Last month, Gov. David Ige joined a group of states in a fight against a proposal by the Trump administration to bar clinics that provide abortion services or referrals from receiving federal family-planning funds.
Fourteen states — Hawaii included — have threatened to sue, with attorneys general arguing that the proposed changes are unconstitutional. And in a principled move, Ige, along with Washington state’s Gov. Jay Inslee and Oregon’s Gov. Kate Brown, vowed to pull their states from the program in question, known as Title X, if the proposed changes are implemented.
The changes, which critics compare to a “gag rule,” raise ethical red flags as they would likely lead to doctors not being allowed to discuss a full range of legal health-care options.
Ige’s impulse to defend the rights of patients to secure comprehensive and accurate information about their medical care is commendable. However, while standing up against wrong-headed federal rules, he also stumbled.
Last week, in an article by Honolulu Star-Advertiser’s political editor, Sophie Cocke, the Governor’s Office said there were no specific plans in place to make up for more than $2 million in annual funding that Hawaii would forgo by rejecting Title X money. That’s worrisome as the funding largely serves low-income, uninsured women and college students — and, if approved by the U.S. Department of Health and Human Services, the changes could take effect this fall.
The funds tagged for Hawaii are awarded to the state Health Department, which distributes grants annually to health clinics statewide. They’re used to help pay clinic personnel salaries as well as subsidize delivery of contraception and other services. An abrupt loss of funding will surely hamper availability to reproductive care. The governor must now correct his short-sighted misstep on this matter by pinpointing funds that can replace any lost funding.
IN 1970, when Congress enacted Title X of the Public Health Service Act, it became the only federal program — then and now — devoted solely to providing individuals with all-inclusive family planning and related preventive health services. It aimed to make good on a promise President Richard Nixon made a year earlier — that “no American woman should be denied access to family planning assistance because of her economic condition.”
The push for the program dates back to mid-1960s research that showed inequitable access to contraceptives was largely to blame for the difference between lower- and higher-income women’s ability to have the number of children they wanted. Also, at that time evidence had begun to mount that unintended childbearing increased poverty and hindered ability to pursue employment or complete an education.
While the program covers services ranging from pelvic examinations to treatment for sexually transmitted disease, from its launch it has explicitly prohibited use of funds to pay for abortion. However, the program requires that a pregnant woman must be offered information and “non-directive counseling” about all options — pregnancy termination among them — and referrals upon request.
The new rule, announced in May by the White House, is described by its supporters — anti- abortion groups among them — as an effort to create a “bright line” of physical and financial separation in the Title X program, which now gets $260 million in federal dollars, so that taxpayers do not “indirectly fund abortions.”
The changes, which also tag new funding for organizations that promote abstinence and fertility awareness as approaches to contraception, are part of an apparent move to fulfill President Donald Trump’s campaign pledge to cut federal funding for Planned Parenthood.
Because the nonprofit performs abortions, it would automatically lose its Title X funding. It’s estimated that Planned Parenthood, which serves about 40 percent of the 4 million people who get care through the program, could lose as much as $60 million. Planned Parenthood clinics on Oahu and Maui get a total of about $600,000 in Title X funding. Hawaii’s other clinics do not offer abortion services.
Under proposed Title X changes, if a patient asks for a referral for an abortion, a doctor can release a list of health care providers that offer comprehensive prenatal care but cannot tell them which offer abortions. Clearly, this tactic is misguided.
Recently, the American Medical Association expressed rock-solid reasoning in its opposition, saying if implemented, the rule would “dangerously interfere with the patient-physician relationship” and conflict with ethical obligations.
The AMA, along with the states opposing the proposed new rule, are right to put up a fight. Over the span of five decades, Title X has helped correct inequity by spurring development of a nationwide network of high-quality, low-cost family-planning health care.