Trump administration will pull funds from groups that perform abortions or provide referrals

WASHINGTON – The Trump administration is proposing a far-reaching change in the distribution of Title X family-planning funds that would make clinics that provide abortion services or referrals ineligible for the federal funding. The move would potentially defund Planned Parenthood by millions of dollars.

Under the proposal filed Thursday and announced Friday by the Department of Health and Human Services, the $260 million program would require a "bright line" of physical and financial separation between Title X services and providers that perform or support abortion services or refer to abortion as a method of family planning.

These requirements are similar to those that were in place, although not enforced, during Ronald Reagan's presidency. Unlike the Reagan regulation, the proposal will not prohibit counseling for clients about abortion. It does, however, take away the requirement that providers must offer pregnant women the opportunity for "neutral" and fact-based counseling regarding pregnancy termination unless she indicates she does not wish to receive such information.

Neither the White House nor HHS would comment publicly on the proposal, which was sent to the White House Office of Management and Budget for an interagency review. But antiabortion activists received a briefing by phone from administration officials on Friday and were quick to praise the measure as evidence of President Donald Trump's commitment to their cause.

Jeanne Mancini, president of the antiabortion group March for Life, praised the administration in a statement Friday for taking action to direct taxpayer dollars to centers that do not promote or perform abortions.

"This money will now be redirected to comprehensive family health and planning centers that don't perform abortions and understand that abortion is not health care," she said. "The pro-life grass roots will be pleased to see President Trump deliver on yet another pro-life promise, and we look forward to continued progress is restoring a culture of life here in the United States."

Trump has delivered on several top priorities for abortion foes since taking office. He has appointed several judges with a history of opposition to abortion to federal appellate courts, including Supreme Court Justice Neil Gorsuch. He reimposed a provision that bars federal funds from going to groups overseas that provide abortion referrals, which is known as the Mexico City policy. He signed legislation that allows states to withhold federal Title X funds from facilities that provide abortion services. And his administration has attempted to curtail the Teen Pregnancy Prevention Program, which funds comprehensive sex education programs that can include information about abortion.

Many family planning experts, by contrast, said the plan could deprive Americans of access to the services they need to prevent unintended pregnancies.

Title X-funded health centers provide several basic services such as cancer screenings, birth control, sexually-transmitted-infection screenings, pregnancy testing and well-woman exams. While the changes do not affect the level of funding the government is providing, there has been a lot of alarm about how difficult it would be for smaller, community-based providers to absorb the vast number of patients served by Planned Parenthood. The organization – which receives $50 million to $60 million in Title X funds and serves an estimated 41 percent of the 4 million patients who receive care through the program – is by far the largest recipient of the grants.

The policy would have ripple effects far beyond Planned Parenthood. Susan Buchanan, chief executive of the Boulder Valley Women's Health Center, said in an interview Friday that it "puts us in the position of having to make a Hobbesian choice" of having to choose between the 90 percent of the clinic's patients that get a range of services from the clinic and the 10 percent that receive abortions.

The center is the only Title X recipient in Colorado that provides abortions, and the funding accounts for $550,000, or roughly 20 percent, of its annual budget.

Buchanan noted that the state had made major strides between 2009 and 2014 through the privately-funded Colorado Family Planning Initiative, which focused on providing women with long-acting reversible contraceptives. The state's teen birthrate dropped 50 percent during that five-year period, she said, avoiding at least $66 million in spending on entitlement programs such as food stamps. The center uses its federal funding to operate a free clinic for teenagers, which allows young women to obtain contraception without telling their parents or having to file insurance claims.

"They're shooting themselves in the foot, really," she said.

This week, more than 200 members of Congress – including Sens. Elizabeth Warren, D-Mass., and Patty Murray, D-Wash., and Rep. Joseph Crowley, D-N.Y., – expressed their opposition to the change in a letter to Secretary of Health and Human Services Alex Azar. "The move would disproportionately impact communities of color, the uninsured, and low-income individuals, and could reverse progress made in critical areas," they wrote.

Planned Parenthood as well as other proponents, such as Washington Gov. Jay Inslee, D, said Friday they were prepared to challenge the proposed rule in court. It will take several months before the rule will take effect, because HHS must first subject it to public comment, respond to that feedback, and issue a final version of the proposal.

"Washington has been, and will continue to be, a state that stands with women and their right to safe and legal abortion and reproductive care," Inslee said in a statement. "Attorney General Bob Ferguson is exploring our legal options, and if this administration insists on weaponizing the Title X program, I will work our legislative leaders to make sure that no matter what happens in DC, every woman in Washington state has access to all the family planning and health care services she needs."

Conservatives are confident that the new rules will withstand a legal challenge because similar Reagan-era requirements overcame a Supreme Court challenge.

David Christensen, vice president of government affairs for the Family Research Council, said in an interview that those standards required operations receiving Title X funds to be physically and financially separate from those performing abortions.

"Under Reagan, they could not be co-located, they couldn't refer for abortion," Christensen said.

In a conference call with reporters Friday, Planned Parenthood's leaders characterized the new rules as "draconian" and "an attack" on women's basic rights and safe, legal abortion.

"It's completely outrageous that a small group of people's ideological views are being pressed through these government agencies onto women's health care across the country," said Dawn Laguens, executive vice president of the organization.

The American College of Obstetricians and Gynecologists expressed deep concern about the anticipated changes, which the group says go far beyond the abortion debate.

"Anticipated changes to Title X pose an egregious intrusion in the patient-provider relationship and may force physicians to omit essential, medically accurate information from their patient counseling," Hal Lawrence III, the group's executive vice president and chief executive, said in a statement.

An administration official, who spoke on the condition of anonymity because the rule had not been issued yet, said that the changes would not necessarily result in the defunding of Planned Parenthood as long as the group is willing to "disentangle" their abortion-related services from family-planning services. However, Planned Parenthood officials have argued that informing women of all their choices – including abortion – is an integral part of the family-planning discussion, and on Friday, its leaders reiterated that they would not waver from that commitment.

Buchanan noted that eight years ago, it separated its family planning and abortion provider operations to comply with requirements imposed by then-Gov. Bill Owens, R, but was disqualified from receiving state family planning funds anyway.

"We separated into two different corporate structures. We had separate books, insurance, separate boards, separate everything," she said. "It doesn't matter what you do, they'll figure out a way to disqualify you.