Gag, Retch! How the New Gag Rule Will Enforce “Separate and Unequal” in Women’s Health
Amidst the latest news of presidential mood swings — Trump vs. FBI, Trump vs. DOJ, Trump vs. North Korea (again), Trump vs. Planet Earth — welcome to the latest iteration of Trump vs. Women.
Notwithstanding the White House’s tributes to “President Donald J. Trump’s promise to continue to improve women’s health,” let’s not mince words: Trump’s Department of Health & Human Services (HHS) has just proposed a gag rule on healthcare providers.
Specifically, the rule targets providers receiving Title X funding — government funds earmarked for family planning and preventive-care services, in particular for low-income patients. Title X organizations include state, county, and local health departments, as well as Planned Parenthood Federation of America (PPFA) and other private non-profits.
That’s a lot of healthcare providers… and a lot of patients. PPFA alone serves about 2.5 million patients annually, with 97% of its resources going to preventive healthcare (the remaining 3% go to abortion). In total, more than 4 million people rely on Title X funding for wellness exams, contraceptive counseling and provision, STD testing, cancer and other preventive screenings, and referrals to other health/social services.
According to the National Family Planning & Reproductive Health Association, 64% of these patients are at or below federal poverty level, and 43% are uninsured. Fifty-three percent of patients identify as Black or Latino. Eighty-nine percent of patients are female, meaning 89% of Title X patients need reproductive healthcare.
See where this is going?
That’s right, abortion. Because reproductive healthcare has always included abortion (at least verifiably back to 3000s BC China, when the earliest record of abortion was recorded).
In 129 pages of byzantine linguistic contortions, Trump’s HHS mandates the new normal for government intrusion:
* A “bright-line rule” would ensure financial and physical separation between abortion and Title X services.
To be clear, the law ALREADY enforces financial separation between abortion and Title X services. Title X funding recipients may not apply any government funding toward abortion services (if provided), and must maintain separate income streams and bookkeeping services.
Now HHS wants to enforce separate healthcare records and workstations, prohibit “signs and materials referencing or promoting abortion,” and impose a “degree of separation from facilities (e.g. treatment, consultation, examination and waiting rooms, office entrances and exits, shared phone numbers, email addresses, educational services, and websites) between an organization’s abortion facilities and other programs.”
Well, that should be easy and non-disruptive for millions of patients and doctors. What does “separate” mean? Down the hall? Across the street? Over the river and through the woods? Will abortion providers have to enter their place of work by the back door? What about the water fountains?
“We intend to take a case-by-case approach,” promises HHS. Wouldn’t it be easier just to… oh, never mind.
* Doctors would be barred from mentioning abortion to patients, except in a “nondirective” manner.
Thus “protecting Title X health providers so that they are not required to choose between the health of their patients and their own consciences,” thank goodness.
“In no case would the [rule] permit a Title X-funded family planning program to make a referral for, or determine the appropriateness of, abortion as a method of family planning… [A] doctor, though not required to do so, would be permitted to provide nondirective counseling on abortion. Such nondirective counseling would not be considered encouragement, promotion, or advocacy of abortion.” Never mind that abortion is “family planning” in the largest, last-resort sense.
A doctor could offer a patient “a list of licensed, qualified, comprehensive health service providers, some (but not all) of which provide abortion in addition to comprehensive prenatal care.” However, he or she could do so “only in cases where a program client who is currently pregnant clearly states that she has already decided to have an abortion.”
Just imagine the levels of mind-reading and linguistic acrobatics necessary in order for patients and doctors to abide by these rules.
It’s clear that HHS wants to limit women’s access to abortion. Reducing the number of abortions overall, of course, requires effective and accessible contraception, but HHS’ recommendations on this front don’t exactly inspire confidence: the “broad range of acceptable and effective” contraceptive options under Title X must include “natural family planning methods,” such as abstinence, and — this would be funny, if it weren’t — “fertility awareness methods” such as the “rhythm method.” The rhythm method? Wasn’t this what we were explicitly warned against in our youth? Truly, everything old is ew again.
Needless to say, medical professionals aren’t happy about the administration’s proposed censorship. The American College of Physicians condemns this “discriminat[ion] against clinics unless they agree to unacceptable intrusions on the patient-doctor relationship.”
As should we all. As of now, HHS is still legally required to hold an open period of comment on any proposed law. Quick, speak up before comments are outlawed! You can send a pre-written message through Planned Parenthood’s Action Fund, or, better yet, submit your own at https://www.federalregister.gov/documents/2018/06/01/2018-11673/compliance-with-statutory-program-integrity-requirements. Deadline is July 31. Make your voice heard, before the Trump administration silences you, too. And when you do, remind HHS that it was Richard Nixon, a Republican president, who created Title X in the first place.
Juliet Eastland is a writer with strong opinions.