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U.S. Sen. Ed Markey, medical experts and pro-choice advocates slammed the Trump administration's proposed changes to the Title X program on Tuesday, arguing that withholding federal funds from centers that provide or refer abortion services "would turn back the clock" on women's rights and reproductive health.
The Title X program offers federal grants to support family-planning services for low-income patients across the country. However, a new rule floated last year and finalized this month by President Donald Trump would cut off those funds for any provider that performs abortions or makes abortion referrals.
At a press conference held at a Planned Parenthood clinic, Markey called the proposed change "disastrous."
"From the halls of the Supreme Court to the halls of local health centers, the Trump administration is waging an all-out assault on women's reproductive health," Markey said. "A woman's reproductive health decision should be left up to a woman and her health care provider. That is it. A health care provider receiving federal funds should be judged on its ability to serve a patient. That is it."
The change is set to take effect in May. Attorneys general in 21 states, including Massachusetts' Maura Healey, joined Planned Parenthood and the American Medical Association in a federal lawsuit challenging the rule. Markey said members of Congress also plan to file legislative amendments aimed at blocking the proposed change.
The senator spoke Tuesday alongside leaders from Planned Parenthood, the Massachusetts chapter of pro-choice group NARAL, and the Massachusetts Medical Society. They warned that withholding funding from centers where abortion is performed or discussed would suppress rights and cause damage to public health. The teenage pregnancy rate, they said, is at a 30-year low because of greater access to reproductive health care.
"Providing a patient with all the relevant information and options within the context of a confidential, trusting relationship is an obligation for physicians, one that we don't take lightly," said Dr. Carole Allen, a trustee with the Massachusetts Medical Society. "To strip from a physician the ability to provide all needed information to a patient is unconscionable."
In 2017, almost 100 providers around the state, five of which are Planned Parenthood clinics, received a combined $6.1 million in Title X money. Those providers served 75,000 patients in Massachusetts, almost two-thirds of which had incomes below the federal poverty line, according to the National Family Planning and Reproductive Health Association.
The administration's rule change would revoke a 2000 regulation requiring Title X-funded programs to provide abortion referrals when requested by patients because, the policy reads, "that referral necessarily treats abortion as a method of family planning." In a January press release, about two months before the final rule was released, federal Department of Health and Human Services Secretary Alex Azar said the administration's goal is to promote "the dignity of human life from conception to natural death."
"At HHS, through our work in healthcare, human services, public health, and biomedical science, we are committed to this effort," he said in the release. "This means not just protecting human life in the administration of our programs, but also respecting the conscience rights of those who participate in HHS-funded programs."
Massachusetts Citizens for Life, which supports restrictions on abortion access, praised the administration's new Title X rule. Bridget Fay, chair of the group's legislative committee, said she believes the change will shift some funding from Planned Parenthood to other clinics across the state that do not offer or refer abortions.
"Directing women to these clinics enables women to get the health care they need while also not directing hundreds of millions of dollars toward the nation's largest abortion provider," Fay said.
Speakers at Tuesday's event, though, said the move was unfairly targeted at Planned Parenthood and similar health centers. Because Title X-funded clinics are often the most — or only — accessible form of reproductive health care for low-income patients, they said, the new restrictions would disproportionately affect the most vulnerable members of society.
"Health care providers are forced into an impossible position: withhold information from patients, or get pushed out of the program," said Dr. Danielle Roncari, medical director of the Planned Parenthood League of Massachusetts. "This gag rule will threaten the health care of the 4 million people a year who rely on Title X, including the 75,000 people who rely on this program right here in Massachusetts."
Trump is not the first president to suggest restricting Title X funding for clinics that provide abortion services. In 1988, President Ronald Reagan proposed a similar rule, but the move was challenged in courts, upheld by the U.S. Supreme Court in 1991 and then revoked by Reagan's successor, Bill Clinton.
If the administration's new rule is not overturned, advocates said they may turn to state leaders to help make up the difference by allocating additional money to health centers.
"That is not an ideal solution across the nation because there are 50 different states with 50 different opinions about health care and about family planning funds," said Rebecca Hart Holder, executive director of NARAL Pro-Choice Massachusetts. "We're lucky to be in a state like Massachusetts where we can exert some real pressure on the leadership of our government and talk to them about the need to make up the difference, but it's not a tenable solution."
In 2018, when the Trump administration first proposed the rule change, the Massachusetts Department of Public Health submitted a formal objection, and Republican Gov. Charlie Baker said the rule should be "rescinded in its entirety." The governor also included $1.6 million in a supplemental budget last year to cover what was at the time a gap in Title X funding.
"Governor Baker supports a woman's right to choose and has publicly opposed the Administration's decision that will have the most detrimental effect on the low-income residents who rely on Title X funded services," Lizzy Guyton, the governor's communications director, said in a Tuesday statement to the News Service. "The Baker-Polito Administration will continue to work with family planning agencies to ensure women across the Commonwealth have access to critical family planning services."
In a statement, House Speaker Robert DeLeo said the state "takes the issue of protecting women’s health seriously."
"Just last year we acted to remove outdated and harmful legislation to support the protection of women’s reproductive rights," DeLeo said. "We will continue to watch federal action closely."
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