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Medical associations want withdrawal of Title X changes


Leading medical societies are calling on the Trump administration to withdraw its proposed changes to the federal Title X family planning program, calling the modifications a threat to essential health care for women.

In late May, the Department of Health & Human Services proposed broad changes to Title X, including no longer allowing staff at Title X clinics to counsel, refer, or provide information to women about abortions and mandating that Title X clinics that offer abortions maintain a separate facility for abortion services. The proposed changes aim to “refocus” the Title X program and ensure that all Title X services align with its family planning mission, according to the proposed rule published June 1.

In a July 31 letter to HHS, the American Medical Association requested that HHS withdraw the proposal, citing concerns from the medical community.

“We are very concerned that the proposed changes, if implemented, would undermine patients’ access to high-quality medical care and information, dangerously interfere with the patient-physician relationship and conflict with physicians’ ethical obligations, exclude qualified providers, and jeopardize public health,” James L. Madara, MD, chief executive officer and vice president of the AMA, wrote in a letter. “We urge HHS to withdraw this [proposal].”

The American College of Obstetricians and Gynecologists, the American College of Physicians, the American Academy of Pediatrics, the American Psychiatric Association, and 13 other health care associations also have called on the HHS to rescind its proposed rule. According to a statement from these associations, the proposal endangers women’s lives by restricting access to medically accurate information and preventive health care.

Title X is a long-standing federal program that provides funding for women’s health care and comprehensive family planning services, primarily to low-income and uninsured patients. Federal law prohibits the use of Title X funds to pay for abortions.

Under the proposed regulations, the Trump administration would define “family planning” as the voluntary process of identifying goals and developing a plan for the number and spacing of children and the means by which those goals may be achieved. This includes planning methods and services “to limit or enhance the likelihood of conception, including contraceptive methods and natural family planning or other fertility awareness-based methods,” according to the proposal. HHS specifies that family planning does not include postconception care, obstetric or prenatal care, or abortion as a method of family planning. HHS has proposed that, if a woman comes to a Title X–funded clinic and is pregnant, she be referred externally for pregnancy services. However, the proposed rule would no longer allow Title X programs to provide abortion counseling and/or referral.

According to HHS, requiring separate facilities for abortion-related care would ensure that Title X funds are used for the purposes expressly mandated by Congress – to offer family planning methods and services – and that any infrastructure built with Title X funds would not be used for impermissible purposes.

More than 100,000 comments have been submitted on the proposed rule since June. Antiabortion organizations, such as the Susan B. Anthony List, have expressed strong support for the proposed rule.

“The American people have repeatedly expressed their predominant policy preferences by supporting Congressional enactments designed to distinguish and separate abortion from family planning,” SBA List President Marjorie Dannenfelser wrote in a comment. “Abortion is not health care, nor is abortion family planning. The Clinton administration and subsequent presidential administrations have erroneously allowed the blatant distribution of Title X funding to abortion centers and abortion-referral facilities for years and in direct violation of the original purpose of Title X funding.”

A group of 14 state governors, meanwhile, has threatened legal action if the Trump administration moves forward with finalizing its rule. In a May 31 letter, the 14 Democratic governors urged HHS to halt its changes to the Title X program and said they would explore all options, including legal avenues, to protect patients’ access to care. More recently, Democratic governors in Washington, Oregon, Hawaii, and New York have said they will refuse all Title X funding if the Trump administration does not rescind its proposed changes to the program.

“This is not an issue about life or choices. This is an issue about the rights of millions of individuals who deserve the best health care available,” Hawaii governor David Ige said in a July 30 statement. “Hawaii will not accept federal funds for these programs if the proposed rules are implemented.”

Public comment on the proposed rule closed on July 31.

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