Murphy Resists Trump’s Changes to Funding of Women’s Healthcare

Lilo H. Stainton | June 5, 2018 | Health Care
Fears that Title X programs will be undermined and access to family planning limited for women of low income

The Murphy administration is forcefully pushing back on several federal proposals it fears will limit access to family planning and preventive healthcare services. The effort is the latest in a number of challenges the Democratic governor has launched against policies backed by President Donald Trump.

Gov. Phil Murphy joined the Democratic governors of 13 other states, including New York, Pennsylvania and Delaware, in a sharply worded letter sent Thursday to U.S. Department of Health and Human Services Secretary Alex Azar opposing his call for changes to the federal Title X funding program, which supports community programs that provide birth control, cancer screenings and other preventive care to low-income families.

Last month HHS proposed reforms to further separate programs funded by Title X from groups that provide abortion — which are already banned from receiving federal dollars. New Jersey received $8.8 million in Title X funding this year, which is distributed among 43 family health programs. (These facilities also received $7.5 million in state dollars that Murphy reinstated soon after taking office.)

Azar said the regulatory changes are needed to update and improve the integrity of the nearly 50-year-old program, which serves 4 million Americans and has long received bipartisan support. Among other things, he is seeking greater separation between abortion services and other healthcare programs, and would prohibit clinicians working for Title X programs from referring patients to abortion providers.

But women’s health advocates — including Murphy and his fellow governors — called it a “reckless policy” that will “upend decades of bipartisan cooperation” and “undermine” women’s health nationwide by forcing organizations to change their practices, or eliminate aspects of care, to protect their federal funding. The proposal, which is posted for comments through July, has triggered concerns for women’s groups like Planned Parenthood, which operates more than half of the federally funded clinics in New Jersey.

Domestic ‘gag rule’

“We strongly urge you to reconsider this plan, which is nothing more than a domestic ‘gag rule’ that poses serious risks to women’s health,” the Democratic governors wrote, noting the states will file suit if needed to block the proposed changes. “Our voices will be heard on this damaging proposal, and we are prepared to match our words with action.”

Earlier last week New Jersey Attorney General Gurbir S. Grewal filed a legal action to challenge a separate HHS rule that would allow certain corporations to deny their employees access to free contraception. The Affordable Care Act required all insurance plans to provide free preventive care, including contraception; religious groups were exempt from this provision, but HHS has sought to expand the “conscience clause” to all corporations, public and private.

“Once again, the federal government is trying to chip away at the health care rights of our citizens,” Grewal said, noting how easy access to contraception benefits public health and the state’s economy. “We believe this new rule is illegal, and we intend to fight it.”

Murphy’s latest actions are not surprising given his strong support for women’s rights and healthcare. Soon after taking office he signed several laws designed to expand access to family planning, contraception and other care for low-income families, including a measure to reinstate the $7.45 million in annual state funding for family planning clinics that was suspended under former Gov. Chris Christie, a Republican.

The progressive Democrat has also been eager to oppose Trump administration plans he sees as dangerous to the Garden State; he appointed a number of cabinet members who he said were able to help protect important federal programs, like the ACA, which have been under attack from Republicans in Washington, D.C. Among other pushback, Murphy’s administration has joined multistate lawsuits to block a question about citizen status from the 2020 Census and protect fuel-economy standards instituted under former Democratic President Barack Obama.

In poll, most women disapproved

The Trump administration’s decision to change the Title X program has sparked widespread concern among women nationwide, according to the Planned Parenthood Federation of America. A national poll conducted in early May found that three out of four women surveyed disapprove of the proposal, including some who voted for the president. One in five women have been motivated to demonstrate in the past 18 months, the group said, and a so-called gag rule will only exacerbate their concerns.

The HHS proposal — which echoes a failed effort under former President Ronald Regan, a Republican — calls for a “clear financial and physical separation” between Title X programs and those that involve abortion; currently, these two aspects of care can be offered in the same facility by the same staff but funded through separate budgets.

Critics said the change would require some organizations to build or rent new space, hire distinct staff and operate independent programs to provide care that is largely integrated — a costly effort that will reduce the quality of care. The changes also call for more detailed reports from those who receive Title X funding, in the name of improving transparency.

In addition, while the reform would not ban providers from discussing abortion as an option, it would prohibit them from directly referring a patient for the medical procedure, which was legalized in 1972 but remains controversial today. According to HHS, this protects providers from having to “choose between the health of their patients and their own consciences,” an apparent effort to ensure clinicians who personally oppose abortion don’t have to recommend it to those they treat.

But women’s health advocates said the change will force these providers to withhold certain legitimate options from their patients, or risk losing their federal funding. Those that opt to forgo this money to continue providing abortions, or referring patients elsewhere for the service, could be forced to cut back cancer screenings and other healthcare services that benefit tens of thousands of Garden State residents annually, they said.

Harming public health?

“Everyone has the right to access information about their health care — including information about safe, legal abortion — and every woman deserves the best medical care and information, no matter how much money she makes or where she lives. No matter what. They won’t get it under this gag rule,” said Casey Olesko, with Planned Parenthood Action Fund of New Jersey, which has praised Murphy’s stance on women’s care.

State Health Commissioner Dr. Shereef Elnahal also called the HHS move a “short-sighted proposal” that puts preventive health services at risk. “Any federal move that withdraws family planning funding would harm public health. That means fewer women screened for cancer and sexually transmitted infections, and reduced access to primary and preventative health care for New Jersey women,” he said, noting he is working with family planning advocates and the governor to “do everything we can to blunt the effects on New Jersey.”