Cutbacks hit family planning clinics that lost federal dollars over Trump abortion rules

By ALICE MIRANDA OLLSTEIN and RACHEL ROUBEIN09/01/2019 06:53 AM EDTSome health clinics that quit the federal family planning program over Trump anti-abortion policies are cutting staff, charging for services that had been free and making other austerity moves to avert a major hollowing out of reproductive health care for poor women.At least four state health departments, hundreds of Planned Parenthood clinics and dozens of independent providers have withdrawn from the more than $250 million Title X program. Trying to preserve as much patient access as they can, clinics are imposing new fees, trimming sex education and suspending some sexually transmitted disease testing even as the Trump White House makes eradicating HIV a national priority.“We're watching the safety net disintegrate right before our eyes,” said Jessica Marcella, the vice president of advocacy and communications at the National Family Planning and Reproductive Health Association, which represents staff at thousands of Title X clinics across all 50 states.The clinics in August quit the Title X program, which dates back to the Richard Nixon presidency, when the Trump administration added restrictions that include forbidding clinics from referring patients for abortions. 18., and must have separate physical facilities for abortion services in place by next March.But some grantees say they’re not entirely clear what HHS will consider as full compliance.“I would not be shocked if they responded and said, ‘Perfect!’ and I wouldn’t be surprised if they said, ‘This is no good,” said Marj Plumb, the acting executive director of the Family Planning Council of Nebraska, the state’s sole manager of Title X funds.Other clinics and groups managing family planning dollars, such as Wisconsin’s Department of Health Services and Unity Health Care in Washington, D.C., submitted plans to the department but are still assessing whether they can comply with the new policy.San Francisco’s Women’s Community Clinic is also seeking more details and has said it's ready to give up $150,000 in annual Title X funding if it feels its principles are being compromised.“If it’s a gag rule, we’ll pull out,” CEO Vitka Eisen of the clinic’s parent group HealthRIGHT 360 said.HHS officials have said they could find new providers to replace Planned Parenthood and other exiting groups “where possible.” But the department has declined to comment or respond to multiple questions about its search and how long that process might take.Jonathan Imbody, vice president for government relations at the Christian Medical Association, which represents Christian health professionals, told POLITICO that he’s confident there won’t be gaps in care, even though Planned Parenthood and the other exiting providers served more than 1.5 million women in Title X.“They won't be missed,” he said. Planned Parenthood was the only respondent each time Vermont’s health department applied for Title X funding and put out a request for proposals, according to a department spokesperson.The Guttmacher Institute, a research organization that supports abortion rights, projects that remaining Title X clinics would have to see an average of 70 percent more patients seeking birth control to make up for Planned Parenthood’s exit — a burden Guttmacher notes poses “massive challenges” for many providers.Organizations like the National Family Planning and Reproductive Health Association contend there's a finite pool of providers willing to be part of Title X and its sometimes burdensome bureaucratic requirements, and that most were already part of the program.