Planned Parenthood Refuses Federal

Funds Over Abortion Restrictions

Facing a Trump administration rule that forbids referrals for abortion, the
organization decided to reject federal funds for family planning for low-
income women.

A Coalition for Life staff member, near the entrance of a Planned Parenthood clinic in
May, in Missouri.Credit...Alyssa Schukar for The New York Times

By Pam Belluck
 Aug. 19, 2019
Planned Parenthood said Monday that it would withdraw from the federal
family planning program that provides birth control and other health
services to poor women rather than comply with a new Trump
administration rule that forbids referrals to doctors who can perform
abortions.

Planned Parenthood receives about $60 million annually through the

federal program, known as Title X. The funds have enabled the group to
provide more than 1.5 million low-income women each year with services
like birth control and pregnancy tests, as well as screenings for sexually
transmitted diseases and breast and cervical cancer. In some rural
communities, Planned Parenthood is the only provider of such services.

In states like Utah, where Planned Parenthood is the only organization

receiving Title X funds, and Minnesota, where Planned Parenthood serves
90 percent of the Title X patients, those seeking care may face long waits
for appointments, the group said, while other patients may delay care or go
without. Over all, Planned Parenthood gets more Title X money than any
single group, and it serves 40 percent of all Title X patients.

The group’s decision to stop accepting the money was cheered by anti-
abortion groups that have long sought to deprive Planned Parenthood of
federal support. “It is a long-awaited victory that will energize the pro-life
grass roots,” said Jeanne Mancini, president of the March for Life.

Planned Parenthood has continually received Title X money since the

program was enacted in 1970 during the Nixon administration.

Alexis McGill Johnson, acting president of Planned Parenthood, on

Monday accused the administration of forcing Planned Parenthood out of
the Title X program. “When you have an unethical rule that will limit what
providers can tell our patients, it becomes really important that we not
agree to be in the program,” she said.

The Department of Health and Human Services said in a statement

Monday that groups that refused to comply with the rule “are now blaming
the government for their own actions.” The agency added: “They are
abandoning their obligations to serve their patients under the program.”
The rule says that while clinics accepting Title X funds may continue to talk
to patients about abortion, they may not refer women to an abortion
provider or suggest where to obtain an abortion.

Planned Parenthood and many other organizations, including the American

Medical Association, say the restriction would force physicians and clinics
to withhold medical information from patients, would interfere with the
doctor-patient relationship and could deny pregnant women the range of
options available to them.

“We will continue to defend the right for patients to talk freely with their
physicians about all their health care options,” Dr. Patrice A. Harris,
president of the American Medical Association, said in an email.

The Trump administration has steadily shifted federal health programs

toward conservative preferences like promoting abstinence in teen
pregnancy prevention programs and allowing exemptions to insurance
coverage of birth control for employers with religious objections.

Withdrawing from Title X will not deprive Planned Parenthood of all

government funding, a longtime goal of many conservatives. Figures from
Planned Parenthood’s 2017-18 annual report showed that the organization
received about $500 million from Medicaid, the joint federal and state
health care program for low income people. Federal funds cover most of
that spending.

The immediate effect of a Planned Parenthood withdrawal is unclear and

likely to vary by state. Hawaii, Illinois, New York, Oregon and Washington
have said their states would not participate in Title X under the new rule.
Legislatures in Massachusetts and Maryland have passed laws that
essentially have the same effect. Planned Parenthood expects some of the
states to make up some of the money.

The rule, announced in February, is being challenged in court by Planned

Parenthood, other organizations and more than 20 states, but a federal
appeals court in July said the policy change could take effect while the legal
cases were pending.

Planned Parenthood and some other organizations that receive Title X

funds had decided to stop using the money until the legal challenges were
resolved, although they had not officially withdrawn from the program.
The Department of Health and Human Services said that such an
intermediate status would not be acceptable. It said that organizations had
until Aug. 19 to submit an “assurance and action plan” showing they intend
to make “good faith efforts” to comply with the new rule.

Last week, Planned Parenthood sent a letter to the United States Court of
Appeals for the Ninth Circuit, asking a panel of judges to stay the deadline
until the legal cases could be decided. On Friday, the court declined to do
so.

Earlier this month, the Department of Health and Human Services

posted an explanation of the timeline and details of the new policy, saying
that it is “not a gag rule.”

“Health professionals are free to provide nondirective pregnancy

counseling, including counseling on abortion, and are not prohibited in any
way from providing medically necessary information to clients,” the
department said. “The Final Rule does NOT include the 1988 Regulation’s
prohibition on counseling on abortion — characterized by some as a ‘gag
rule’ — but neither does it retain the mandate that all grantees MUST
counsel on, and refer for, abortion.”

The department said that “while Title X providers are prohibited from
referring for abortion as a method of family planning, referral for abortion
because of an emergency medical situation is not prohibited.”

It said providers may give pregnant women “a list of comprehensive health

care providers (including prenatal care providers), including some (but not
the majority) who perform abortion as part of a comprehensive health care
practice. However, this list cannot serve as a referral for, nor identify those
who provide abortion — and Title X providers cannot indicate those on the
list who provide abortion.”

Because clinics receiving Title X money will no longer have to counsel

women on all reproductive options, including abortion, the new rule may
make faith-based providers and others that oppose abortion eligible for
funding — a change that could significantly alter the guidance patients
receive.

Organizations receiving Title X funds will still be able to perform abortions

but will have to do so in a separate facility from their other operations and
adhere to the new requirement that they not refer patients to it. Clinics
have been prohibited for years from using federal money to finance
abortion services, except in cases of rape, incest or when the pregnancy
would endanger the woman’s life. The new rule goes a step further by
ordering them to keep separate books for their abortion operations. Those
changes are expected to take effect in 2020.

Planned Parenthood is not the only provider that has bridled at the new
rule. In Maine, the only Title X recipient, Maine Family Planning, has
decided to withdraw from the program, but has said that, for now, it will
not close any of its 18 clinics.

Pam Belluck is a health and science writer. She was one of seven Times
staffers awarded the 2015 Pulitzer Prize for International Reporting for
coverage of the Ebola epidemic. She is the author of “Island Practice,”
about a colorful and contrarian doctor on Nantucket. @PamBelluck

A version of this article appears in print on Aug. 20, 2019, Section A,

Page 1 of the New York edition with the headline: Planned Parenthood
Opts Out Over Trump Rule. Order Reprints | Today’s Paper | Subscribe