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Title X Needed Now More Than Ever Under Obamacare

Friday, November 22, 2013

The only federal program dedicated to family planning will be critical to the job of providing and expanding women's health care under the Affordable Care Act. But several states are attempting to restrict Title X at the very time it is needed most.

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The only federal program dedicated to family planning will be critical to the job of providing and expanding women's health care under the Affordable Care Act. But several states are attempting to restrict Title X at the very time it is needed most.




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Credit: LaDawna Howard on Flickr, under Creative Commons (CC BY 2.0)

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(WOMENSENEWS)-- In the coming months millions of Americans will obtain health coverage for the first time under Obamacare. In that context, Title X--– the only federal program dedicated exclusively to family planning –will be more important than ever.

Under the Affordable Care Act, the Title X-funded clinics on which millions of low-income women rely for family planning and reproductive health care will become an even more essential pillar to the nation's health system. We will need more health facilities to accommodate the ranks of the newly insured and private providers do not have the capacity to take on scores of new patients.

Research from Massachusetts indicates that even when the uninsured population shrinks, the patient base at publicly funded health facilities grows. Women turn to Title X clinics not because it is a place of last resort, but because they trust their providers, they can receive sensitive medical services in complete confidence and can easily access the full range of reproductive health services they need and desire.

There also will be an increased demand for these providers in the years to come because millions of women will remain uninsured despite the significant advancements brought forth by Obamacare. Twenty-two states currently refuse federal funding for the expansion of Medicaid, which, as the New York Times reported, will leave two-thirds of poor blacks and single mothers and more than half of low-wage workers uninsured.

Unsurprisingly, nearly all of the states that have had reduced or restricted family planning funding over the past three years also refuse funding for Medicaid expansion. Women in those states will be doubly impacted by a lack of coverage and a shrinking safety net.

You're not alone if you've never heard of Title X. While the recent efforts of conservative lawmakers to blockade abortion access with countless unnecessary regulations have commanded much deserved attention and outrage, their attempts to restrict and eliminate Title X and other sources of family planning funding have turned fewer heads.

Effective Public Health Program

Title X is one of the nation's most effective public health programs. It enables low-income, immigrant and young women to access preventative and lifesaving health services, and also pays for facilities, staffing, equipment and contraceptive supplies that most other funding streams will not cover. Every year the federal government distributes Title X funding to grant administrators in each state who oversee a competitive application process and then disseminate the funds to organizations and individual clinics.

Last year the program provided care to 4.76 million women and prevented an estimated 996,000 unintended pregnancies (200,000 of which were among teens). Every year it saves federal and state governments more than $3 billion by preventing unintended pregnancies, sexually transmitted infections and other reproductive health problems, which in most cases would otherwise be covered by Medicaid. For many low-income women, immigrant women and young women and men Title X-funded clinics serve as an entry point into the health system and remain their only place of care.

Title X was passed into law under Republican leadership in 1970 and for much of the last 40 years enjoyed broad bipartisan support, as members of both parties saw the extraordinary economic, social and health benefits of providing family planning to those who need it.

But the days of family planning being a rare middle ground in American politics came to a screeching halt in 2011 as Tea Party Republicans swept into state legislatures around the country. They came to power fiercely determined to destroy the social safety net and get the government out of the business of governing everything except women's bodies (in which case, of course, there's no regulation too intrusive). That year, and again in 2013, Republicans unsuccessfully attempted to eliminate Title X as part of broader state and federal efforts to restrict reproductive health access.

The threat to federal funding has subsided for the time being, as it seems unlikely that budget negotiators will attempt to cut back Title X any further in upcoming discussions about non-defense discretionary spending, of which Title X is a part. The most likely scenario is that funding will stay flat, hardly an ideal scenario given that sequestration has reduced the already underfunded program by approximately 10 percent, down to $278 million, when it should really be operating somewhere in the ballpark of $800 million annually.

State-Level Threat

The current danger for Title X is more at the state level. Lawmakers in Texas, Ohio and Michigan have established tiered systems that give funding priority to health department providers, primary care community health centers and "crisis pregnancy centers" (most often religiously-affiliated organizations purporting to be full-service medical facilities that actually only offer pregnancy tests, ultrasounds and anti-abortion counseling). That leaves little to no funding for family planning clinics.

Lawmakers in Oklahoma now prohibit family planning providers not affiliated with state health departments from receiving state and federal funding. Indiana, Kansas, North Carolina and Wisconsin have all blocked family planning providers from receiving various streams of family planning funding. And other states have slashed their family planning budgets all together, putting even more strain on Title X and the providers who remain.

State efforts to restrict family planning funding will weaken a health system upon which millions of low-income individuals rely and will undermine the potential impact of Obamacare. When Texas cut family planning providers out of Title X, four of the eight Planned Parenthood clinics in the Rio Grande Valley – one of the nation's most underserved regions – were forced to close, and those that remained open reduced hours, cut staff and stopped providing some of the most desirable and effective methods of birth control. A recent report by the Center for Reproductive Rights and the National Latina Institute for Reproductive Health illustrates just how devastating these cuts have been.

Some believe that the new health care law's historic commitment to women will obviate the need for Title X, but as I argue in my recent paper published by the Roosevelt Institute, the program is in fact more important today than ever before.

Developments in North Carolina, Tennessee, New Jersey and Texas have disrupted restrictions to Title X and provide some hope. In those states, the federal government decided to entrust the Title X grant not to state health departments but to organizations such as Planned Parenthood and the Women's Health and Family Planning Association of Texas that are committed to sustaining and strengthening family planning providers.

In the future, we could see more health departments in states hostile to women's health cut out of the Title X process.

For the time being we can be thankful we have a president dedicated to women's health and rights. And we should know that conservatives are unlikely to rest until essential reproductive health services are out of reach for many women. They have learned it's far easier and more effective to erode women's health at the state level than it is to overturn constitutional rights or eliminate federal programs.

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