Biden administration begins to undo Trump changes to family planning program

The Biden administration on Wednesday took the first steps to undo Trump-era restrictions on the Title X federally funded family planning program, which effectively prevented clinics that referred patients for abortions from receiving federal funding.

A proposed rule from the Department of Health and Human Services (HHS) published Wednesday would eventually revoke the restrictions put in place by the Trump administration, which critics called a domestic “gag” rule.

However, the proposal did not immediately revoke the prior policy, and the Trump rules will remain in place until the current administration formally ends them through a final rule, which could take months.

A 30-day public comment period begins April 15, when the proposal is formally published.

The proposed rule would largely revert the Title X program to the way it was run from 2000 until the Trump administration changed the rules in 2019. 

“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 OPA [the HHS Office of Population Affairs] and the Title X program,” HHS wrote in the proposal.

“By focusing on advancing equity in the Title X program, we can create opportunities for the improvement of communities that have been historically underserved, which benefits everyone,” the agency wrote.

Title X funds thousands of providers across the country offering contraception, cancer screenings and other services to millions of low-income women and men. 

Advocates argue Title X disproportionately serves Black, Latino and Indigenous patients, as well as patients with low incomes and those who live in rural areas.

The Trump administration issued rules in 2019 banning any providers that receive Title X funds from referring people for abortions while mandating referrals to prenatal services for all pregnant patients. 

After the rules took effect, about one-quarter of nearly 4,000 providers left the program, arguing they could not in good conscience agree not to provide patients with information about abortion. As a result, several states were left with no Title X providers.

California, the single-largest Title X project in the nation before the 2019 rules, had 36 percent of its Title X service sites withdraw from the program, leaving more than 700,000 patients without access to Title X-funded care, HHS said.

Overall, the rules resulted in about 844,000 fewer people getting care from Title X in 2019.

“As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings” for sexually transmitted infections, HHS said in the proposal.

Planned Parenthood left the program rather than abide by the Trump administration’s rules. Prior to its exodus, Planned Parenthood served about 40 percent of Title X patients. 

While federal family planning funds cannot be used to pay for abortions, conservatives have long tried to “defund” Planned Parenthood and saw the Title X program as the best way to do so. They argued that any money flowing to abortion providers would indirectly support the procedure. 

The program provides $286 million in grants to family planning clinics for a range of services, including infertility treatments, contraceptive education and counseling, breast and cervical cancer screening, as well as sexually transmitted infections and HIV testing.

“Given the previous success of the program, the large negative public health consequences of maintaining the 2019 rules, the substantial compliance costs for grantees, and the lack of tangible benefits, the Department proposes revoking the 2019 Title X regulations,” HHS wrote.