Planned Parenthood fights on despite Trump judicial decision

In another move to retreat from the decisions of earlier presidents, the Trump presidency, in May, filed for a retraction from Title X monies, those earmarked, initially from the Nixon administration to allow low-income people the right to healthcare. And, this recent move will, if enacted, will prevent women from receiving the necessary information for an unwanted, or unplanned pregnancy, and all mention of abortion, as one option, or even accurate and inclusive contraceptive information, for the future.

With rumors swirling that the next Supreme Court nominee will be Washington insider, Brett Kavanaugh, whose first mission is to recall the landmark decision of Roe. v. Wade, this move comes at the expense of poor women, of color, and the most vulnerable, to access to health care, in general. And, some see this as a trial balloon, of sorts, to test the waters for a repeal of Roe.

Of major concern for Planned Parenthood, is the violation of ethics that would prevent a provider from giving complete health information to a patient, from a provider, especially from a physician, who take the eponymous Hippocratic oath.

In response, “Planned Parenthood and the National Family Planning & Reproductive Health Association . . .  asked a federal judge to prevent HHS from making changes to Title X funding that could effectively cut them off from federal dollars because their programs focus on contraception over abstinence,” according to the website ModernHealthcare.com.

The major change is that HHS would score grant applications for Title X family planning providers from this past February’s ruling, in a way that decreases organizations like Planned Parenthood from getting much needed funding, both for care, up to, and including, basic women’s health issues, and prevention; and, where in some areas, they are the only provider available.

“The program doles out $260 million to healthcare providers. Under the revamped system, grant applications that emphasize natural family planning and abstinence and don't reference abortion would be scored higher, thus increasing their chances of securing funding”.

According to the government website - HHS.gov, “The Title X Family Planning program, was enacted in 1970 as Title X of the Public Health Service Act. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. The Title X program is designed to provide access to contraceptive services, supplies, and information to all who want and need them. By law, priority is given to persons from low-income families.”

The federal government, in its response, asked U.S. District Judge Trevor McFadden McFadden to “toss Planned Parenthood's suit because the policy change does not constitute a final decision and cannot be reviewed by the courts.”

On Tuesday their hopes were dashed when McFadden dismissed Planned Parenthood’s claims as “not reviewable,” ruling that the announcement outlining guidelines for considering Title X grants is not a “final agency action” that would mandate a stricter approval process.

McFadden also fobbed off Planned Parenthood's argument that the new rulings, or scorings, were arbitrary and capricious”, saying that “The Announcement merely encourages Title X providers to discuss healthy relationships and sexual risk avoidance, in a nuanced and research-informed way.”

In a statement, the national office of Planned Parenthood, said: “Additionally, 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.”

Cold water was also dashed on all of that by the judge, who noted the emphasis on abstinence, and said, in part, “However unpopular, decisions to choose forms of sexual abstinence have undeniable relevance to family planning, and the administrative record supports the Government’s conclusion that a meaningful emphasis on this topic can be part of a well-reasoned approach to Title X programs.”

“Though Planned Parenthood already does provide guidance on abstinence and works with faith-based community groups, the organization said in the lawsuit that its commitment “to following evidence-based best practices for patients’ health, and to providing comprehensive family planning care” — which Planned Parenthood is unwilling to sacrifice in exchange for a better shot at Title X funding — runs counter to the new HHS guidelines.”

Absent the recent judicial decision, the rule is similar to a Reagan era proposed restriction that failed to take effect because of legal challenges, and a subsequent change of administration.

As upsetting for the pro-choice organizations, from the decision, there is the prospective and chilling effect on low income women, the intended beneficiaries of the Title X legislation, many of whom are African American, or Hispanic.

But that took another, some say misguided turn, as  “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,” noted Planned Parenthood.

In Ohio, “Rob Salem, a Toledo attorney and board member of Planned Parenthood Advocates of Ohio, introduced a resolution, saying the measure “essentially imposes a gag rule on health care providers” by preventing them from counseling patients about where to obtain a legal abortion.”

Concurring is Julie Lynn, Manager of External Affairs of Illinois Planned Parenthood, who said in a telephone interview, Wednesday, that she is doubly concerned because this is also part of “the global gag network because of a political football” that has been tossed as far as Africa.

She also points out that the gag order also has wide range consequences, for other groups, and gives a deleterious effect, beyond the initial view, with a negative impact on those that are HIV-Positive, in the absence of condoms, as an option, to protect individual health.

The transgender community can also be affected if someone “who identifies as a man, but [is still biologically a woman] and needs a pap smear, might be denied outside of one of our facilities; we have always been a safe and healthy place for the LGBTQ community.”

The American Medical Association opposes this gag rule, saying they “are particularly alarmed about government interference with the patient-physician relationship in the exam room.”

Many say the timing is ironic considering that, “The Trump administration's proposal comes at a time when both teen and unintended pregnancy rates in the U.S. are at historic lows.

Yet, as critics have pointed out, with other areas of “revision”, from the Trump administration, be they anti-rape procedures on college campuses, public education or food stamp work requirements, logic is not the primary concern.

“The decision to uphold the new guidelines could have dire effects for Planned Parenthood, which noted in the lawsuit that it will now have to “compete for Title X funds with one hand tied behind their backs” against faith-based and pro-abstinence organizations and “face the prospect of losing some or all of [their] Title X funds.”

Lynn emphasized the scope of Title X funds that “affect 4 million people and those that are below the poverty line who rely on them”, and even where there are other providers, “they could not take on additional patients, without access to these funds, and in many communities Title X facilities are the only options in the community [they live in].”

Also problematic is that “Heavy patient loads are common at these clinics, says Sara Rosenbaum, a health policy professor at George Washington University. Rosenbaum says these community health centers provide important services but aren't as equipped to provide the reproductive services that Planned Parenthood is known for,” in an interview with National Public Radio, earlier this March.

The turnabout from legislation designed to help, in part, women of color, of whom Lynn says, in Illinois, are “21 percent Black and 32 percent, Hispanic or Latino, also live in places where there is health care disparity,” which tears at the social fabric of communities that have a legacy of economic disinvestment, and poverty.

According to the Guttmacher Institute, there are a total of 95 Title X locations in Illinois, and of those run by Planned Parenthood, there are 17, and, significantly, Planned Parenthood of Illinois, makes up almost 18 percent of Title X providers in the state.

Other figures are total female contraception patients served at Title X locations in Illinois: 119,470, plus total female contraception patients served at Title X Planned Parenthood locations in Illinois are 50,340.

Of note, PPIL is the only Title X provider in six  Illinois counties: LaSalle, Macon, McLean, Peoria, Sangamon, and Tazewell, and as Lynn emphasized, “PPIL makes up only 18 percent of Title X providers in Illinois but serves 42 percent of those patients.”

As she stressed, much “like the Reagan proposal, this takes it to another level,” but there is a public comment period where all interested, can issue a comment, ending on July 31st, and Lynn notes that “DHS must respond.”

Those interested, in stopping the gag rule, can do so by clicking here.

In a statement released after McFadden’s decision, from the national office of Planned Parenthood, Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America, said in part, “We will not stop fighting for our patients and the four million people who depend on this health care. This program is meant to ensure that every person -- regardless of where they live, how much money they make, their background, or whether or not they have health insurance -- has access to basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and regular check-ups. The Trump-Pence administration is trying to impose its ideology on people -- no matter how many it hurts. We will never stop fighting for people’s health and rights. No matter what.”