The Republican-led House this week overturned a regulation then-President Barack Obama put in place to protect Title X funding, prompting criticism from Democrats and others over the move's impact on women's health care.
The House on Thursday scrapped a rule that barred state and local governments from withholding federal funds from family planning providers that offered full reproductive services, including abortion.
“With this bill, Republicans are demonstrating that they will stop at nothing to limit women’s access to health care,” a spokeswoman for House Minority Leader Nancy Pelosi told NBC.
The Republican-sponsored H.J. Res. 43 passed in a 230-188 vote, largely along party lines.
Obama had finalized the regulation on Jan. 18 — two days before leaving office — in an attempt to enforce pre-existing Title X laws after states had tried to circumnavigate them during his presidency. Implemented under Richard Nixon, Title X provides federal funding to the United States’ most qualified family planning providers.
Federal funds are not used to perform abortions, and Title X is a reimbursement program, requiring beneficiaries to report how they use grants.
When Rep. Diane Black defended her resolution on the House floor, she said, “while I am unapologetically pro-life, you don’t have to be in order to support this resolution.” She cited the 10th Amendment and claimed that Obama had violated states’ rights.
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“Despite the histrionics you may hear on the other side of the aisle today, with this resolution we are not voting to defund Planned Parenthood, voting to cut Title X funding, or voting to restrict abortion rights,” Black continued.
But for many, H.J. Res. 43 was a move toward an abortion-less America.
“We are very pleased with the House vote today on H.J. Res. 43,” Carol Tobias, President of National Right to Life, told NBC. “This 11th-hour rule, promulgated by the Obama administration, was a last-minute gift to Planned Parenthood, the nation's largest abortion provider.”
Of the four million Americans who benefit from the Title X program, 1.5 million are patients at Planned Parenthood. According to Monica McLemore, assistant professor at University of California-San Francisco, the House measure was “a thinly veiled campaign to start to defund Planned Parenthood."
For Rep. Julia Brownley from California’s 26th congressional district, “it was a very easy choice” to vote “no.”
“The resolution is obviously deeply disturbing and morally corrupt,” Brownley told NBC.
She said that even before she took office in 2013, conservatives had targeted “health benefits for women, and particularly women who need it the most.”
According to a Department of Health and Human Services annual report, at least 30 percent of Americans who benefited from Title X services identified as nonwhite, and 32 percent said they were Hispanic or Latino in 2015. Two-thirds had a family income below the poverty level.
There’s also a “geography issue” when it comes to women’s health care, according to McLemore. As a certified nurse, she travels around California. In rural areas, she said, patients sometimes have to drive for an hour or two to find a clinic.
According to the Guttmacher Institute, a center for reproductive health research, 39 percent of American women ages 15-44 lived in counties without abortion clinics in 2014. That doesn't necessarily mean that residents in those areas didn’t have access to reproductive care, but it might limit their contraceptive options.
A 2017 report from Guttmacher found that Planned Parenthood locations are far more likely than health departments or federally qualified health centers to provide same-day IUD insertions, which are more effective than other forms of birth control. For those in need of pill packs, 83 percent of Planned Parenthood clinics offer on-site distribution, compared to 34 percent of federally qualified health centers.
“Cutting out a provider that sees nearly a third of patients in the Title X program will mean that more women will go without services, have to pay out of pocket for care, or travel farther for services,” said Audrey Sandusky, director of advocacy and communications at the National Family Planning and Reproductive Health Association. “You can’t simply shift providers overnight.”
The New England Journal of Medicine published a study detailing how since 2011, anti-abortion initiatives in Texas have resulted in a 27 percent increase in childbirth among women who had previously taken injectable contraception through publicly funded programs. The state itself has reported that there was over a 25 percent decrease in clients from the Texas Women’s Health Program between 2011 and 2013.
"For many people, not being able to get care at their trusted health care provider means that they don’t get care at all,” Danielle Wells, a spokesperson for Planned Parenthood, told NBC. “Those hurt the most would be people who already face barriers to accessing health care — especially people of color, those who live in rural areas, and people with low incomes.”
Attempts to defund Planned Parenthood don’t only affect reproductive health. The clinic is known for its wide-ranging care, including treatment for STIs and breast and cervical cancer screenings. Title X funding doesn’t exclusively benefit women, either: in 2015, one out of 10 patients were male. Planned Parenthood serves both genders.
Proponents of H.J. Res. 43 believe other health service providers are poised to take Planned Parenthood’s place if it loses its Title X grants.
“It’s not about defunding women’s health care or trying to take away access to people getting the care that they need,” said Melanie Israel, research associate at the The Heritage Foundation’s DeVos Center for Religion and Civil Society.
Israel said that for every Planned Parenthood facility, there are 20 other federal community health centers that could provide services for women. She pulled this tally from analysis by anti-abortion organizations Charlotte Lozier Institute and the Alliance Defending Freedom; House Speaker Paul Ryan cited the same number at a CNN town hall in January.
“That’s just a false statistic,” Brownley said.
As the Washington Post reported, the ratio may indeed be misleading. A little over 4,000 of the 13,000 facilities included in the study are part of the Rural Health Clinic program, which does not require its providers to accept low-income clients. This means that some of the centers could turn away the most vulnerable demographics represented under Title X.
The Congressional Budget Office found that at least in the short-term, 5- to 25 percent of Planned Parenthood patients would have reduced health care access if the reproductive health organization were defunded. Experts said they don’t know of any existing medical resources that could fill Planned Parenthood’s shoes.
“There is no health care service provider that currently exists that could absorb the volume of patients across the country that Planned Parenthood sees,” McLemore said.
“If services are lost in a community, there is a significant lag in terms of another service provider or another health care system being able to adjust,” she added. “We’re not that nimble.”
In January, the House passed H.R. 7, another attempt to prohibit abortions by dissuading insurance companies from covering the procedure. Both H.R. 7 and H.J. Res 43 will be kicked to the Senate, where a Republican majority will decide their fate.
