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Nationwide “Gag Rule” Has Never Been Implemented in the United States Before

ALBANY, NY -- On Tuesday, May 23, 2018, the Trump-Pence administration released a nationwide gag rule, marking a radical departure from how health care has operated in the United States up until this point. The proposed rule, issued by the Department of Health and Human Services tonight but not yet posted to the Federal Register, would do three main things:

  • Make it illegal for doctors, nurses, hospitals, and community health centers across the country that participate in the Title X program to refer their patients for safe, legal abortion.
  • Impose new restrictions designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood.
  • Remove the guarantee that people are getting full and accurate information about their health care from their doctors. For nearly two decades, Title X law has been clear: Health care providers cannot withhold information from you about your pregnancy options. This rule means they can.

Statement from Robin Chappelle Golston, President and CEO, Planned Parenthood Empire State Acts:

“The Trump-Pence administration has launched the most blatant attack on women’s health and rights that this country has ever seen. They have based their health care policies on extreme ideology, not facts. New Yorkers will not stand for the Trump-Pence brand of bad medicine which endangers us all. We refuse to let them roll back our rights and will continue to work closely with our state champions to safeguard reproductive health care in New York State. Planned Parenthood has been an essential component of our state’s health care system for over 100 years, our doors remain open, and we will never stop fighting to ensure equal access to essential care.”

The proposed rule includes a slew of additional changes designed to dismantle the program — including a new policy stipulating that Title X projects do not have to provide every effective and acceptable method of birth control. This is a sharp departure from the way the program has been operating, in which HHS put an emphasis on ensuring women have access to all 18 FDA-approved contraceptive methods. The rule also deletes the requirement that contraceptive methods provided by Title X projects be “medically approved.”

The rule also re-defines what “low-income” means — expanding it to now include women whose employers no longer allow them to have their birth control covered by health insurance — in an apparent attempt to rectify the gap in care caused by the administration’s previous rule on insurance coverage of birth control. However, the rule does not stipulate any additional resources or funding to help the program or providers meet this increased need.

The rule is expected to include a 60-day comment period after the yet to be determined date it is posted to the official federal register.

Background:

The domestic gag rule has never gone into effect in the United States before. The Reagan administration did try to implement this in 1988, but the rule was held up in the courts and later retracted by the Clinton administration in 1993 after an intense outcry from the medical community, including the American College of Physicians and the American College of Obstetricians and Gynecologists. Reinstating this rule would prevent millions of people from getting birth control and preventive care at Planned Parenthood health centers. At the same time, it would also force doctors and nurses to withhold information from patients across the country.

Planned Parenthood plays an irreplaceable role in connecting patients to health care. In New York State, 34% of Title X service sites are Planned Parenthood health centers, and those sites serve 52% of Title X patients. Yet this rule would bar those patients from coming to Planned Parenthood health centers, leaving many with nowhere else to turn.

Title X is a decades-old popular and effective program designed to ensure that everyone, no matter where they live, how much money they make, and whether or not they have health insurance, has access to basic preventive reproductive health care like birth control, cancer screenings, STD testing and treatment, and well-woman exams. It has received bipartisan support from Congress since its inception. Every year it serves more than four million people, although many people who get care through the program may not even be aware that they are Title X patients. In 2016, more than 306,000 New Yorkers received care at Title X funded health centers.

The domestic gag rule wouldn’t just affect Planned Parenthood. The rule “gags” any Title X provider from referring for abortion. It would affect every health care provider in the program, from community health centers to hospitals.

Title X serves a racially and ethnically diverse patient base: Out of the four million family planning clients served by Title X, more than one-third are Hispanic or Latino, 13 percent have limited proficiency in English, and at least a third are people of color. Racial or ethnic bias, along with language barriers, can already make health care difficult to access and an attack on Title X will limit health care options even further.  

Key facts about Title X and Planned Parenthood:

In New York State, 34% of Title X service sites are Planned Parenthood, and those sites serve 52% of the patients. Nationally, while Planned Parenthood health centers make up only about 13 percent of the Title X health centers, they serve 41 percent of the patients (four in 10 Title X patients) who get care through Title X

There are two direct Title X grantees in the state, the New York State Department of Health and Public Health Solutions. Together these entities support 187 health centers that provided care to 306,070 New Yorkers in 2016.

It is estimated that in 2015, Title X services in New York prevented 59,200 unintended pregnancies.

83% of New York Title X patients have incomes at or below 250% of the federal poverty level ($29,700 for an individual).

In 14 states including New York, Planned Parenthood serve more than 50% the Title X patients in the state. This includes Alaska, Arizona, California, Connecticut, Iowa, Michigan, Minnesota, New Jersey, Ohio, Washington, Wisconsin, Utah, and Vermont.  

More than half of Planned Parenthood’s health centers are located in medically underserved areas.

Research has shown that Planned Parenthood consistently outperforms other publicly funded providers, including FQHCs, when it comes to meeting the family planning needs of people across the United States by:

Providing the full range of birth control methods on-site;

Filling longer-term contraceptive prescriptions; and

Offering shorter wait times and expanded health center hours.

Community health centers will not be able to fill the huge void if Planned Parenthood is blocked from Title X program, dealing a major blow to health care access for thousands of low-income people across the country.

Community health centers themselves say there is no way they could fill the gap if Planned Parenthood health centers were no longer allowed to serve these patients.

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Planned Parenthood Empire State Acts is a non-profit, statewide organization dedicated to protecting and expanding access to a full range of reproductive health care services. It represents New York’s Planned Parenthood affiliates and works to protect and expand access to reproductive health care for all New Yorkers.

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