The logo of Planned Parenthood is seen outside the Planned Parenthood Reproductive Health Services Center in St. Louis, Missouri, May 30, 2019, the last location in the state performing abortions. - A US court weighed the fate of the last abortion clinic in Missouri on May 30, with the state hours away from becoming the first in 45 years to no longer offer the procedure amid a nationwide push to curtail access to abortion. (Photo by SAUL LOEB / AFP) (Photo credit should read SAUL LOEB/AFP via Getty Images)

In 2016, most people didn’t know about the existence of Title X — a funding program for low-income or uninsured people that gave them access to affordable family planning services – but over 4 million people relied on it. The program was established in 1970 under the Nixon administration as part of the Public Health Service Act.

Title X funds clinics that offer basic preventive and primary health care services such as wellness exams, cervical and breast cancer screenings, contraceptive education, testing and treatment for STIs, HIV testing and more. It was created to provide these services to those who otherwise could not obtain them. 

Such as the users of Title X themselves – the federal planning program has often been taken for granted – that was until 2019 when the Trump administration instituted a “gag rule” that undermined the program. 

Trump’s rule banned doctors in the Title X program from telling patients how they could access abortion services, making it more difficult to obtain birth control because doctors and nurses were prohibited from giving information about sexual and reproductive health care options. 

“Censoring and gagging these providers threatens the patient-provider relationship and prevents patients from having information about all of their options,” the Planned Parenthood administration explained in a press release. “Because of our commitment to ethical patient care, it would be impossible for Planned Parenthood to continue participating in the program.” 

Before the Trump administration, Title X was still not supportive enough of patients, said Brigid Leahy, the Senior Director of Public Policy at Illinois Planned Parenthood Action. Title X funding has been steadily decreasing since 2010 and as a result, there are fewer family service clinics. 

“Even before [the gag order], Title X funding was not meeting the level of the number of people who need it,” she said. “Unfortunately, during the Trump administration, it became a political football in the abortion debate, even though none of the money goes to abortion.”

Gag Rule Hurts Most Marginalized Communities  

Before the gag rule, Planned Parenthood health centers served 41% of the 4 million people relying on Title X. The 2019 rule forced Planned Parenthood and other wellness clinics to withdraw from the Title X program. According to the Guttmacher Institute, the rule cut the program’s patient capacity in half. 

In 2017, more than 50% of Title X patients were people of color. This isn’t an isolated attack – the intersectionality of the matter hurts patients with marginalized identities more – the very same communities that are suffering the most from COVID-19.

“Planned Parenthood centers across the country, including here in Illinois, were pushed out of the program,” Leahy said. “The Illinois Department of Public Health left the program and they had sub-granted Title X funding to dozens of providers across the state, including health departments, local FQHC and a variety of providers. Thousands of people in Illinois were relying on this program and the funding disappeared.” 

Six states were left without any Title X providers – Hawaii, Maine, Oregon, Utah, Vermont and Washinton. Meanwhile, the majority of Title X clinics in Alaska, Connecticut, Illinois, Maryland, Minnesota, New York and New Hampshire left the program. 

Some states who left the Title X program were able to seek state funding to offset the loss of federal funds, but the future remains unknown. 

Approximately 100,000 people in Illinois relied on Title X to access basic care, a year after the ban went into place six counties in Illinois are still left without providers – LaSalle, Macon, McLane, Peoria, Sangamon and Tazewell. 

Leahy explained that Planned Parenthood Illinois Action has had good donors but for a year and a half, they have struggled with funding, making it a challenge to provide service. And in the long run, it costs more to not have these services because patients will miss recommended health check-ups due to the lack of access and run into more health issues in the future that could have been prevented with annual check-ups. 

The Future of Coverage and The Role of State Plan Amendments 

The Biden Administration has said they are working on restoring and improving Title X, but as we wait, more and more Americans go without simple checkups such as pap smears and cancer screenings and other preventive care that is life-saving. 

Another big chunk of Planned Parenthood’s revenue comes from patients who are insured by Medicaid. And while Medicaid is a federal-run program, states have some say in how Medicaid works in their region.  

This is why State Plan Amendments (or SPAs) that expand Medicaid coverage for family planning services can help keep low-income clinics going.

Illinois Senator Cristina Castro recently passed SB 967, which is one such amendment that expands Medicaid coverage up to 208% above the federal poverty level for family planning. The bill also increases maternal health services such as prenatal and postpartum care and addresses the difference in treatment Black mothers received in Illinois. 

This amendment provides funding that can help Americans while they wait for Title X restoration, but it does not match the previous Title X coverage which covered folks up to 250% above the federal poverty line, according to Leahy. So even with the state amendment, without Title X funding restored, there is a wide gap of folks who are not covered. 

In addition, SPA plans do not offer full Medicaid coverage, only specific family planning services that the state approves. Leahy said that SB 969 is still useful, regardless of Title X restoration in Illinois.

“It does help with the loss of Title X funding, but it really is a separate program,” Leahy said. “Many states have both at the same time. It will help, but it is really just a smart policy to have on its own for increasing access to healthcare.”

Sam Stroozas is a writer and the calendar editor for Rebellious Magazine. Follow her on Twitter @samstroozas.