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Reproductive health facilities looking to state for help

  • FILE - In this June 28, 2019 file photo, Ashlyn Myers of the Coalition for Life St. Louis, waves to a Planned Parenthood staff member in St. Louis, Mo. The Trump administration has told federally-funded family planning clinics it may be willing to delay enforcement of a controversial rule that bars them from referring women for abortions. (Robert Cohen/St. Louis Post-Dispatch via AP) Robert Cohen

  • Planned Parenthood supporters rally next to designated Executive Council parking spots outside the State House on Wednesday morning, June 29, 2016, ahead of an Executive Council vote on restoring family planning funding to the state's Planned Parenthood clinics. (ELIZABETH FRANTZ / Monitor staff) Elizabeth Frantz

  • Kat Dillon (right) leads a group of Planned Parenthood supporters in a rally next to designated Executive Council parking spots outside the State House on Wednesday morning, June 29, 2016, ahead of an Executive Council vote on restoring family planning funding to the state's Planned Parenthood clinics. (ELIZABETH FRANTZ / Monitor staff) Elizabeth Frantz

Monitor staff
Published: 8/20/2019 5:03:05 PM

For months, Planned Parenthood and other state reproductive health facilities had been hunkering down, preparing for the release of a Trump administration rule that would add new abortion restrictions to receive federal funds.

But it wasn’t until two weeks ago that the rule became iron clad. In a letter, the federal Health and Human Services department warned the organization of an upcoming obligation. They had to spell out an “assurance and action plan” – and they had until Aug. 19 to draw it up.

The hitch: Planned Parenthood, which provides abortion services as well as contraceptive and health care services, had no intention of complying. And many other organizations didn’t either, citing requirements they say are medically unethical.

The rule required complete physical separation of abortion services from areas that receive funding – and for recipients to agree not to refer pregnant patients to abortion services at all – described by critics as the “gag rule”.

“All Planned Parenthood affiliates abide by Planned Parenthood medical ethics and standards of care,” said Sabrina Dunlap, vice president of public policy for Planned Parenthood of Northern New England. “And so we all knew early on that the gag rule violated those.”

Now, as last-minute legal efforts to halt the ruling have come up short, the funding hammer has dropped. On Monday, the day of the deadline, the national Planned Parenthood organization announced it would withdraw from Title X completely – the program that since 1975 has helped family planning centers subsidize services for low-income people.

Some New Hampshire organizations say now that they’re entering an era of austerity, with emergency funds being tapped and services reduced. The crunch is affecting contraceptive services, cancer screenings and sexually transmitted disease testing and treatment, organization leaders say. 

Some 16,000 Granite Staters receive services at least partially funded through Title X; 11,000 of those come from Planned Parenthood, according to the organization. 

And with the federal door now closed, all eyes have turned to the state Legislature for help.

A Democratic proposal to make up for the federal funding with state dollars has been put on hold after Gov. Chris Sununu vetoed the budget in June. But as the weeks of budget negotiations drag on, some are advocating for a faster approach: emergency funds.

In an interview, Democratic Sen. Tom Sherman argued that Sununu should direct the Department of Health and Human Services to seek an emergency waiver to the continuing resolution – the temporary funding measure in place while the budget is negotiating – to free funds for family planning centers.

Doing so would require going through the state fiscal committee, which has already allowed emergency spending for other services deemed critical, including for people with developmental disabilities, state parks, and paving.

“When politics results in the denial of care, people are physically hurt by the political decisions of their elected officials,” Sherman said. “And that’s exactly the result of this.”

The governor, meanwhile, has indicated he would accept the backup funds – about $3.2 million – in the budget, as long as other conditions are met.

“The only thing standing in the way of this supplemental funding and delivering a fiscally responsible budget are the legislators in Concord who have insisted on raising taxes,” he said in a statement.

Emergency funding measures

For Planned Parenthood and other family planning organizations in the state, the financial crunch was felt long before Monday’s compliance deadline. Most providers have declined Title X funding since May, when the rule first took effect.

The self-imposed cutoff has affected those facilities in different ways. The cutoff is having an impact on Planned Parenthood of Northern New England, 25% of whose operating budget was once comprised of federal funding. But it’s one they say they have been able to manage so far.

The three-state organization – which also covers Maine and Vermont –  is losing about $1700 a day, but is able to so far tap into emergency funding to keep its services running, according to Dunlap.

As for how long it might be able to continue before making cutbacks, Dunlap says she’s unsure. “Our plan is to do this as long as possible,” she said.

Dalia Vidunas, executive director of Equality Health Center in Concord, faces a different calculus. Her budget impact is only 11%, but for an independent, single-facility clinic like Equality Health Center, there is far less padding to even it out, Vidunas said. 

The organization has prepared with staffing cuts and a partial withdrawal of certain discounts – and is contemplating more, Vidunas said.

“It’s a huge effect for us,” she said. “Huge.”

To Vidunas and Dunlap, the cuts are counterintuitive to public health goals.

Critics of abortion-providing family planning services have said that while federal and state laws prohibit the use of public dollars to go toward abortions, the funds still benefit those services indirectly. And they argue that to continue accessing the funds, the providers should simply comply with the rules. 

But complying is not an option, Vidunas and Dunlap argued. Restructuring physical facilities to separate abortion functions and create entirely separate staff for them is largely unfeasible, Dunlap said. 

“I think as a technical, literal matter, anyone in the Title X program could conceive of doing that, but it’s impossible,” she said. “It’s a total unnecessary burden on providers. And I think financially it’s impossible.”

And declining to tell patients about options for abortion is against the facilities’ moral beliefs, Vidunas said in a separate interview. 

“When someone has an unintended pregnancy and go to a Title X provider, the only thing that provider is allowed to talk about is continuing the pregnancy, and either to parent or put it up for adoption,” Vidunas said. “That to me is the same as giving someone a cancer diagnosis, and saying you have options of radiation and surgery and someone asks do you have chemotherapy and saying ‘I’m sorry I can’t talk about that.

“You’re not getting the full information, and when you’re not getting the full information, we believe that’s lying.”

State funds unaffected

Though the new federal rules apply to money available under the Title X program, they do not have an impact on state-appropriated dollars. 

Funds typically approved by the Legislature and the Executive Council can still go to organizations, according to the state Department of Health and Human Services. 

In the Fiscal Year 2019, state dollars accounted for about 45% of taxpayer money heading to family planning facilities, or $572,000 total, according to Lisa Morris, director of the Division of Public Health Services at the Department of Health and Human Services.

The rest – $686,000 – came from Title X, Morris said. Those organizations that are leaving Title X will still receive the state money – about half of the assistance they usually enjoy.

But not all of the ten organizations are leaving Title X, according to Morris.

Some have chosen to continue accepting the funding and attempt to get into compliance with the new rules, she said.

Morris declined to disclose which facilities fell into that category, citing the fact that the Department is currently amending contracts for all family service providers and can’t divulge details. 

As for the leftover federal Title X money that the state won’t be distributing to the departing organizations? The Department will be issuing a call for new providers soon – ones that could be in compliance with the rules, Morris said. 

In the meantime, state officials stressed that the Department of Health and Human Services would continue to attempt to support the work of the reproductive health facilities in other ways, whether via state funding, STD awareness and data collection, or collaboration with physicians and providers.

Beth Daly, chief of the Bureau of Infectious Disease Control, said that the outreach and awareness around STD treatment – in addition to direct funding of for services in Manchester and Nashua – would continue regardless of the hardships facing other facilities. 

“Even though we have not had funding to fund the public testing clinics, we have mounted a rather large response at the health department,” she said. 

Uncertain legal options

Monday’s decision to withdraw from the Title X program completely came after Planned Parenthood’s efforts to put a halt to the rule through court injunction have run out.

A lawsuit by the organization is currently before an 11-judge panel in the Ninth Circuit Court of Appeals in San Francisco. And despite the formal withdrawal, oral arguments are set for late September, with a decision to come in following months, according to Derek Edry, a spokesman for Planned Parenthood of Northern New England. 

“All of the attempts at getting the injunction back in place are now exhausted,” Dunlap said. “...It will be litigated fully in the Ninth Circuit.”

Still, given the wide latitude afforded to federal departments in setting rules, some opponents of the rule aren’t holding their breath. 

(Ethan DeWitt can be reached at, at (603) 369-3307, or on Twitter at @edewittNH.)

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