Today, Explained - The Title X factor

Episode Date: March 7, 2019

The Trump administration got a lot closer to defunding Planned Parenthood this week — 21 states are fighting back with a sweeping new lawsuit. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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I've been a health care reporter here in D.C. for about a decade, and for that entire time, Republicans have been on this mission to defund Planned Parenthood. Defund Planned Parenthood. Stop the killing. Stop hurting women. It's about dignity of life. And we would like to see Planned Parenthood defunded immediately and prosecuted for the barbaric crimes committed inside of there. This week, the Trump administration got a lot closer to mission accomplished. So close that 21 states are now taking Trump to court. We are filing suit against the Trump administration for this unlawful, harmful rule.

The rule tells health clinics that if they want to keep all of their public funding, they are going to have to change two big things. One, they're going to have to keep their abortion sides and their non-abortion sides completely physically and financially separate. They might have to have a separate entrance for the abortion patients or have separate examination rooms. Two, they can't even refer patients for abortions. So if I come in for birth control and it turns out that I'm already pregnant, I wouldn't be able to be directly referred to an abortion provider,

even if I'm in a clinic that is also an abortion provider. Olga Kazan is a staff writer at The Atlantic. Planned Parenthood in particular has really come out strongly saying that this is kind of anathema to medical ethics. So, Olga, this whole debate, it really comes down to this specific type of public funding called Title X. Yeah, this is a program that was established in 1970, and it essentially just provides affordable birth control and reproductive health care to people mostly with low incomes and a lot of uninsured people as well who otherwise couldn't afford these services on their own. And it's especially important for things like IUDs, which are really expensive if you pay for them without health insurance. And does Title X currently fund abortions? No. So it's important to note that no Title X money actually goes to abortions.

It provides non-abortion health services, birth control, mostly to poor and uninsured women on like a sliding scale. And it also pays for things like outreach and education. There's been a couple of studies showing that Title X clinics are really kind of like specialists in birth control, and they provide kind of the widest range of different birth control methods. And they also tend to be able to see patients faster for getting things like IUDs. So it's this really crucial resource for people who don't have insurance, who have really low incomes, and who are looking for these really good forms of birth control. So if Title X isn't funding abortion, it's funding

birth control, other sort of services, why is the Trump administration even making a change to, you know, who these funds are and aren't available to? The pro-life community is really concerned that any federal money is going toward any entities that provide abortions, even if those funds are kept separate. Abortion is not family planning, it's family destruction. And so we want there to be a clear, defined line, both physically and financially, between a Title X facility that is to do family planning and one that is doing family destruction in abortion. They still believe that there's too much of a commingling of those funds and that it somehow helps keep these Planned Parenthoods afloat. It can pay for rent, utilities, staff salaries, and computers. It can also fund

advertising to recruit clients. So when abortion businesses like Planned Parenthood use Title X dollars to build their client base, they're also building their potential abortion business. The way Steve Aiden, who's the chief legal officer at Americans United for Life, put it to me, anytime abortion is advocated as a means of family planning, that's tax money going to the promotion of elective abortion. And this rule kind of opens a door to more faith-based clinics. Some call them crisis pregnancy centers might be able to see some Title X patients because they're no longer required to refer anyone to an abortion. So it kind of opens a door for these clinics that the pro-life community sees as kind of a better option for pregnant women to

be able to see Title X patients. Do you have a sense of how many providers might have to exit the program or would be impacted in some way if this rule change goes through? Yeah, from reading the rule, it looks like about 15 to 20 percent of Title X providers would potentially be impacted. That's just sort of an early estimate of like, here are all the people who might have to change the way their clinics look in order to meet these new guidelines. But of course, that could vary kind of after they start to take a closer look at the clinics and after we find out more about, you know, could you put up a curtain? Could you, you know, what exactly is a physical separation? So it could be like a curtain or a wall to create a physical separation,

but they might even have to make the abortion and non-abortion sites even more separate. Do you have a sense of how much it would cost to do that? Yeah, in the rule, it estimates that it would cost about $20,000 to $40,000 for each of the providers to come into compliance with the physical separation requirement only. But then, of course, there's also like a financial separation. So you might have to have like separate health records and things that might cost additional money. How do you think about what the impact would be on women's access to reproductive health if you have this new rule come into effect? It's going to have major impacts for women.

Women might have to go to like a health department or just a different provider that still takes Title X. So you might have things like wait times go up, harder to get an appointment. But this is already happening at a time when it's kind of hard to make ends meet as an independent clinic that does reproductive health care, whether you do abortions or not. Unplanned pregnancies are going down because more women are getting IUDs. And IUDs are kind of this set-it-and-forget-it device where you get one and then it lasts for several years. You don't have to see a doctor and you don't have to come in for birth control refills. In that way, it's great for patients. I mean, you have people out there who are healthier or having fewer unintended pregnancies or having fewer abortions, in fact, but that does change the business model for these family planning clinics because those are the services that they provide. Their services are

less in demand and they're having to think about, you know, how are we going to make up this shortfall of patient visits? And for some clinics, it's fine because even if they don't take Title 10, they might have enough privately insured patients who come in for things like abortions. Abortion is a very expensive medical procedure. It costs something like $600. You know, if you have a few patients who pay for that, that's going to be fine. But if you're doing a good job as a family planning clinic, you're not doing a lot of abortions because you're inserting a lot of IUDs. You know, women aren't getting pregnant. So it does make it more complicated for them. And this is sort of just another complication to add to that mix.

You know, there's this argument I've heard a lot from people who support cutting abortion clinics out of Title X, where they'll say, you know, other providers like the crisis pregnancy centers that you mentioned can come in. They can fill the gaps that it won't be a problem for women to have access to health care. We have 9000 community health centers that do everything that Planned Parenthood does, but they don't get into abortion. So it'd be much less emotional for everyone if we just funded community health centers and didn't fund Planned Parenthood does, but they don't get into abortion. So it'd be much less emotional for everyone if we just funded community health centers and didn't fund Planned Parenthood. Do you think these centers would come in and close the gaps? I mean, potentially, but honestly, in the past when states have cut family planning funding and have put all sorts of restrictions on Planned Parenthood. Unfortunately, what we do see is usually some clinics closing and unintended pregnancies going up and women getting less health care.

That happened in Texas a few years ago. Pulling out this option for women is going to have ramifications. In which women is this? Are we talking about high income, low income? Like who are the women being affected by this? The women who are mostly affected by Title X are going to be poor, uninsured, and actually predominantly women of color. It's actually an important resource for teenagers who want birth control and IUDs. If they don't want to tell their parents about it, there's certain programs that will allow you to come in as a Title X patient.

Do you have a sense right now of if this lawsuit has a good chance of being successful? I know this rule is supposed to come into effect in about two months, and I'm curious if clinics are girding for that or expecting some kind of relief. I think they're kind of in a scramble right now amid the lawsuits and figuring out the rule. What does it mean? It's going to differ depending on the clinic. Each clinic is going to have to do something different in order to comply with it. And maybe in some cases they could just move all their abortion services, say, down the street to the other Planned Parenthood. And that would be a physical separation.

You know, but in some cases there's not another Planned Parenthood down the street. So I think it kind of it's really case by case as far as what the individual clinics are doing. I think that this lawsuit will have to prove that it will have a major impact on women. And also, I think this might violate a provision of the Affordable Care Act, and that might also come into play as this goes through the courts. I think those are going to be some major points that the lawyers are going to so how would this rule actually affect the day-to-day at health clinics after the break i sit down with the president of planned parenthood Sean, your mom's around, right? I've heard her on the podcast. Yeah, she's here.

I'm in her home, actually. Does she want to talk to me about toothbrushes? Mom, you want to talk to Sarah Cliff? Okay. She's famous. Okay, hold on. Your mom's famous on the podcast. Hi, Sarah.

Hi, how are you? Okay, doing good. Is it nice to have Sean home? Yes, of course, always. Well, we miss him here, but I am calling with a message about toothbrushes. Have you heard about the Quip electric toothbrush? Almost every day. Sean advertises it. Well, I will tell you a few things. I'm filling in. I'm doing his ads. And I can tell you that the Quip has sensitive sonic vibrations. It is gentle on your sensitive gums and has a built-in two-minute timer that pulses every 30 seconds to remind you when to switch sides. Is Sean very good at brushing his teeth?

That seems like something a mom would know. He's very good at it. If he needs a new toothbrush, you can send him to getquip.com slash explained. The quips start at $25. And right now you get your first refill pack for free with a Quip electric toothbrush backed by over 20,000 dental professionals. If you think your son might need a new toothbrush, you can send them to getquip.com slash explained. Dr. Lena Nguyen, you are the president of Planned Parenthood. You just started a few months ago. I know that you're in the middle of this tour of different Planned Parenthood clinics and was hoping you could tell us a bit about where you've been going and what you are seeing on your visits. We have over 600 health

centers all around the country. And I just came back from visiting some of our health centers, and I'm so struck by the differences. In California, our health centers, because of the laws there, we provide the full spectrum of health care, including mental health needs. Somebody comes in for birth control, they may also get their blood pressure checked, their diabetes checked. And then I went to visit Texas. Because of the restrictive laws there, Planned Parenthood in Texas is not allowed to participate in programs that provide breast and cervical cancer screening, public health programs that fund for cancer screenings, that fund for HIV testing and treatment.

Because of the restrictive laws there, half of the health centers in Texas have closed. And it's no wonder that Texas has one of the highest rates of teen pregnancies, one of the highest rates of chlamydia and other STIs. This is what happens when it's a failure of public health and when we don't see reproductive health care as what it is, which is health care. So tell me a little bit about Planned Parenthood's relationship to Title X. How many patients do you see through that program? What role does it play for you all as a source of funding? There are 4 million people who are served through Title X, and that allows people with low incomes who live in rural areas who are uninsured or underinsured to receive STI screenings, cancer screenings, birth control,

and primary and preventive care. And for so many patients served through Title X, we are their only source of health care. We are extremely concerned about the Title X gag rule that the Trump administration issued, and we know what will happen. What will happen is that if you are white and wealthy, you will find a way to receive abortion care. But if you are a person of color, if you're a person with low income, if you're a person who already faces a disproportionate barrier when it comes to health care, that's something that will affect you the most. The majority of people served under Title 10 are people of color, Hispanic or Latino. And these are people who already bear the brunt of health disparities and inequities. And these are the people who will suffer the most if the safety net program is dismantled.

So if this rule goes forward, if the court challenge is not successful, would Planned Parenthood be able to accept the restricted Title X funds? No. For us, it is not a choice. It is not an option. It's our promise to our patients that if you come in to our health centers, we will provide you with honest, full, comprehensive medical information. It's my duty as the doctor to see my patient for the whole person that they are, meet them where they are with their needs, and provide honest and accurate information to allow them, to allow my patient to make the best decision for himself, herself, themselves. And so it would force us to compromise

our ethics, and we as Planned Parenthood would never do that to our doctors, our nurses, and clinicians. It's not an option for us to accept gagged funds. We're talking about safety net systems being dismantled, and it's not just Planned Parenthood. Multiple states, their governors have already said that they will not accept gagged funds. There is a possible world in theory where you could almost split Planned Parenthood

into one half that doesn't accept Title X funds, continues to operate as normal, another half that accepts Title X, is able continues to operate as normal. Another half that, you know, accepts Title X is able to use that money to provide birth control and maybe provides more access to care. It seems like almost a bit of a tension there that if you accepted the restricted funds, you could be providing more birth control. How do you think about, you know, trying to finagle a way to comply with the new rules? We know in medicine that the full range of reproductive health care includes safe legal abortion care. We cannot provide care.

As the nation's leading provider of sexual reproductive health care, we cannot provide care that's anything but the high standard of health care. And for any of your listeners who think that, oh, if only we stopped performing abortions, the attacks on women's health will stop, just think about what is happening under this current Trump administration. We're seeing attacks redefining of what sex ed should include, that now it includes quote-unquote natural family planning and not condoms and hormonal methods. Where let's look at what Trump did less than 24 hours after the midterms, which was to finalize a rule that would allow employers to deny women birth control coverage. Already, abortion care is so stigmatized. We as Planned Parenthood will not stigmatize it further. We will certainly never stigmatize and shame our patients. Dr. Alina Nguyen is the president of Planned Parenthood. I'm Sarah Cliff, filling in for Sean Ramos-Verm while he is on vacation this week.

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