For millions of low-income American women and families, a “gag rule” imposed on the federal Title X program and Planned Parenthood’s resulting decision to — at least temporarily — end its role as a program provider will mean longer wait times, higher costs and tougher access to family planning services that includes contraceptive care and screening for sexually transmitted diseases.
Except in Washington state.
Last week, after Planned Parenthood said it would leave the program rather than comply with a Trump administration rule, state officials — among them Gov. Jay Inslee and Attorney General Bob Ferguson — announced that the state will cover nearly $3 million in the costs of the program here, at least through March. Additional funding could also be included as part of the state’s supplemental budget when the Legislature begins its 2020 session in January.
Title X, enacted by Congress in 1970 to reduce the number of unintended pregnancies and break the cycle of poverty among low-income women and families who couldn’t afford contraception, serves an estimated 4 million women in the U.S. Two-thirds of the women served by the program are at or below the federal poverty level. As well as contraceptive care and screening for STIs, Title X providers also screen patients for breast cancer, diabetes, high blood pressure and depression, often delivering the only health care available to low-income women.
Planned Parenthood provided about 40 percent of the $286 million in care provided through Title X and had provided funds for 85 clinic sites in the state, including Planned Parenthood offices in Everett, Lynnwood and Marysville.
The change to Title X, finalized earlier this year by the Trump administration but facing court challenges — including by Washington state — prohibits clinics and staff in the program from providing abortions or referring or discussing abortion as an option with patients. Planned Parenthood and other providers have long complied with a decade-old federal rule that forbids the use of federal funds for abortions, except for a medical emergency or in cases involving rape or incest. Providers must use other funding sources for abortion services.
Rather than discouraging abortions, however, the Trump administration’s Title X rule change presents the likelihood of numerous unintended consequences, including poor health outcomes for women and families, a rise in unplanned pregnancies, a greater incidence of sexually transmitted disease and a loss of ground in the current drop in the nation’s abortion rate.
Denying patients full information on the options available to them — not to mention limiting their access to contraceptives — can only result in more unintended pregnancies and a reversal in the trend of fewer women seeking abortions.
Under Title X’s former rules, the national rate of abortions has dropped steadily and significantly since hitting a high of 29.3 abortions per 1,000 women between the ages of 15 and 44 in 1982, according to the Guttmacher Institute. As of 2014, that rate has dropped to 14.6 abortions for every 1,000 women, its lowest level since the 1973 Roe v. Wade decision that legalized abortions.
The same trend was seen in Washington state. Between 2011 and 2014, the rate declined from 16 to 13.7 abortions per 1,000.
The rule change also is likely to mean increased costs for states and the federal government because of the expected increase in unintended pregnancies and STIs, a point made by Christine Charbonneau, the chief executive for Planned Parenthood of the Great Northwest and the Hawaiian Islands.
“States can’t afford not to pay for family planning programs,” Charbonneau said during last Thursday’s news conference. “They end up with an untenable burden in labor and delivery costs — and Medicaid afterward — if they don’t.”
Washington and eight other states are challenging the rule change in court, although the states lost a decision on a stay of the rule while the U.S. 9th Circuit Court of Appeals rehears arguments regarding a district court’s temporary injunction.
Ferguson and other state attorneys general have challenged the rule change on the grounds that it violates the Affordable Care Act’s protections against government interference with the doctor-patient relationship; ignores Congress’ mandate that Title X pregnancy counseling be non-directive; violates physicians’ constitutional rights to free speech; and violates women’s constitutional freedoms protected under Roe v. Wade.
Until the Trump administration’s Title X rule is overturned in the courts or by a change at the White House, state officials and lawmakers have done the right thing by stepping in to provide the funding for the program’s patients under the former rules.
They can continue that funding with the knowledge that — despite the outlay — they will save the state money in the long run and will assure better health outcomes for women and families throughout the state as well as continuing the decline in abortions.