If the Trump administration wants to require health care facilities to abide by what has been called a “gag rule,” the state of Vermont said it can pay for its own reproductive health care without taking any Title X funding.
“This is the climate we’re in,” said Vermont Commissioner of Health Dr. Mark Levine. “Vermont is saying as a state we’re not part of that.”
Title X funding, which helps health care facilities access money to provide patient care for low-income residents, provides for “preventative” health care services. These include patient education and counseling, breast and pelvic examination, breast and cervical cancer screenings, counseling and testing for sexually transmitted disease and HIV prevention as well as referrals, pregnancy testing, counseling and diagnoses, Levine wrote. The new rule aims to prohibit referrals to abortion providers.
In a letter addressed to Mr. David Johnson, operations and management officer for the U.S. Department of Health and Human Services, Levine called the rules issued by the HHS office on July 15 “bad policy,” and said Vermont would refuse to abide by them.
“The Department will be moving, therefore, to use State Funds to preserve our high-quality family planning network and ensure that health care providers will be able to continue to offer ethical patient care to Vermonters,” Levine said in his letter.
All state offices, including the governor’s office, Legislature, and health offices, agreed that accepting the federal funds would be unethical.
“It’s important that we maintain women’s rights and access to health care,” Gov. Phil Scott said in a press release. “It’s unfortunate we are at this point, but I appreciate the collaboration with the Attorney General and Legislature to put aside contingency funding in the 2018 budget. Vermont joins Hawaii, Illinois, New York, Oregon, Washington, Massachusetts and Maryland in foregoing Title X.”
The funding does not provide funding for abortion, and Levine said the state funding budgeted for the next year — about $800,000 — won’t either.
“This decision wasn’t made abruptly,” Levine said in an interview on Monday. “For several months we’ve been talking about this.”
Levine said the money was already set aside in a contingency fund from the last session in the state budget, and would not result in a rise in anyone’s property taxes. The money is going back to retroactively fund health care services for July 1 through June 30, 2020, Levine said.
“We’re delighted,” said Lucy Leriche, vice president of Public Policy for Planned Parenthood of Vermont, upon hearing the news. “We are so grateful to the Health Department, the governor, and the VT state legislature for stepping in and being leaders here, making sure Vermonters can access basic, primary health care.”
If the rules went on for longer than a year, the state would have to budget for it, Levine said.
“Title X (rules) undermine confidentiality, trust, and undermines the access to the quality of care people are welcome to expect,” Levine said. “This will allow for the continuance of the status quo of Vermont.”
Levine credited a “certain ideology” being espoused in the rules as infringing on peoples’ right to confidential, full-range health care and health care advice.
“It’s unethical, it’s not very feasible to comply with, and in some ways it’s what people fear,” Levine said. “Legislating the practice of medicine is usually not a good idea.”
Title X was implemented in 1970 and helps health care facilities gain access to a portion of over $250 million in funding for health processes including cancer screenings, family planning, birth control, sexually-transmitted disease testing and treatment.
Eileen Sullivan, communications director for Planned Parenthood of Northern New England, said the funds currently help 10,000 Vermonters access health care through their clinics.
The Trump administration announced it would start enforcing the new abortion referral rule starting mid-July.
Planned Parenthood, Vermont’s sole beneficiary of the federal grant money, stopped using the $1 million it normally receives annually, choosing instead to rely on emergency funds to keep clinics open and providing literature on all patient options.
“Using those dollars would mean complying with the gag rule, that would mean providing health care that doesn’t comply with our ethics,” Leriche said in a previous interview.
Forty percent of the 4 million patients who are cared for through Title X funds do so through Planned Parenthood across the country. A total of 1.5 million people, many of whom can only go to Planned Parenthood, receive on-site IUD application or other forms of birth control.
Many are people of color.
“This may put affordable health care out of reach for many underserved communities, including communities of color and rural communities,” said Dr. Georges Benjamin, executive director of the American Public Health Association, on the rule. “The majority of patients in the Title X program identify as people of color, Hispanic, or Latino.”