Abortion clinics brace for funding cuts as federal lawsuit looms

Monitor staff
Published: 3/4/2019 5:21:00 PM

For abortion care clinics, it’s been a setback in slow-motion. Nine months after the Trump administration proposed an administrative rule that could strip funding from abortion clinics, the rule is on the cusp of taking effect.

Late last month, U.S. Health and Human Services officials formalized the “domestic gag order,” imposing new restrictions on reproductive health centers that could affect their federal funding allotment.

On Monday, 21 states announced they would be filing a federal lawsuit Tuesday in Oregon, arguing the rule imposes “an unlawful and unethical restriction on health care professionals.”

But facilities in New Hampshire are still bracing for sweeping reductions.

Planned Parenthood’s New Hampshire clinics expect to see a quarter of their collective budget vanish if the rule moves ahead: $1.6 million over two years, according to Sabrina Dunlap, vice president of public policy at Planned Parenthood of Northern New England. And independent clinics say the funding cuts will draw away from nonabortion related care such as contraceptives and STD treatment.

Under the new rule, any clinic receiving “Title X” funding would be prohibited from referring any patients to an abortion provider – or suggesting abortion as an option for those pregnant and weighing their choices.

Those clinics that do provide abortions would be required to physically and financially separate abortion services from other health care at the facility.

The 312-page rule – which includes other changes to reproductive and contraceptive health care – is meant to strengthen existing prohibitions against using any Title X funding for abortion services, federal officials have argued.

Since 1976, U.S. abortions have been governed by the “Hyde amendment,” which strictly prevents federal funds from being used for abortion, except in cases of incest or rape.

Anti-abortion activists and U.S. Health and Human Services officials, however, argue that even if that firewall exists in name, the federal money still sustains the same clinics and employees. The rule change would require reproductive health clinics to build entirely separate facilities for abortion care with separate staff and financial processes, in order to completely distinguish public and private funding sources.

Providers counter that the rules are constructed to make it impossible for most abortion care providers to remain eligible for the funding.

“(The rule) specifically states that a provider cannot talk to a patient about all of their options when they’re pregnant,” said Dalia Vidunas, executive director of Equality Health Center, a clinic that provides health services and abortion care in Concord.

“That’s basically lying to them. This is the government telling people who are licensed to practice medicine ... how to practice medicine.”

According to Vidunas, the Title X money amounts to less than a tenth of the Concord facility’s budget. But she said the impact would still be felt.

Presently that money allows for numerous services to be priced down for low-income families – a “sliding scale fee” for those slightly above the income level for Medicaid or Medicaid expansion.

For example, Equality Health Center can provide intrauterine devices (IUDs) – which provide long-term reversible contraception – for around $300 for low-income patients when the facility uses Title X money, Vidunas said. That’s a fraction of the near-$1,000 that the same device might cost in out-of-pocket costs at other facilities.

The Center also uses Title X money to bring down the prices of sexually transmitted infection testing, offering tests for chlamydia, syphilis, gonorrhea and HIV for one package price of $95. To pay for those tests without insurance elsewhere could cost around $300, Vidunas said.

Losing the federal funds will likely mean those low prices can’t be sustained, she added.

“I think medical providers need to let politicians know that they need to keep their noses out of an area that is not where they got their schooling and where they really know about,” Vidunas said. “It should not be up to politicians to decide how health care is handled.”

Providers have also bristled at the prospect of withholding information or referrals on abortions from patients in order to adhere to the rule. Both Planned Parenthood and Equality Health Center have said they have no intentions of making the changes called for in the rule to accommodate it.

“Despite the challenges of this unnecessary and dangerous gag rule, (Planned Parenthood) will continue to provide high quality, affordable care to low-income women, men, and young people in New Hampshire, and our doors will remain open,” Dunlap said in a statement. For now, any potential effects of the rule are a ways off. The rule entered the federal register on Monda y; barring a legal injunction, it will take effect in 60 days.

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