Abortion providers and their advocates in Texas are raising alarm this week about a new proposal by the U.S. Department of Health and Human Services that would strip federal family planning funding away from clinics affiliated with abortion providers or clinics that refer patients to those providers.

It’s the latest effort at the federal level under President Donald Trump to steer funding away from reproductive health providers that have any connection to abortions. The prospective rule, which is being praised by anti-abortion advocates, also comes as the application for states, health departments and other health providers to compete for federal family planning dollars under the program known as “Title X” approaches its May 24 deadline.

The rule will still need to go through federal rule-making procedures, including a 60-day comment period, before it goes into effect. 

Right now, the state of Texas doesn't distribute those federal family planning dollars; the Women’s Health and Family Planning Association of Texas is responsible for spreading the $14 million among 28 providers and 100 clinics statewide. The state lost its bid to oversee the pot of federal money in 2013 but hopes to regain that responsibility soon — and anti-abortion advocates are hopeful that this new rule will help it achieve that goal.

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The 129-page proposed rule released Tuesday would make a number of sweeping changes to how Title X providers offer services to women and advocate for themselves. Some provisions of the rule include banning providers from initiating conversations with women about abortions as a family planning option or referring them to abortion providers. The proposal also aims to break up how affiliates work with centers that offer abortion services, saying that "shared facilities create a risk of the intentional or unintentional use of Title X funds.”

Reproductive rights groups have gone on the defensive and dubbed the proposal a "gag rule." 

Under Title X, federal money pays for family planning services such as contraceptive counseling, pregnancy tests and tests for sexually transmitted diseases. No state or federal funds may be used to cover the cost of abortions, and no funds in Texas go to clinics that provide abortions. Any changes to Title X funding or rules have the potential to impact 200,000 Texas men, women and teens who use the program.

Kami Geoffray, CEO of the Women's Health and Family Planning Association of Texas, an organization that works to increase access to family planning programs, said it’s unclear how soon the rule would be implemented or what clinics would need to do in order to comply. But she’s worried women won’t have the information they need to make a decision about their pregnancy.

“I’m scared about everything about Title X right now,” Geoffray said. “I’m scared access will be lost in the state, I’m scared women’s health has become so politicized we don’t see the patients we are serving, we don’t understand the real world impacts of what continuously attacking these funding streams means for people and their ability to access health care.”

The rule would make an exception "to promote patient safety" by allowing doctors to provide a list of health clinics if a woman makes clear she wants an abortion. But that list doesn't have to specify which clinics on the list offer abortions. The rule would also disallow Title X grantees to be affiliated with groups that lobby for abortion rights.

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Currently, Title X providers offer what’s called “non-directive options” for patients, meaning that when a woman has a positive pregnancy test, she discusses all of her potential next steps with her doctor. Those steps include continuing the pregnancy, looking into adoption and terminating the pregnancy. Title X providers can then refer her elsewhere for abortion services.

At the national level, Planned Parenthood has said the proposed rule is a direct attack. The women’s health provider has repeatedly stressed that its abortion services are done separately from other reproductive health services and are not funded by public dollars. The organization's latest annual report shows 3 percent of all Planned Parenthood health services are for abortions. Planned Parenthood surgical centers are where abortion procedures happen, not the clinics.

Dawn Laguens, executive vice president for Planned Parenthood Federation of America, said in a conference call on Friday before the rule was released that it “radically reshapes the Title X family planning program” and “allows doctors to lie to their patients about their options.”

Planned Parenthood of Greater Texas and Planned Parenthood of San Antonio are the only two affiliates of the organization that currently receive Title X funding. They serve 26,000 people with that money.

Blake Rocap, legislative director for the abortion rights group NARAL Texas, said funding for women’s health is slowly being diverted to organizations with no experience providing health care. He pointed to the state’s decision to give women’s health funding to the Heidi Group as an example.

The Heidi Group was in the news in August after the Texas Health and Human Services Commission took away $4.1 million from the Round Rock-based center, which has promoted alternatives to abortion to low-income women, after it only provided reproductive health services to a small portion of the 17,895 women that it contracted with the state to help. The commission still opted to renew millions in funding for the Heidi Group in the Healthy Texas Women program, which has tried to reimagine how to provide reproductive health and family planning services for low-income women without the involvement of Planned Parenthood, and the state’s Family Planning Program.

“I think it makes it far easier for unlicensed, unregulated folks to attach themselves to these funding streams that really should be for medical care,” Rocap said of the proposed rule. 

Anti-abortion groups have expressed concern that state and federal family planning dollars ultimately help providers perform elective abortions and in recent years pushed for ways to siphon off funding to Planned Parenthood.

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John Seago, legislative director for Texas Right to Life, said the proposed Title X rule will give Texas “the advantage” during the current application period to see who will be keeper of the federal family planning money.  The application is due for everyone on Thursday and it will be months before the federal government makes decisions about who gets funding.

“It’s our belief if you have a family planning grant and you have a business model around selling elective abortions to Texas women that those two kinds of goals — the goal of the grant and abortion business — conflict with one another,” Seago said.

State leaders have been adamant that Texas get a fair shot for being reconsidered as stewards of the federal family planning dollars.

In a news release on Monday, Texas Attorney General Ken Paxton called giving funding to abortion providers “a bit like giving matches to an arsonist, so long as he promises he will use somebody else’s matches to start fires.”

“In making a true separation between family planning clinics and abortion providers a requirement for receipt of Title X funds, President Trump again demonstrated his commitment to protecting the sanctity of life and the conscience rights of millions of Americans,” Paxton said. 

Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

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