A new rule for family-planning grants would prohibit family-planning clinics funded by the federal Title X program from making abortion referrals — a provision that critics rightly denounce as a “gag rule,” as it would result in literally silencing any doctor-patient discussion about the legal medical procedure.
Title X of the Public Health Service Act (1970) is devoted to providing individuals with all-inclusive family planning and related preventive health services. Its framers aimed to make good on a promise President Richard Nixon made — that “no American woman should be denied access to family planning assistance because of her economic condition.”
If implemented, the new rule, announced last week by the U.S. Department of Health and Human Services, essentially reneges on that promise.
In response to this misguided administrative overreach, a coalition of 21 states — Hawaii included — has filed a lawsuit in federal court asserting that the referrals ban violates Title X’s mandate for delivery of complete, unbiased information about health care options, and unconstitutionally infringes on health care providers’ responsibilities to patients.
Planned Parenthood Federation of America and the American Medical Association (AMA) have filed a similar legal challenge. The AMA views Title X as a cost-effective federal health program; its grants totaled $286 million in the 2017 fiscal year.
Clearly, over several decades, the program has helped correct economic inequity by spurring development of a nationwide network of high-quality, low-cost health care, which includes Planned Parenthood. If the rule is implemented, the nonprofit plans to leave Title X, forgoing an estimated $60 million in annual funding.
In August, in a similarly principled move, Gov. David Ige, along with Washington state and Oregon governors, vowed to pull out of the program rather than abide by the rule’s restrictions. Ige’s stance is commendable, but he must also be ready to make up for more than $2 million in annual funding that Hawaii would forgo.
Annual Title X funding is awarded to the state Health Department, which distributes grants to health clinics. The grants help pay clinic personnel salaries as well as subsidize delivery of contraception and other services. An abrupt loss of funding would surely hamper availability to reproductive care that largely serves low-income, uninsured women.
Since the program’s launch, Title X has prohibited tapping its funding to pay for an abortion; and federal laws prohibit the use of taxpayer funds to pay for the procedure except in rare cases.
However, Title X has required that a pregnant woman must be offered information and “non-directive counseling” about all options — pregnancy termination among them — and referrals upon request. That practice should remain in place as it allows a neutral relaying of legal options.
The new rule, proposed by the White House last spring, is described by supporters — anti-abortion groups among them — as an effort to draw a brighter line of physical and financial separation in the program, so that taxpayers do not “indirectly fund abortions.”
In addition the unjustified censorship provision, another would require clinics to establish separate sets of facilities and personnel — one that addresses abortion issues and one that doesn’t — or risk losing all Title X funding. Such a requirement sets the stage for unnecessary duplication, and a potential drain on funding available for patient care.
Hawaii Attorney General Clare Connors said implementation, scheduled for later this year, stands to “directly harm Hawaii families, particularly women, by limiting their access to quality comprehensive health care.” The states coalition and other opponents have rock-solid, valid reasons to put up a fight.
