For weeks, reports have suggested that the president is considering making good on his campaign promise to defund Planned Parenthood. While totally defunding the nonprofit is not on the table, multiple outlets have reported that he is considering one approach that would reduce funding while also potentially making it much harder for lower income patients to receive affordable reproductive care. On Monday, over 210 lawmakers condemned Trump's potential abortion gag rule, asking Secretary of Health and Human Services Alex Azar to oppose any changes to how Title X funding currently operates.
While Trump has not confirmed that he is considering implementing a domestic gag rule, reports have been circulating for weeks, suggesting that he is mulling over pushing one forward before the end of May. As has been reported by Modern Healthcare and Axios, the rule would prevent any health care provider who receives Title X funding from providing abortion services, referring patients to abortion providers, or discussing abortion as a medical option.
Sen. Elizabeth Warren, who was the first signatory on a letter from senators fighting this possibility, describes the potential rule as a move to further politicize essential health care. "This attack on Title X is another part of a broader assault by Republicans on the health, safety, and economic independence of women and their families," Warren says in a statement to Bustle. "Americans deserve to access basic medical services — including reproductive health services — without right-wing politicians getting in the way."
In two letters, one sent from members of the Senate and one sent from members of the House, elected officials outlined why they believed Title X funding was essential, and decried any attempt to limit health care providers from accessing its associated funds. Addressing Sec. Azar, the senatorial signatories described Title X as ethically and economically essential:
In addition to providing care to low-income, uninsured, and underinsured individuals, Title X yields critical cost savings to the American healthcare system. Every dollar invested in Title X saves more than seven dollars in Medicaid-related costs. By helping individuals obtain the preventative services they need, Title X advances the health and well-being of individuals, families and our nation as a whole while saving taxpayer dollars in the process.
They also pointed out that Title X does not fund abortions. Instead, it supplements other reproductive health care services that are frequently provided at facilities that separately provide abortion services. If a domestic gag rule were implemented, health care providers who offer abortion services could potentially be put in a position where they could no longer fund some of the services that Title X covers — preventative services like birth control, cancer screenings, STD screenings, and breast exams.
Signatories from the House underscored just how vital Title X funding is, for precisely those reasons. "Each year, roughly 4 million women, men, and adolescents rely on Title X-funded health centers for basic preventative health care, including cancer screenings, birth control, sexually transmitted infection screenings, pregnancy testing, and well-woman exams," the representatives wrote.
Members of the House also pointed to the fact that the potential domestic gag rule has been characterized by critics as largely an inefficient move to defund Planned Parenthood. While it would affect the nonprofit, it's not clear that it would have the perceived intended outcome. Instead, it would likely have devastating effects on other health care providers who would have to shoulder the cost and labor of servicing the patients health care clinics like Planned Parenthood could no longer take care of. Indeed, almost 75 percent of Planned Parenthood's public funding actually comes from Medicaid reimbursements — not Title X.
The possible gag rule, members of the House wrote, "is nothing more than an opportunity for President Trump to fulfill his pledge to 'defund Planned Parenthood,' whose health centers serve 40 percent of Title X patients and remain an essential part of the family planning safety net."
Additionally, a domestic gag rule would likely affect some of the most vulnerable populations in the United States. The Guttmacher Institute reported that two-thirds of people who receive care through Title X funding are at or below the poverty level. Additionally, nearly six in 10 women who use federal funds to purchase contraception do so through Title X.
Title X is a grant program, separate from Medicaid, specifically set aside for those preventative services. It has been around since 1970. Sec. Azar has not yet publicly responded to the congressional letters.