House budget filled with reproductive health restrictions

While last week’s debt ceiling deal between the Democrats and President Trump and emergency Harvey aid dominated headlines about the federal budget, the fiscal year 2018 House appropriations bill that is likely to be voted on this week contains dangerous restrictions to reproductive health care access.

The bill would cut the Title X Family Planning Program — the only federal grant program solely dedicated to providing comprehensive family planning — and also includes a religious exemption rider. The Conscience Protection Act expands the Weldon Amendment, which has been in effect since 2005 and bars appropriations funds from going to any federal agency or program, or to a state or local government, that “discriminates” against a health care entity if that entity refuses to provide, pay for, cover, or refer for abortions. 

The CPA would go further. It “creates a new right for certain health care entities, including insurance companies, hospitals, and even employers, to refuse to ‘facilitate,’ ‘make arrangements for,’ or ‘otherwise facilitate’ abortion,” said Amy Friedrich-Karnik, senior federal policy advisor for the Center for Reproductive Rights. “This ambiguous and dangerous language could allow for anyone, from an insurance company to an ambulance driver, to claim a legal right to discriminate against women seeking safe abortion services. And it would open the door to frivolous lawsuits by allowing almost anyone opposed to women’s reproductive health access to sue in order to block policies designed to promote women’s reproductive health.”

According to a 2016 American Civil Liberties Union report, Health Care Denied: Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives, one in six hospital beds in the United States is in a Catholic hospital; in Washington State, 40 percent of beds are in Catholic hospitals. These hospitals receive billions in taxpayer dollars, yet many adhere in part or in full to the Ethical and Religious Directives for Catholic Health Care Services issued by the United States Conference of Catholic Bishops, which prohibit a range of reproductive health services including contraception, many infertility treatments, and abortion, even when a women’s health or life is in jeopardy due to a pregnancy. There are numerous cases of Catholic hospitals denying emergency care to women who are suffering pregnancy complications.

“The Conscience Protection Act uses the cover of religious liberty to allow discrimination against women seeking abortion — constitutionally protected health care,” said Georgeanne Usova, legislative counsel at the ACLU. “Religious liberty is one of our nation’s core principles and guarantees everyone the freedom to believe what they choose, but it does not allow anyone to discriminate in the name of religion.” 

The CPA could mean that even more women in emergency situations are turned away without proper treatment for or information about their conditions. “This policy is a slippery slope — if medical providers are able to opt out of providing the full spectrum of reproductive health care, what’s next?” said Renee Bracey Sherman, senior public affairs manager for the National Network of Abortion Funds, which provides financial and logistical support to people seeking abortions. “The Trump Administration and Congress have shown they will use backdoor means and piecemeal legislation to chip away at health care for those who are most marginalized. They consistently attack contraceptive coverage and abortion access, but we know they will also destroy access to mental health, pediatrics, and prenatal and postnatal care. It’s all too obvious that families and pregnancy are the main targets, and [it’s] appalling that so many politicians are showing themselves to be blatantly anti-pregnancy, anti-birth, and anti-family, in addition to anti-abortion.” 

Additionally, the appropriations bill would bar Planned Parenthood from participating in any programs funded through the appropriations bill, including Medicaid, Zika prevention, Violence Against Women Act grants, and HIV prevention grants. The bill eliminates the Teen Pregnancy Prevention Program, an Obama-era initiative that funds evidence-based sexual education programs; instead funds would go to abstinence-only programs. It would also end Title X–funded programs, which are intended to serve people from low-income families. Of the four million people a year who receive services from Title X clinics, most are uninsured or ineligible for Medicaid and over half are women of color.

“Any proposal that cuts or eliminates funding for the Title X program cripples the family planning provider network and makes it nearly impossible for patients to receive the preventive care they need,” said Audrey Sandusky, director of advocacy and communications for the National Family Planning & Reproductive Health Association. “These efforts target those with the greatest need and who have the most to lose. The impact of the Title X program reaches well beyond contraception to provide health screenings and other preventive services for hundreds of thousands of women and men across the country.”

A new report from the Guttmacher Institute, Beyond the Rhetoric: The Real-World Impact of Attacks on Planned Parenthood and Title X, found that if anti-choice policymakers are successful in their efforts to cut Planned Parenthood from federally funded family planning efforts, the remaining providers will not be able to serve all the women in need. “Those who are intent on redirecting funding to federally qualified health centers [FQHCs], it just doesn’t comport,” said Kinsey Hasstedt, author of the report and the senior policy manager at the Guttmacher Institute. “FQHCs are not situated to provide the quality of comprehensive contraceptive care that Planned Parenthood health centers are. FQHCs, in fact, are charged with offering a broad range of primary care services — everything from eye to mental health. It is indeed largely because of this that FQHCs often don’t provide the same degree of quality contraceptive care that Planned Parenthood and other reproductive health–focused providers do. It’s just not feasible for FQHCs to fill the gap. Excluding certain types of providers based on the fact that they also provide abortions is out of line.” 

At press time, the Senate Appropriations Committee included funding for Title X programs and the Teen Pregnancy Prevention Program in its bill, which had bipartisan support. It did not include the Conscience Protection Act or religious exemption language. “It’s reassuring that the bill language reiterates what is already the case — that the Trump Administration and Department of Health and Human Services [HHS] can’t simply override the will of Congress by fundamentally changing these programs or withholding the appropriated funds,” said Friedrich-Karnik. “Only Congress has the authority to alter or eliminate federal funding for authorized programs. Yet, inexplicably, we have seen that HHS has issued notices to Teen Pregnancy Prevention Program grantees alerting them that their FY 2018 funding will be cut off, a highly unusual move since Congress is clearly still in the process of making FY ‘18 appropriations. In the end, we are very hopeful that the House language, which defunds the programs, will not prevail.” The final spending bill will most likely not be voted on until December.