grossman, MD, of the Bixby Center for Global Reproductive Health, San Francisco, told Healio Family Medicine.

According to HHS, Title X funds can be used for breast and cervical cancer screenings, pregnancy tests, STD testing and counseling, and to provide contraception options, but cannot be used to fund abortions or fund programs where abortion is a family planning method.

One of the main recipients of Title X funding is Planned Parenthood, which, according to its website, provides sex education, reproductive health care and information to millions of women, men and young people each year. The organization’s website also states that just 3% of the services it provides are abortion services. Federal funding for abortions was banned in 1976.

During his campaign, Trump issued a statement that read, in part, he would “defund Planned Parenthood as long as they continue to perform abortions and reallocate their funding to community health centers that provide comprehensive health care for women.”

His remarks left health advocates wondering what will happen to Title X funding come Jan. 20.

Planned Parenthood expressed concern as well.

“While the rule provides strong protections, it could face attacks in Congress or by [an HHS] Secretary determined to undo these common-sense protections,” according to a Planned Parenthood press release. “It comes amid mounting concerns over the future of reproductive health and rights…”

The organization’s website makes it clear its centers will remain open and its president said it will fight for the right open if needed.

“We will not back down, and we will continue to fight for our patients’ access to care,” Cecile Richards, president, Planned Parenthood Federation of America, said in the release. “Every person deserves the right to control their bodies, their own health, and their own well-being without politicians getting in the way.”

The AAFP, AAP and the American Congress of Obstetrics and Gynecology (ACOG) sent a letter to HHS during the rule’s review period expressing hope the proposed rule would become law.

“This clarification is necessary to provide state-initiated efforts that would limit low-income and adolescent patients’ health care access for reasons not supported by current medical evidence or best practices and to ensure the quality of such care,” the letter read in part.

In the final rule, HHS noted approximately 91% of the 145,303 responses were in favor of the action HHS ultimately took. Other comments included concerns the funds would support abortions, the short length of the comment period and whether HHS had the power to make such a decision.

Grossman and others provided examples to show the impact of the HHS ruling being revoked.

“We can learn a lot from what happened in Texas over the past 5 years, where a variety of efforts aimed at defunding Planned Parenthood had far-reaching impact on the family planning services for low-income women,” Grossman said. “When Planned Parenthood was excluded from the state-funded fee-for-service family planning program, use of the most effective contraceptive methods declined and unintended pregnancy appeared to increase. In some areas of the state, there were no other family planning providers that could provide services when family planning clinics closed.”

The AAFP, AAP and ACOG brought these data to HHS’s attention during the rule’s review period.

“These types of results are contrary to the goals of the Title X program and can only lead to adverse impacts on the health of the patients whose access to care has been so dramatically reduced,” the letter from the groups stated.

The HHS also acknowledged the impact restricting funding would have.  

“Following the exclusion [in Kansas] of specific family planning providers in 2011, the number of clients, 87% of whom were low income (at or below 200% of the Federal Poverty Level), declined from 38,461 in 2011 to 24,047 in 2015, a decrease of more than 37%” the agency wrote in the final rule. It also noted the decrease in services seen in Kansas, like Texas, is substantially higher than the national average of 20% where Title X funding has come under debate.

Grossman noted family planning clinics are critical to the well-being of their patients and also help keep health care costs low for everyone, regardless of whether they use family planning services.

“Family planning is one of the most cost-effective medical services since it’s much less expensive than paying for an unwanted birth,” he told Healio Family Medicine. “For example, women who have closely spaced pregnancies are at risk of delivering the subsequent baby prematurely. It’s also much better for women with any kind of health problem, such as diabetes, for example, to optimize their health before they get pregnant.”

In 2015 alone, more than 4 million persons received services from a Title X-funded center, according to HHS. –  by Janel Miller

Disclosures:

Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.

Resources:

https://www.federalregister.gov/documents/2016/12/19/2016-30276/compliance-with-title-x-requirements-by-project-recipients-in-selecting-subrecipients (accessed 12-29-16)

https://www.donaldjtrump.com/press-releases/trump-campaign-announces-national-co-chairs-of-pro-life-coalition (accessed 12-29-16)

http://www.aafp.org/dam/AAFP/documents/advocacy/prevention/women/LT-ACOG-HHS-TitleX-100716.PDF (accessed 12-29-16)

https://www.plannedparenthood.org/about-us/newsroom/press-releases/obama-administration-protects-access-to-health-care-for-millions-of-people1 (accessed 12-29-16)

https://www.plannedparenthood.org/about-us/who-we-are/planned-parenthood-at-a-glance (accessed 12-30-16)