Planned Parenthood Rally,” Photo by Jessica Nolte

March 29, 2019; Politico

The state of Utah may come to represent the Title X family planning conundrum that’s now front and center in many of the Republican-leaning states that have vowed to pull all funding from Planned Parenthood. Since no federal dollars can be used to support abortion services, these rules changes would also ban the use of federal funds (particularly Title X) for clinics that provide abortion referrals. Planned Parenthood has made it clear that they will leave a state rather than abide by these rules and jeopardize the integrity of their work and that of their medical staff.

For a state like Utah, this is particularly difficult, where there is $2 million in Title X monies at stake and few options if Planned Parenthood pulls up stakes.

“We’re the only game in town,” said Planned Parenthood Association of Utah President and CEO Karrie Galloway. “We’re a unique and challenging state, and people don’t have a lot of options for comprehensive, non-judgmental reproductive health care.”

The situation in Utah is particularly acute. Planned Parenthood has been the state’s only Title X grantee since the early 1980s, and currently serves about 37,000 low-income patients who depend on its clinics to get free and subsidized birth control, testing for sexually transmitted infections, and other reproductive care. Low-income women in Utah rely even more heavily on Title X because the state has not yet implemented the Medicaid expansion that voters approved in November and that state Republicans are working to curtail.

Planned Parenthood’s Utah affiliate says it will keep clinics open even if it drops out of the program, but that the loss of Title X dollars would reduce the availability of free and subsidized health services in the state.

Utah’s health department would have seemed to be a logical successor; state agencies in about three dozen states are in charge of distributing Title X funds to community health centers, school-based organizations, Planned Parenthood affiliates, and other providers.

But Utah’s health department has long been ineligible for Title X money because of a state law requiring unmarried minors to get parental consent before obtaining any family planning services—a policy that clashes with the program’s federal mandate to provide confidential reproductive care to people of all ages.

But Utah is not alone. Planned Parenthood serves an estimated 40 percent of the more than four million patients nationwide who receive care under Title X and that includes more than half of those in states like Utah, Ohio, and Wisconsin. A new round of Title X grants is set to be awarded in the coming week and the new rules are to go into effect on May 3rd, 2019. While lawsuits have been filed to stop what Planned Parenthood and others in the pro-choice community call a “gag rule” on patient referral by its providers, no one knows how quickly the courts will act or how they will rule.

Missouri and Arizona have their own tales of woe. In Missouri, Title X is administered by the Missouri Family Health Council that currently distributes funds to Planned Parenthood clinics serving about 34 percent of the state’s Title X patients. If Planned Parenthood were to leave the state, the care for such patients would change dramatically—currently family planning clinics can have a wait list of four to six weeks for new patients, according to the council’s executive director.

In Arizona, the nonprofit Arizona Family Health Partnership receives most of the state’s Title X money and distributes it to several different providers. Though Planned Parenthood only runs 17 percent of the Title X-funded clinics, it served 53 percent of the program’s patients in 2015, according to the pro-abortion rights Guttmacher Institute.

“They’re one of our more efficient and effective delegates in terms of the number of clients they are able to see and the cost per client,” Bré Thomas, the partnership’s CEO, said.

Thomas said the group hasn’t begun looking for prospective replacements, but that it might be difficult to find ones that meet the new Trump rule’s requirements.

And the experience with replacements for Planned Parenthood has not proven to be a piece of cake either. Texas is the prime red-state example for this. In 2011, Texas stopped funding Planned Parenthood and the state gave contracts to The Heidi Group, an anti-abortion group that ran crisis pregnancy centers and offered limited forms of contraception. The Heidi Group lost its multimillion-dollar contract last year after charges that it had mismanaged state funds and served only five percent of the clients that it indicated it would in its state contract. Texas has reapplied for Title X funds and has indicated that, again, it will not fund Planned Parenthood. In its newest application, the state indicates that it intends to serve 53,000 residents, compared to the 200,000 served by the independent agency currently holding the Title X grant today—a 73 percent decrease.

The conundrum here is complex. Title X funds family planning and related health care—much needed services for low-income families. In some areas and states, the most cost-effective and sometimes only provider of those services is Planned Parenthood. No federal funds can be used for abortion services. But for deeply red states, the tinge of abortion, or even abortion referrals make Planned Parenthood a pariah when it comes to receiving funding for what is the majority of their work. And, equally, for Planned Parenthood, they are clear in their position that they will not have their staff “gagged” in what medical information they can and cannot deliver to a patient. We have a standoff. The courts will eventually determine if these new rules for Title X will hold up. But in the meantime, in states like Utah, Missouri, Texas, Arizona, Wisconsin, Ohio, hundreds of thousands of low-income women are at risk of being left without options for reproductive health.—Carole Levine