Following through on a promise made last month, HHS on Thursday formally moved to rescind the Trump administration’s “gag rule” that bars clinicians who receive Title X funding from discussing, offering, or referring patients for abortions.
Under President Trump, HHS had instituted the rule in February 2019, requiring “clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning.” That erected a big hurdle for many family planning organizations, including the nation’s largest, Planned Parenthood, which chose not to accept Title X funds for any of its programs.
On Thursday, HHS began the legal process to roll back the rule, which is likely to take months.
In a statement, HHS said the Trump administration “rules have undermined the public health of the population the program is meant to serve.” The Federal Register notice announcing the proposed revision said the number of grantees has dropped “precipitously,” while access has also declined, “thereby contributing to the increase in health inequities and unmet health needs within these populations.” The final 2019 rule may have led to more than 180,000 unintended pregnancies, HHS estimated.
The new regulations for Title X, enacted originally in 1970, would require family planning services “to be client-centered, culturally and linguistically appropriate, inclusive, [and] trauma-informed.” Sites that lack a broad range of on-site services and methods would have to provide referrals, presumably to include abortion counseling and procedures.
Federal law still bars federal funds from being used to pay for abortions and that will not change under the proposed rule. Rather, organizations providing abortions would now be allowed to use Title X funds for other programs without having to maintain separate facilities, staff, and financial accounting — as they were prior to 2019.
The proposed rule would also allow nurse practitioners, physician assistants, and “other healthcare providers” besides physicians to see patients for family planning. The reforms seek as well “to include primary healthcare providers in the list of referrals and to state that referrals are to be to providers in close proximity when feasible to the Title X site.”
Overall, HHS is striving to make family planning services more accessible — especially for low-income Americans, per law. Title X “is the only federal grant program dedicated to providing individuals with comprehensive family planning and related preventive health services,” the department said. It “has played a critical role in ensuring access to family planning and preventive health services including breast and cervical cancer screening and STI/HIV testing.”
“Advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality, is a priority for the Department,” HHS said.
The 2019 changes were controversial, leading 23 states, major medical associations, and grantees to sue HHS, according to the rule document. Cases reached the U.S. Supreme Court before being dismissed in March.
HHS also said the rule contradicted guidelines from both the CDC and the department’s Office of Population Affairs, and “increased compliance and oversight costs, with no discernible benefit.”
The American Medical Association “strongly applauds the Biden administration’s proposal to reverse the Title X ‘gag rule’ — a rule that has inappropriately interfered with the patient-physician relationship and jeopardized safe access to reproductive care,” according to president Susan R. Bailey, MD, in a statement.
“We are pleased to see the Biden administration move to restore the Title X program, which for decades has ensured access to affordable reproductive health care to patients who would otherwise go without,” said Georgeanne Usova, senior legislative counsel at the American Civil Liberties Union, in a statement: “The Trump policy gutted this critical safety net program, devastating access to care for people with low incomes and disproportionately harming people of color.”
Planned Parenthood, as expected, also welcomed the move, saying in a statement that it hopes “to swiftly end this discriminatory policy and to create a pathway for health care providers that were forced out by the gag rule to re-enter the program, so that patients can once again obtain health care through Title X from trusted community providers.”
The public has 30 days from Thursday to submit comments on the proposed changes.