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Patients could face new challenges in accessing birth control and other reproductive health services, particularly in rural areas, under Trump administration changes to a federal health care program. family planning.
Planned Parenthood, government agencies in blue states and other health providers are expected to announce Monday to the Department of Health and Human Services (HHS) that they will not abide by the new rules prohibiting recipients of funds Family Planning Title X to refer women for abortion.
This means they will have to leave the Title X program and give up millions of dollars of funding that was used to provide low-income women and men with contraceptives, cancer screenings, HIV and AIDS. STI. [sexually transmitted infections] tests and other reproductive health services.
This loss of federal funding could be a blow to non-profit, already cash-strapped clinics, which are often the only providers in their communities to offer low-cost services.
These clinics, however, say they can not participate ethically in a program that would require them to hide information from patients.
"Where do you send someone who is not insured, who is underinsured, who has an STI or an HIV-infected partner?" It's scary for us, "said Lisa Leach, executive director of the Lovering Health Center in Greenland, N.H., who will leave the program on Monday.
HHS has set Monday a deadline for recipients to provide proof that they are acting in "good faith" to comply with the rules.
Any dealer who does not respond or tells HHS that he will not comply with the rules, "must give up his grant or incur the termination of his grant," said an HHS spokesman at The Hill.
About 100 beneficiaries oversee hundreds of X-funded clinics across the country. Most beneficiaries have not yet announced whether they will leave the program.
But Planned Parenthood, which serves 40% of Title X patients and receives about $ 60 million from the program each year, said this week that its 400 clinics would stop, leaving states like Utah, Minnesota, Vermont and some parts of New Hampshire untitled. Supplier X.
Planned Parenthood said it was going to tap into its reserves to continue providing services to patients. But every subsidiary of Planned Parenthood has its own budget and will have to make its own decisions about the services it can offer.
In Minnesota and Vermont, where Planned Parenthood serves all Title X patients, or so, "waiting times for appointments will skyrocket and people will wait or dispense with care", said a manager of Planned Parenthood.
In Utah, where Planned Parenthood is the sole beneficiary, it will lose $ 2 million of Title X funds. Managers say they are raising money, seeking private funds and looking for cost savings to make sure that they "do not have to repress anyone".
And although changes have not yet been decided, patients may have to pay more for services.
"That means women may have to try to find $ 10 to contribute to their health care when they only have $ 5," said Karrie Galloway, Executive Director and President of the Planned Parenthood Association. 'Utah.
"It's really frustrating to think that in politics, women and their families will suffer a little more. If you do not know them, maybe you do not care, but Planned Parenthood of Utah cares about everything. "
The Trump administration says the loss of Title X funding by Planned Parenthood is a "self-inflicted" injury, as the organization could simply agree to comply with the new rules. In addition to banning abortion referrals, Planned Parenthood should also stop providing abortions.
HHS argues that changes are needed to ensure that clinics do not use federal funds for abortions. Under the current law, federal funding can not go to the procedure. This is the biggest change that has known the Title X program in almost 50 years of existence.
Planned Parenthood and many states are suing the administration, a court of appeal organizing hearings next month.
"As Planned Parenthood says it has to make some big changes to comply with the final rule, it is actually choosing to give more priority to the possibility of applying for abortion instead of continuing to receive. federal funds to provide a wide range of services. acceptable and effective family planning methods and services to clients who need these services, "says HHS on its website.
But it is probably the smaller clinics, not affiliated with Planned Parenthood and its large donor base, that will struggle the most to continue providing services to low-income patients, particularly those in rural areas.
Leach at Lovering Health Center has yet to make any changes, but may need to do so after Monday, when the clinic will lose funding under Title X, which represents 20% of its budget.
He has a small emergency fund from which he draws resources, solicits grants from foundations and solicits other private donations.
But Leach added that she was already considering the changes she may need to make, such as ending nights at the clinic where patients can enter without an appointment or remove counseling, testing and treatment services. for the treatment of STIs and HIV.
She is especially concerned about having to end the clinic's sliding fee schedule, which allows patients to pay for services based on their income. About 25 to 50% of his patients use it.
"It even kills me to say because it's a huge reason why people are looking for centers like ours," she said.
"They often get free or almost free services. And so, if we eliminate that, they simply will not have access to these services. "
In some states, governments are the beneficiaries of Title X. Some Democratic-led states have said they will not accept funding under the new conditions.
The two Title X recipients in Illinois – the government of a state-run Democrats and a private non-profit organization – have announced that they would leave the program.
Washington State and Hawaii also said they would not respect the rules.
The three states announced that they would subsidize their clinics to offset the loss of federal funding.
"It's a short-term strategy, no question," said Alina Salganicoff, Senior Vice President and Director of Women's Health Policy at the Kaiser Family Foundation. "Some states have the option of reprogramming funding to support family planning services."
"But I've seen enough crises," she added, "and it's the programs that are really affected, the programs for the poor."
HHS did not say what it would do about states that do not yet have X Title providers.
Providers who leave the program will likely continue to provide similar services without Title X funding through private donations, schedule changes or lay-offs.
But the law still requires the federal government to fund a strong network of providers to help low-income women and men in family planning.
"To the extent possible, HHS will consider a new administrative body to fulfill any obligation that the non-compliant recipient would not be able to fulfill or not intend to fulfill", stated the spokesperson of the HHS.
HHS has expressed interest in allocating funds to faith-based organizations opposed to contraception and abortion. He also indicated that he could appeal to qualified health centers by the federal government. [FQHC] participate in Title X.
However, the National Association of Community Health Centers, which represents the FQHC, opposes these changes and wonders if they would even be willing to participate in the program under the new rules.
"Their clinicians will be as worried as any other clinician for not being able to properly counsel their patients," said Sara Rosenbaum, professor of law and health policy and researcher at George University. Washington.
"And as health centers begin to hide information from their patients, they have to face the same type of legal responsibility as any doctor."
The American Medical Association, the largest group of doctors representing the country, is also against the rules for that very reason.
Several studies and experts have stated that the FQHC could not handle the large number of patients treated with Planned Parenthood.
"[Planned Parenthood] deals with such a high percentage of Title X customers that it's just hard to know what will happen to them, "said Rosenbaum.
"It's suicidal – it's the most suicidal gesture of a presidential administration I've ever seen."
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