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This week, Secretary of Health and Human Services (HHS) Alex Azar will testify before several Congressional committees regarding the dangerous Trump budget — which guts vital health-care programs, including Medicaid.

Medicaid is the largest sexual and reproductive health program in the country, and a critical resource for preventive health services that millions of people rely on — including family-planning services and pregnancy-related care. Consider

  • Nearly 1 in 5 women of reproductive age are enrolled in Medicaid
  • Across all ages, women make up the majority of Medicaid enrollees

  • Medicaid pays for 75% of family-planning services in the country

  • Medicaid covers roughly half of all births in the United States 

Secretary Azar must answer for the Trump-Pence administration’s focus on attacking Medicaid and sexual and reproductive health care. Any attack on Medicaid, from block-grant waivers to work requirements to budget cuts to “defunding" Planned Parenthood, undermines access to essential, potentially life-saving care.

Here are the questions that we want HHS Secretary Azar to answer:

Why have the Trump-Pence administration’s policies decreased access to care and disproportionately harmed those that already face severe barriers to care — namely people of color, young people, low-income people, and rural communities?

Last year, Azar testified to Congress that the Title X gag rule would increase access to care. Now that the gag rule has been in effect for more than 6 months, the reality is that Title X is serving half as many patients as it typically does.

As HHS Secretary, what will you do to ensure that all Title X patients are able to obtain a broad range of contraceptive method options, and comprehensive counseling on those options, so that they can use whatever methods of birth control work best for them?

For more than four decades, the goal of the Title X program has been to ensure access to affordable birth control. Yet one of the new grantees approved under the Trump-Pence administration has declared that it doesn't offer birth control pills or longer-acting methods. This goes against the very mission of the Title X program.

Why are you actively undermining efforts to address the opioid public health emergency with the Title X gag rule?

President Trump has declared the opioid crisis a “public health emergency.” The Surgeon General has called it an “all-hands-on-deck emergency,” saying that we must “harness the powerful resources of everyone who has a stake in health.” But Title X-funded health centers — as an entry point, and sometimes the only source of health care in many communities — are on the front lines providing care to those most in need, and play an instrumental role in fighting the opioid crisis.

How can you and the Trump-Pence administration proclaim that HIV is a top priority, when you’re attacking the health care programs and providers that are instrumental to eradicating HIV?

During the 2019 State of the Union address, Trump declared that HIV/AIDS was a top priority — and pronounced that he would end the HIV epidemic. The Title X program funded nearly 1.2 million confidential HIV tests in 2017 alone, but the Trump-Pence administration’s domestic gag rule has reduced the Title X network's capacity by 47% nationwide.

The New England Journal of Medicine looked at the case of a 2015 HIV outbreak in Scott County, Indiana, and found that the outbreak was exacerbated by the closure of a Planned Parenthood health center that had been the county’s only regular source of HIV testing. The inability to quickly identify the outbreak resulted in many that could have been prevented. As patients lose access to Planned Parenthood health centers and other providers because of the gag rule, this scenario could play out in communities across the countries.

Why are you weaponizing the Section 1115 Medicaid waiver process and approving states’ backdoor efforts to defund Planned Parenthood health centers? 

Attempts to “defund” Planned Parenthood are clearly ideological attacks — opposed by public health experts because they lead to worse health outcomes. When Texas first barred Planned Parenthood from serving patients in the program, nearly 40% fewer people got the health care they needed. Data from the Center for Public Policy Priorities estimates that nearly 45,000 fewer people received birth control, cancer screening, and other services through the program — a nearly 40% drop — than when Planned Parenthood participated in the program.

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