Funds, which support family planning services, could go away for some clinics under new proposal

Health clinics that provide information about abortions or refer patients to abortion services would lose federal Title X funding under a proposal from the Trump administration to change the rules of the federal health care Title X program.

The Title X Family Planning Program was created in 1970 to provide family planning funding for low income and uninsured people. The rule change proposed by the Trump administration would bar health providers that receive Title X from providing information about abortion services or referring patients to abortion services. Current law already prohibits direct federal funding for abortion services.

The Title X rule change has been called a domestic gag rule by Planned Parenthood, as well as by the American College of Physicians and the American College of Obstetricians, which represent more than 200,000 physicians nationwide.

Planned Parenthood is the largest Title X health care provider in Oregon and the nation, and would be barred from providing Title X services by the rule change. Planned Parenthood provides 41 percent of Title X health services in Oregon.

Adrienne Quintana, chief operating officer of Planned Parenthood Columbia-Willamette, said that Marion County is particularly vulnerable to a loss of services due to recent increased infection rates of HIV, gonorrhea and chlamydia.

Quintana said that the rule change disrupts the relationship between doctors and patients, and removes the guarantee that patients will get full and accurate information about their health care options.

"The first thing we want to emphasize is that this is a gag rule, and it's an attempt to take away women's basic rights," Quintana said. "(Low-income and uninsured) patients that are already limited will not be able to access birth control and services like STI and cancer screening."

In Salem, the Planned Parenthood health center provided 7,749 patient visits to 5,317 patients total in 2017. Women made up 92 percent of patients at the health center, and 27 percent of patients identified as Latino or Latina.

According to the National Latina Institute for Reproductive Health (NLIRH), half of the 4 million people who receive Title X care are women of color, and 32 percent identify as Hispanic or Latina. Latinas also have the highest uninsured rate of any racial or ethnic group in the United States, at 38 percent, and over 20 percent of Latinas live in poverty, according to NLIRH.

Title X clinics do not require verification of immigration status of their patients and are required by law to provide services in patients' primary language. Under the 1996 welfare law, documented immigrants who entered the country after August 1996 are excluded from Medicaid for their first five years of legal permanent residency unless they are specifically covered by state funds, while undocumented immigrants are only covered by federal Medicaid for emergencies.

Planned Parenthood clinics are one of the main sources for undocumented immigrant women to access reproductive health care and prenatal services, Quintana said.

"They often come to find out if they are pregnant, or to confirm a pregnancy. That leads to a conversation about prenatal services, and connection to prenatal care," Quintana said. "We get them into the prenatal system, because the earliest intervention for prenatal visits can ensure a better outcome for the mother and the baby."

Oregon Health Authority is reviewing the potential effect of the proposed change to Title X regulations and the extent to which it impacts Oregon's Reproductive Health Equity Act, according to OHA Communications Officer Delia Hernandez.

RHEA is a state health care bill signed into law in 2017 which put women's health services without cost sharing into state statute and created protections against discrimination for people who identify as transgender or gender-noncomforming.

The bill also expands health coverage for women who are undocumented, including the full range of women's health services and 60-day postpartum care.

Hernandez said that OHA could not comment further on the proposed revisions, but OHA will continue to implement RHEA and ensure access to reproductive health services for all Oregonians, including those who would be ineligible for medical assistance due to immigration status.

Patrick Evans
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