A week ago today, the family planning, women's health and abortion provider announced that it would leave the federal government's Title X family planning program — and turn down millions in federal funding in the process — rather than abide by the Trump administration's new domestic gag rule. The gag rule prohibits clinics receiving Title X cash from providing abortions or referring patients for an abortion.
"(D)ue to an unethical and dangerous gag rule, the Trump administration has forced Planned Parenthood grantees out of Title X — the nation’s program for affordable birth control and reproductive health care," Alexis McGill Johnson, Planned Parenthood Federation of America's acting president and CEO, said on a press call. "We are continuing to fight this rule in court and will do everything we can to make sure our patients don’t lose care. I want our patients to know: while the Trump administration may have given up on you, we never will. But let’s be clear: the impact of the Trump administration's gag rule will reverberate across the country.""(L)et’s be clear: the impact of the Trump administration's gag rule will reverberate across the country." — Alexis McGill Johnson
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For specifics about how the impact of the gag rule, and Planned Parenthood's decision to forgo Title X funds, might affect women's health around the country, one must look no further than Texas.
In 2011, the state moved to exclude abortion providers from what had been, to that point, a joint state and federal women's health program that provided family planning, birth control and sexually transmitted infection tests to low-income women. As a result, Texas' program lost its federal funding, which had been a 9-to-1 match. Dozens of women's health clinics around the state closed.
"It just decimated providers throughout Texas," said Kelly Hart, a spokeswoman for Planned Parenthood of Greater Texas. "Eighty facilities closed, most of them not Planned Parenthood facilities. I don't know that we've recovered from that.""It just decimated providers throughout Texas." — Kelly Hart
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Texas Planned Parenthood clinics recovered some federal funding through sub-grants from other, non-state entities receiving federal grants until about a year ago, Hart said, but Planned Parenthood is no longer receiving any money from either the state or federal governments.
According to the state's own data, the Healthy Texas Women program has served far fewer women since it kicked out Planned Parenthood, which had previously provided care to 40% of the women enrolled in the program. One of the groups that took Planned Parenthood's place, an anti-abortion advocacy organization called The Heidi Group, told the state it could serve 51,000 women enrolled in the program in 2017. That year, The Heidi Group served only 2,327 women at its 22 affiliated clinics, and was subsequently kicked out of the program.
Without Title X funding, Planned Parenthood clinics around the country can model what Texas clinics have done since 2011, but the loss of cash will still hurt.
"We've definitely increased our fundraising. We have fabulous donors. We have our patient assistance program. We run a few of our health centers as though they were Title X health centers, adjusting our pay scale. We've increased the number of commercially insured patients that we see, which helps us to provide at least low-cost services," Hart said. "These are the things that we're doing, but the reality is, there are counties that had a healthcare provider before funding was slashed, and they still don't have a healthcare provider.
"There are still people who can't get to Planned Parenthood or a health center for subsidized STI testing or birth control or a cancer screening or just because something weird is happening and they need to see a doctor."
