New Rule Criticized for Jeopardizing Health Care of Low-Income Women
Abstract
A new Final Rule prohibits referrals for abortion for low-income women in the Title X program and adds many costly new record-keeping and other requirements.
APA and a broad coalition of medical organizations representing more than 4.3 million health care professionals called on the Trump administration to retract its new rule that will sharply curtail family planning and contraceptive services available under the Title X program for low-income patients.
“This regulation will do indelible harm to the health of Americans and to the relationship between patients and their providers,” the coalition wrote in a statement. “By forcing providers to omit critical information about health care and resources available, the final regulation directly undermines patients’ confidence in their care.”
The Title X Family Planning Program was enacted in 1970 as part of the Public Health Service Act. It provides more than 4 million low-income or uninsured women a year with birth control and comprehensive reproductive health services, including breast cancer screening and treatment for sexually transmitted diseases. Since its inception, programs have been prohibited from using funding to provide abortions. About one-quarter of Title X funding goes to Planned Parenthood clinics and its affiliates, which are the nation’s biggest private abortion providers.
The Department of Health and Human Services published the Final Rule in the Federal Register last month. Some of the biggest changes in the overhaul include the following:
Eliminates the requirement that Title X programs refer for abortion clients who request it and instead prohibits referrals for abortion.
Eliminates the abortion counseling requirement and bars programs from using Title X funds to perform, promote, or support abortions as a method of family planning.
Adds a number of reporting and record-keeping requirements, including requiring programs to note actions taken to involve families in the family planning decisions of minors.
Creates a costly requirement that programs create a clear physical and financial separation from abortion services.
“Government gag rules for doctors, intrusive medical record keeping, and other medically unnecessary and burdensome requirements are almost exclusively applied to women’s reproductive health care—and would never be attempted in other areas of medicine,” said Nada Stotland, M.D., M.P.H., former APA president and an expert in reproductive psychiatry. “Attacks on women’s health care hurt not only women; they harm children and families and thus sap the strength of our country and our hopes for the future.”
The final regulation is the administration’s latest salvo against family planning. Previously the administration eliminated funding for teen pregnancy prevention programs, gave more employers insurance exemptions from covering contraceptives, and added substantial payment burdens for individual health plans that cover abortion, making it nearly impossible for such plans to continue covering the procedure.
“Government gag rules for doctors, intrusive medical record keeping, and other medically unnecessary and burdensome requirements are almost exclusively applied to women’s reproductive health care—and would never be attempted in other areas of medicine,” said Nada Stotland, M.D., M.P.H.
“Together, these decisions compound, leaving women and families with increasingly fewer options for obtaining medically accurate, affordable, and timely access to contraception and preventive care,” the coalition wrote.
The new Trump administration rule is scheduled to take effect on May 3, but implementation is likely to be delayed by a multitude of lawsuits. The AMA filed a lawsuit in federal court last month to block the rule, joined by the Planned Parenthood Federation of America and Oregon Medical Association. The lawsuit contends that the rule would force doctors to violate their obligation to give patients honest and informed advice.
“Because of the administration’s overreach and interference in health care decision making, physicians will be prohibited from having open, frank conversations with their patients about all of their health care options,” AMA President Barbara L. McAneny, M.D., said. “The new rule imposes a government gag rule on what information physicians can provide to their patients.”
Leana Wen, M.D., president of Planned Parenthood Federation of America, pointed out that Title X primarily serves women and families with low incomes, most of whom are people of color, Hispanic, or Latina, so the gag rule will worsen existing health disparities. A coalition of 20 mostly Democratic controlled states—plus California separately—also filed suit in federal court to block the rule. Other organizations including the American Civil Liberties Union and the Center for Reproductive Rights have also vowed to sue.
The administration estimates it will cost more than $36 million for clinics to comply with just the physical separation requirements, while providing no economic savings to the government. The other requirements were estimated to cost at least $6 million more. If the rule becomes law, large numbers of health care professionals would have no choice but to withdraw from Title X entirely, the AMA wrote in its statement.
In addition to APA,the coalition is composed of 17 other medical organizations including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Osteopathic Obstetricians and Gynecologists, and the American College of Physicians. ■
