Colorado Governor John Hickenlooper has joined chief executives from thirteen other states in signing a letter decrying restrictions floated by the Trump administration on reproductive health-care providers that accept funding under the federal Title X program. Opponents refer to the proposal as a "gag rule," since even so much as the mention of the word "abortion" would be forbidden.
Turns out that only one Colorado abortion provider would be impacted by this edict: the Boulder Valley Women's Health Center, which has accepted Title X funds since 1985 as a way of helping women of all ages who probably wouldn't be able to access its services otherwise. Susan Buchanan, the organization's CEO, emphasizes that the center offers "good, comprehensive health care. About 90 percent of what we do is family planning and working with OB/GYN patients, and about 10 percent is abortion." She predicts dire consequences beyond losing approximately one-fifth of the center's operating budget if the Trump forces get their way.
"The number of people with sexually transmitted diseases will go up and the unintended pregnancy rate will go up, especially for teens," Buchanan says. "And when teens are forced to parent early in their life, before they finish their education and have time to establish solid relationships, there's a high chance they'll be in poverty for life."
The potential repercussions "drive me wild," she admits. "These are people who claim to be so concerned about the health and well-being of teens and babies, but they're doing the very things that put teens and babies at more risk."
The suggested rule changes were submitted under the auspices of the Department of Health and Human Services and bear the benign-sounding title "Compliance With Statutory Program Integrity Requirements."
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"The rule essentially does two things," Buchanan says. "First, it disqualifies abortion providers from participation in the Title X program unless they have a physically separate facility, which we do not. And the second part of it is the gag rule part of it, which would apply to Title X clinics across the state; I think there are 63 locations at this time. The rule would require that if someone presents to us with an unintended pregnancy, we cannot advise, talk about, indicate a preference for or say anything about abortion as an option."
That's not all.
"There are other bad things in the regulations that haven't gotten as much attention," Buchanan points out. "They also undermine teen confidentiality by requiring more 'family involvement' and require asking teens more in-depth questions about who their partner is and the age of the partner. All of those things work against teens trusting providers. It's a disincentive to seek the health-care services they need."
In addition, the proposal expands eligibility for Title X funding to crisis pregnancy centers, or CPCs. That's no surprise, since Diana Foley, the newly named HHS deputy assistant secretary for population affairs and Title X overseer, once ran two such facilities in Colorado. Congresswoman Diana DeGette has publicly objected to the appointment for reasons Buchanan explains.
"CPCs are commonly known as 'fake clinics,'" she says. "They represent themselves as being medical providers when in fact, they really aren't. They're usually religious-based and anti-abortion. They often put their locations near an actual abortion provider and give themselves a name that is very similar to the abortion provider in an effort to confuse patients who are seeking an abortion. They wear scrubs and may provide services like a pregnancy test or an ultrasound, but they're not physicians or health-care providers, and they counsel against abortion using inaccurate information such as that abortions cause breast cancer, which has been totally disproven."
As Buchanan sees it, "The idea of CPCs being able to apply for Title X funding for family planning, when the only family planning services they talk about are things like abstinence, is antithetical to the purpose of the program, and it decreases the pot of monies available for legitimate health-care organizations that provide services to low-income people."
Helping such individuals is "part of our ethic," she emphasizes. "We were founded as the first abortion clinic in Colorado and a nonprofit organization, and because of Title X, we're able to remove the barriers of cost for our patients. Even though abortion can't be subsidized by federal money, we have other funds that can offset the cost. And for our services, we can slide our fees all the way down to zero for the lowest-income people."
BVWHC programs that are likely to be impacted by the loss of Title X funding include "free teen clinics that we offer in both Longmont and Boulder," Buchanan allows. "You can't do that kind of thing if you don't have government support, and that means teens would have a barrier to accessing our services — particularly teens who don't want the involvement of their parents. And we also serve folks who, either for confidentiality reasons or for cost reasons, can't or won't use their health insurance even if they're insured. We can put them on a sliding fee scale, too, just like we can with trans folks who come to us for hormone therapy."
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The Hickenlooper-signed letter, issued on the letterhead of the Democratic Governors Association, is strongly worded. "We stand with women and men in our states by rejecting this Administration's efforts to interfere in the doctor-patient relationship, gut women's access to family planning services and force medical professionals to knowingly withhold information from their patients," an excerpt reads. Another states, "If this reckless policy is finalized as written, we will have no choice but to explore all possible avenues, including legal options, to block it from harming the women in our states."
This mention of negative effects isn't hyperbole, Buchanan says. She points to a Colorado Department of Public Health and Environment study, "Taking the Unintended Out of Pregnancy." The report digs into what she characterizes as "the success of the Colorado Family Planning Initiative, which expanded access to long-acting, reversible contraception under Title X. These methods are highly effective, and they had the effect of dropping the teen birth rate in Colorado by over 50 percent and dropping the abortion rate in the teen population by over 50 percent during a five-year period."
The CDPHE data "shows how much money the government saves when you prevent unintended pregnancies — and it's in the tens of millions," she goes on. "That's what Title X does. That's the impact of this program. So it's a little counterintuitive to think taking away this money and handcuffing the way we use it is good policy. Because it's not — and it's going to hurt people."