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Abortion and Title X Funding

Summary:
The 9th U.S. Circuit Court of Appeals in San Francisco recently ruled that the Trump administration can deny Title X federal funding to family planning clinics that make abortion referrals or perform abortions. The Office of Population Affairs (OPA)—part of the U.S. Department of Health and Human Services (HHS)—administers the Title X Family Planning program as well as “the Teen Pregnancy Prevention program, the Pregnancy Assistance Fund program, and the embryo adoption program.” The OPA also “advises the Secretary and the Assistant Secretary for Health on a wide range of topics, including adolescent health, family planning, sterilization, and other population issues.” The Title X Family Planning program [“Population Research and

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The 9th U.S. Circuit Court of Appeals in San Francisco recently ruled that the Trump administration can deny Title X federal funding to family planning clinics that make abortion referrals or perform abortions.

The Office of Population Affairs (OPA)—part of the U.S. Department of Health and Human Services (HHS)—administers the Title X Family Planning program as well as “the Teen Pregnancy Prevention program, the Pregnancy Assistance Fund program, and the embryo adoption program.” The OPA also “advises the Secretary and the Assistant Secretary for Health on a wide range of topics, including adolescent health, family planning, sterilization, and other population issues.”

The Title X Family Planning program [“Population Research and Voluntary Family Planning Programs” (Public Law 91-572)] was enacted in 1970 as Title X of the Public Health Service Act. According to the OPA: “For more than 40 years, Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and related preventive health services for millions of low-income or uninsured individuals and others. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.”

For fiscal year 2019, which ended on September 30, 2019, Title X appropriated funds were $286.479 billion. According to the Title X Family Planning Annual Report, Title X-funded services were implemented through grants to 49 state and local health departments and 50 nonprofit family planning and community health agencies that supported a network of 3,954 service sites operated either by grantees or 1,128 sub-recipients in the fifty states and U.S. territories that served over 3.9 million clients through 6.5 million family planning encounters.

Although section 1008 of Title X states that “none of the funds appropriated under this title shall be used in programs where abortion is a method of family planning,” for years organizations like Planned Parenthood received millions in Title X funding even though they made abortion referrals and performed abortions.

In February of last year, the Trump administration issued its final draft of a rule change to Title X funding. The proposed rule was initially published in the Federal Register in June of 2018. After a sixty-day comment period, more than 500,000 comments were “received and carefully reviewed” and “certain changes” were made. The final draft of the rule requires “clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning” and prohibits “referral for abortion as a method of family planning.” Any organization not in compliance is ineligible for Title X funding.

Naturally, “reproductive rights groups” challenged the regulations in court. But after judges in Washington, Oregon, and California issued preliminary injunctions against the rule, a three-judge panel of the 9th U.S. Circuit Court of Appeals voted unanimously to lift the injunctions last June, allowing the rule to be implemented while the case proceeds through the court system. “The Trump-Pence administration’s gag rule is unethical, illegal, and harmful to public health—and Planned Parenthood will not stand for this attack on millions of people across the country,” tweeted then-president of Planned Parenthood, Leana Wen. “We will immediately seek emergency relief from the Court of Appeals.” The ACLU was likewise distressed: “If this new rule takes effect, it will devastate the only federal family planning program and the people who rely on it. “We’re considering all options in response to today’s ruling, to ensure people are able to get the care they need.”

In July of last year, HHS alerted clinics that they it be enforcing the Trump administration’s new rule and deny federal funding to clinics that failed to comply with the new Title X regulations. “We thank President Trump and Secretary Azar for acting decisively to stop taxpayer funding of the abortion industry, as willed by the American people,” said Susan B. Anthony List President Marjorie Dannenfelser. Then in August, Planned Parenthood—the nation’s largest abortion provider, which performed 345,672 abortions in its fiscal year 2018—announced that it was withdrawing from the Title X family planning program and would forgo millions of dollars in federal funding rather than comply with the Trump administration’s new regulations.

On February 28 on this year, the 9th U.S. Circuit Court of Appeals, sitting en banc, in the case of State of California v. Azar, ruled, by a vote of 7-4, that the Trump administration’s final rule was “not arbitrary and capricious because HHS properly examined the relevant considerations and gave reasonable explanations.”

The aforementioned Marjorie Dannenfelser reiterated that abortion is not family planning and that “a strong majority of Americans” oppose taxpayer-funded abortions. She termed the ruling “a vindication of President Trump’s pro-life policies and a victory for the American people.” But as expected, Planned Parenthood called the ruling “devastating,” and claimed that it endangers “birth control, cancer screenings, and other essential care for millions.” The ACLU announced that it was “deeply disappointed” at the decision.

Yes, President Trump should be congratulated for doing what Republicans never had the will to do—strip Title X funding from Planned Parenthood. However, there is still a glaring problem with the Title X Family Planning Program: It should not exist.

Since when is it the job of government to fund family planning programs? If it is a legitimate purpose of government to fund family planning programs, then it is a legitimate purpose of government to fund just about anything. The issue here is the proper role of government, not abortion. Title X funding would be just as illegitimate even if the practice of abortion was ended throughout the country.

And it’s not just Title X funding. Planned Parenthood is still funded by the federal government, mainly via Medicaid reimbursements. According to Planned Parenthood’s 2018-2019 annual report, the organization had revenue of $1.638 billion, of which $616.8 million came from “government health services reimbursements & grants.”

Since when it is the job of government to fund private organizations or businesses that provide certain services? If it is a legitimate function of government to take money from individuals and corporations through taxation and transfer that money to organizations or businesses that provide certain services, then it is a legitimate function of government to transfer money to entities that provide just about any services. Again, the issue here is the proper role of government, not which services are good, important, or necessary and worthy of government support.

Laurence M. Vance
Laurence M. Vance is an author, a publisher, a lecturer, a freelance writer, the editor of the Classic Reprints series, and the director of the Francis Wayland Institute. He holds degrees in history, theology, accounting, and economics. The author of twenty-four books, he has contributed over 700 articles and book reviews to both secular and religious periodicals.

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