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Why Trump’s change to Title X funding means fewer health choices for women

The Trump administration continues to restrict reproductive health care through federal law. Planned Parenthood, which provides reproductive health services to 1.5 million low-income women nationwide, is a central target, and new rules governing federal funding could mean a major drop in the money that organization receives. Yamiche Alcindor reports and talks to Sarah Varney of Kaiser Health News.

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  • William Brangham:

    While it can get lost amid much of his larger agenda, President Trump and his administration have taken a number of steps to restrict reproductive health care through the federal government.

    Planned Parenthood has been a central target.

    As Yamiche Alcindor tells us, new rules could mean a big change in how much money it and other groups receive.

  • Yamiche Alcindor:

    In the U.S., more than 1.5 million low-income women in the U.S. rely on Planned Parenthood for reproductive health services. Many use the group's clinics for birth control, pregnancy tests and STD screenings.

    But access to this care could be at risk. Planned Parenthood and other organizations that provide abortion counseling are facing a deadline to comply with new federal funding rules. In February, the Trump administration announced the policy. It would bring important changes to what's known as Title X, the government's only federal funding program dedicated to family planning for lower-income women.

    In order to get that funding, Planned Parenthood and other groups will not be able to provide referrals for abortion services. The rule led to fierce backlash, and then lawsuits, including from Planned Parenthood. The group serves about 40 percent of the country's four million Title X patients.

    While the decision is being appealed, Planned Parenthood officials say they will pull out of the program.

  • Alexis McGill Johnson:

    We believe that the Trump administration is doing this as an attack on reproductive health care and to keep providers like Planned Parenthood from serving our patients. We will not be bullied into withholding abortion information from our patients.

  • Yamiche Alcindor:

    Nearly 4,000 clinics nationwide received Title X funding in 2017.

    Later this year, a federal appellate court is expected to hear the case.

    For some further insight on the potential impact, we turn to Sarah Varney of Kaiser Health News. She has covered this for the "NewsHour."

    Sarah, thanks so much for being here.

    Millions of women are going to be impacted by this new Title X rule. How might that affect access to abortion and access to other medical services provided by Planned Parenthood and these other groups?

  • Sarah Varney:

    Well, as you mentioned, Planned Parenthood provides medical care to about 40 percent of the four million women who are in the Title X program.

    But the impact of this is likely to be much greater. So today's announcement really focused on Planned Parenthood withdrawing from the Title X program, but a handful of other states have also announced that they're going to withdraw. So, Maine, Washington, Illinois, New York and Maryland have all said that, rather than abide by these new rules that the Trump administration has put out, that they will no longer accept Title X money as well.

    So the impact of this is going to be much greater than just the women and some men who go to these Planned Parenthood clinics.

  • Yamiche Alcindor:

    You're talking about the impact. How might this new Title X rule also impact Planned Parenthood's ability to operate clinics across the country and patients seeking services?

    And how might these groups make up the money that they're going to lose from Title X?

  • Sarah Varney:

    So, in terms of sources of funding, Title X makes up about 19 percent of the budgets for Title X clinics overall.

    So you can imagine that's going to be a pretty significant loss. Planned Parenthood today on a conference call would not say how they were planning on making up the money. It's clear that, at least for the short-term, these clinics are not going to close right away.

    Most likely, what you will see — I have been talking to people who run these programs in different states around the country today, and what they generally say is that women will start to pay more out of pocket when they go to these clinics.

    So, right now, Title X is, by its nature, designed to serve low-income women. There is a disproportionate number of women of color who gets services at these clinics. So, in a sense, many of these clinics might start charging them more to come see their physicians and nurses.

    Some of these clinics may be forced to lay off medical staff. And so, therefore, the wait times for accessing these services will be much larger.

    And we will also probably see a change in the types of services that women are able to get. So one of the things that's really been interesting on the last couple years is, after Obamacare came into play, and it mandated that birth control be a covered benefit, so you no longer had to pay a co-pay, many more women started getting these long-acting birth control methods like IUDs, which historically had been quite expensive. They can be up to $700.

    So we saw a lot of low-income women moving on to these longer-acting methods of birth control, which are very effective, in some cases almost 100 percent effective. So now you can imagine a woman going to a Title X clinic. She no longer is going to be able to get that reduced price or free price for an IUD.

    And then, at the same time, the clinic won't have the money that it needs to go out and stock those IUDs. So you're going to end up with a situation where many women will no longer be accessing these kinds of longer-term birth control, which we know have reduced unintended pregnancies and teen pregnancies.

    We actually saw this play out in Texas a number of years ago, where we did, in fact, see the unintended pregnancy rate go up. And, in fact, the abortion rate went up there as well.

  • Yamiche Alcindor:

    What can you tell us about how these groups with religious ties, how they might benefit from this new Title X rollback from the Trump administration?

  • Sarah Varney:

    Well, there's one particular group called the Obria Medical Group that is really positioning itself to take over from Planned Parenthood and provide a national network of clinics in this new administration, in this new era of women's reproductive health care.

    It's called the Obria Medical Group. And they do not provide any type of birth control, with the exception of the fertility awareness method, so no pills, no IUDs, and no condoms. They do, do STD testing, Pap smears, those kinds of things, but they don't do any type of birth control, traditional birth control, or abortions.

  • Yamiche Alcindor:

    And that group wants to see itself as the new Planned Parenthood.

    Tell me about how this new Title X rule factors into the broader agenda from the Trump administration to take on the access to abortions in Planned Parenthood.

  • Sarah Varney:

    Well, this is really part of the Trump administration and particularly Vice President Mike Pence really making good on a promise that they campaigned on, which was to really remake women's reproductive health care in the United States.

    So it's not just about turning off the spigot to access to abortion, but it's really changing the types of birth control that women are on, the types of education that children receive around birth control. So there's been a big shift towards abstinence funding.

    We have seen a number of additional religious protections for medical workers. And we have also seen a rollback of an Obama era rule that required that employers offer birth control to their employers.

    So this is really part of a much broader agenda that this administration has been implementing ever since it took office.

  • Yamiche Alcindor:

    Thank you so much, Sarah Varney of Kaiser Health News.

  • Sarah Varney:

    Thank you.

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