WHAT IS THIS ALL ABOUT?

In March, the Trump-Pence Administration’s Department of Health and Human Services (HHS) finalized a new rule that would make clinics ineligible to receive Title X funds if they provide abortions or referrals for them. The rule clearly targeted Planned Parenthood, but also has serious consequences for many patients and providers receiving Title X Family Planning Funds. The rule makes it illegal for health care providers in the Title X program to refer patients for abortion.

Congress has mandated since 1996 that patients receiving information about their pregnancies through Title X must receive full, unbiased information about their options (“nondirective counseling”). The gag rule violates that by forcing doctors to withhold information from patients.

In 2010, Congress went even further, mandating that HHS cannot impose rules, precisely like the gag rule, that create unreasonable barriers to care, that interfere with doctors giving their patients a full range of options, that restrict the ability of health care providers to disclose all relevant information to patients making health care decisions, or that violate the ethical standards of health care professionals.

Title X helps millions of people struggling to make ends meet –– the majority of whom are people of color, Hispanic, or Latino –– access birth control, cancer screenings, STI testing, and other essential reproductive health care.

The medical community, public health experts, and the general public are against this rule. In addition to the American Medical Association, the gag rule has been opposed by major medical associations, like the American College of Obstetricians and Gynecologists, the American College of Physicians, as well as 110 public health organizations, and public health experts such as former U.S. surgeon general Dr. Vivek H. Murthy, and many others. A group of 19 different medical organizations, mayors, state lawmakers, over 200 Members of Congress, newly elected Democratic governors, and several other governors have opposed this legislation as well.

More than 20 state attorneys general and numerous civil rights and health groups filed suit to stop the gag rule from going into effect when it was announced by the Department of Health and Human Services in March of this year. California, Oregon and Washington won preliminary injunctions from lower courts temporarily blocking the rule from going into effect. 

This week, the Ninth Circuit granted the request from the Trump-Pence administration to block the preliminary injunctions, which allows the gag rule to go into effect in all states besides Maryland. Judges on the 9th Circuit found the gag rules to be “reasonable” and said they were in line with current federal law that prohibits taxpayer funds from going to “programs where abortion is a method of family planning.”

Read the Ninth Circuit’s ruling here.

HOW WOULD THIS IMPACT LOUISIANA?

Louisiana consistently falls at the bottom of national rankings in health, education, income, and other metrics that influence the opportunity for residents to live long and healthy lives.^[1]

In Louisiana, 53,190 individual patients were cared for through the Title X program in 2015. Over seventy-five percent of those patients were at or below the federal poverty line (FPL), and ninety-five percent of patients were below 250% FPL.^[2]

In Louisiana, publicly funded reproductive health services lead to enormous cost savings by preventing reproductive cancers, STIs, and unintended pregnancies. In 2014, 58.2% of respondents to the Louisiana Pregnancy Risk Assessment System reported that their pregnancies were unplanned, reflecting a need for better access to effective birth control as well as continued outreach and education on the importance of preconception and interconception care.^[3] Reproductive health services funded by programs such as Title X help families plan the number and spacing of their children.

Louisiana’s provider shortage creates disparities in access by geographic location across the state. Federally Qualified Health Centers (FQHCs) help close gaps in provider shortages, but the scope and quality of services available vary greatly, and reproductive health-focused providers, like Title X clinics, have distinct advantages over FQHCs.

The Louisiana Department of Health Reproductive Health Needs Assessment found the following:

A 2014 study showed that while 99.8% of FQHCs provide one or more contraceptive methods, only 87% provide “typical” family planning, defined as STI testing and treatment; oral contraceptives; and one other contraceptive method. Only 51% of FQHCs provide “typical” family planning services plus one other contraceptive method, in addition to IUDs and/or hormonal implants.^[4] The Title X program’s focus on service quality, scope of practice, and confidentiality plus the skills and experience in the area of reproductive health meets an important need within the state.

In 2010, 26,500—or 78.7%--of unplanned births in Louisiana were publicly funded, compared with 68% nationally. That year, the state’s public spending for those unplanned pregnancies totaled an estimated $651 million, which was equivalent to $700 per woman aged 15–44 in Louisiana. Comparatively, public spending for unplanned pregnancies among women of the same group nationwide was much less, averaging $201.^[5]

In 2014, 321,480 Louisiana women aged 13–44 were in need of publicly funded family planning services.^[6] In 2010, public expenditures for Title X family planning client services in Louisiana totaled $3.2 million. These publicly funded family planning centers helped avert 12,000 unintended pregnancies in 2014, which would have resulted in 5,800 unplanned births and 4,300 abortions. By preventing unintended pregnancies and other negative reproductive health outcomes, publicly funded family planning services provided by safety-net health centers in Louisiana helped save the federal and state governments $128.6 million in 2010.^[7]

In Louisiana, over 40 percent of the population are people of color.^[8]

About one-third of Title X patients identify as people of color, and roughly one in 10 have limited English proficiency. This is why the proposed rule will disproportionately affect people of color who already face significant obstacles to accessing reproductive health care due to racism and other systemic barriers that have contributed to income inequality and health disparities.

As of 2015, 19.6% of Louisiana residents live in poverty, the third-highest proportion in the nation. Over 37% of the population in the state is considered “low income” (measured as living within 200% of the poverty line); higher than the national average.^[9]