Detroit Proper: Title X and the Fight for Women’s Health Issues

For nearly a decade, you could depend on a congressional “shutdown showdown” over the funding of Planned Parenthood. I was shocked this year when the annual spectacle turned out to be a war over a wall, not a war over our wombs. But just because the border wall battle has taken center stage, it doesn’t mean the conservative onslaught against women’s health has gone away.

Late last year, the Trump administration tried a different tactic. Rather than threaten a government shutdown over funding for the organization that has been serving American women and men for more than a century, the president proposed changes to the rules about how Planned Parenthood gets paid. Barring legal action, the changes could be law in the coming months.

In case you didn’t know, Planned Parenthood operates like any other doctor’s office. There are fees for its services, and you can pay with cash or insurance (including Medicaid). If you don’t have either, your services may be all or partially paid for by a government program called Title X.

Title X was established in 1970 by Republican President Richard Nixon to make sure that low-income women could afford basic reproductive health care, like breast exams, birth control, testing and treatment of sexually transmitted infections, and cancer screenings. These days, 4 million economically distressed patients get their reproductive health care subsidized through Title X, 40 percent of whom choose Planned Parenthood for that care.

News flash: Except in rare cases, abortions cannot be paid for with state Medicaid funds or federal Title X funds. Despite the fact that Planned Parenthood does not receive public funds for abortion services, congressional conservatives have pushed to “defund” the organization practically every year since 2007 – without success.

That’s because the idea is a non-starter for most Americans. Last summer, a Gallup Poll revealed that 62 percent of Americans across gender, education levels and socio-economic status had a favorable view of Planned Parenthood. So, President Trump decided to attack the organization by attacking Title X.

Under the administration’s new rules, sites that serve low-income Title X patients no longer have to stick to FDA-approved methods of birth control. If a doctor wishes to only recommend abstinence and/or the rhythm method for birth control (both proven to be ineffective), he can do so and still receive federal funds.

The rules also restrict when and how medical practitioners can refer patients for abortions. And if practitioners perform abortions themselves, they can’t do the procedure in the same buildings where they also offer other Title X services, like Pap exams, breast exams and birth control.

This largely affects Planned Parenthood, which does not offer abortions at all of its facilities, but which does typically provide the full range of reproductive services in the health centers where abortions are performed. If the rule goes into effect, the organization may be forced to close some health centers, creating a shortage of care options for low-income patients.

“That could mean that the 62,700 Michigan residents who received Title X services last year – more than two thirds of whom came to Planned Parenthood – will not get the care they need,” says Lori Carpentier, president of Planned Parenthood of Michigan. “Right now, we are the only organization that serves Title X patients in the entire city of Detroit.”

“Imagine the consequences if a nephrologist were forbidden to discuss transplant options with a patient struggling with kidney disease, or if a primary care physician couldn’t talk about insulin with a diabetic patient,” says Dr. Barbara L. McAneny, president of the American Medical Association (AMA), in a March statement. “We cannot allow outside parties to insert themselves into the most personal conversations between patients and physicians.”  

That’s why the AMA sued the Trump administration in March to stop the rules from going into effect. The AMA has been joined by nearly half of the nation’s attorneys general, including Michigan’s attorney general. As a former employee of Planned Parenthood, I continue to puzzle over how conservatives keep trying to make political hay by railing against a well-respected health care organization that has served Americans for 100 years.

If the goal is to reduce abortions (a goal all of us can get behind), restricting access to preventive health care and education for those who need it most hardly seems like a logical approach. Maybe the proposed changes will be defeated in the courts. Or maybe, after years of unsuccessful political attacks on Planned Parenthood, congressional conservatives finally will start playing smart and stop playing doctor.