A 20-something woman sat on a chair in the waiting room of the Glen Cove Planned Parenthood clinic recently, her legs curled against her torso, her eyes gazing down at the rug. A man around her age was seated beside her.
A TV in the corner broadcast the local news as the couple waited in silence for 15 minutes before a physician’s assistant asked the woman to follow her to an exam room. The man waited for her in the reception area, pacing at times with his arms crossed or his hands behind his head.
Among its three facilities — in Glen Cove, Hempstead and Massapequa — Planned Parenthood of Nassau County serves about 14,000 patients a year, according to JoAnn Smith, the organization’s president and CEO, and its clinics’ waiting rooms host no shortage of emotional patients.
People often turn to the almost century-old nonprofit, a widely known reproductive and sexual health care provider, for medical attention that requires discretion that they don’t trust their pediatricians or primary-care physicians to provide. Its clients include underage, sexually active youths exploring birth-control options, gay men seeking preventative HIV medication and women considering ending unplanned pregnancies.
On June 1, the Department of Health and Human Services proposed a new federal rule that would limit Planned Parenthood’s ability to provide family planning and preventive health care, especially for low-income patients.
If enacted, the rule would strengthen a 1976 statute that prevents federal grant money from being used for abortions. The statute, known as the Hyde Amendment, was named for its author, former U.S. Rep. Henry Hyde, a Republican of Illinois.
To date, clinics that provide abortions have demonstrated compliance with the Hyde Amendment through accounting procedures that show how funds from Title X, a Nixon-era family planning program, are spent. The new rule would require a physical distinction between a clinic’s abortion-related services and others. Put another way, each clinic would need two buildings, one for Title X health care services and another for abortions.
The new rule would also bar doctors who receive Title X funds from discussing abortion as an option with their patients, which the American Medical Association has said could compromise the doctor-patient relationship “and force physicians . . . to withhold information that their patients need to make decisions about their care.”
Critics say that the federal government would essentially impose a gag rule on doctors. Since the 1980s, every Republican president has enforced a “global gag rule” on foreign aid money, while each Democratic president has rescinded it. If enforced, the new DHHS rule would be the first government-implemented domestic gag rule.
In its proposal, DHHS contends that the proposed rule would bring the department’s Title X regulations into compliance with laws already on the books, noting that the Hyde Amendment’s broadly defined terms give the department the leeway to interpret the prohibition on funding programs for abortion.
“Title X programs that subsidize other programs where abortion is a method of family planning, through infrastructure building, cost sharing, or otherwise, run afoul of the statute,” the DHHS proposal reads. “Congress made clear that ‘none’ of the Title X funds should go to support such programs.”
Family planning economics
“We will not take gagged money,” as a matter of principle, Smith said unequivocally, explaining that medical ethics require doctors to provide patients with as much information as they need to make informed decisions about their health care.
Title X funding comprises 3 percent of Planned Parenthood’s budget in Nassau, which would not be a crippling loss, Smith said. In 2017, the group’s annual budget was roughly $10 million, according to its annual report. The organization could lose about $300,000 in funding if the new federal rule were enacted.
At the same time, Planned Parenthood needs to remain enrolled in another federal rebate program dating back to the presidency of George H.W. Bush that, according to Smith, reduces the cost of an $800 intrauterine contraceptive to between $50 and $200. “All of our patients benefit from this pricing,” she said.
“Regardless of any federal defunding,” Smith continued, “our doors will stay open for our patients. Whatever we can do, we are going to do.”
Beyond providing less-expensive care for Planned Parenthood clients, she said, funding family planning efforts is fiscally responsible for taxpayers. Citing a 2015 study by the Guttmacher Center for Population Research Innovation, Smith said that “every dollar spent on family planning saves seven Medicaid dollars down the road.”
She added that because fewer people would be able to afford contraceptives, stripping Planned Parenthood’s Title X status could result in more unplanned pregnancies and more abortions.
The political issue
State Assemblyman Charles Lavine, a North Shore Democrat, said he wasn’t surprised that the federal government would, under President Trump, propose a rule to further limit abortions without considering the possible consequences. “They don’t care about that,” Lavine said. “They care about satisfying an emotional issue and a hyper-religious issue.”
If the rule were to go through, he said, New Yorkers might be able to take the issue to the courts, Lavine said, because the State Constitution goes beyond the rights delineated in the U.S. Constitution.
He called the proposed policy a “mostly symbolic” nod to Trump’s base, adding, “We’re always in grave danger when symbolism . . . becomes more significant than the issue itself.”