The Fight to Keep Title X Strong

By Lauren Weiss, Director, Advocacy & Communications, National Family Planning and Reproductive Health Association and Zara Day, Pharmacy Analyst, Planned Parenthood Federation of America

 On March 4, 2019, the Trump-Pence administration finalized a regulation, sometimes referred to as the domestic gag rule, which would dramatically alter the Title X (ten) family planning program. For nearly 50 years, Title X has served as the nation’s only federal program dedicated to ensuring high-quality, affordable family planning and sexual health care for poor, low-income, and otherwise underserved people.

 For the last six years, the Department of Health and Human Services has been appropriated $286.5 million to administer the competitive grant program in communities across the country. Unfortunately, this funding level for Title X is wholly insufficient to meet the demand for the program. In fact, current funding levels are less than 40 percent of what is needed to meet the need for publicly funded family planning in this country, according to analyses published in the American Journal of Public Health. Despite reflecting a small portion of federal dollars spent on health care and the program’s statutory prohibition on using funds for abortion services, Title X has been on the receiving end of criticism and pushback in recent years from conservative lawmakers who seek to undermine the program as part of an anti-choice policy agenda.

 Title X funding goes to nonprofits and state and local public health agencies to subsidize family planning and related preventive health services, including contraceptive counseling, services, and supplies; Pap smears; cancer screenings; sexually-transmitted infection (STI) testing and treatment, HIV testing and education, and community outreach and sexual and reproductive health education. All services are provided at no cost to people who have incomes below the federal poverty line (FPL) – who make up more than two-thirds of patients served - and on a schedule of discounts to people with incomes between 101 and 250 percent FPL.

 All of these critical services are at risk under the new rule. The Trump-Pence administration’s final rule gags providers from offering patients a full range of medical options, prohibiting them from referring for abortions even if a patient requests a referral, and coercively requiring that all patients with a positive pregnancy test be referred for prenatal care regardless of the patient’s wishes. The rule also removes the term “medically approved” from a requirement that Title X projects offer a broad range of contraceptive methods, potentially opening the door for crisis pregnancy centers to receive federal funds to provide confusing, medically unsound and unethical care to patients. The rule imposes unnecessary physical and financial separation requirements between a Title X program and the provision of abortion services or any other activity the administration deems to support, promote or advocate for abortion. Additionally, the rule creates onerous reporting requirements for program participants. In the aggregate, all of these changes are targeted at penalizing the current network of highly qualified health centers, some of whom separately offer abortion care, an ethical and legal service. If the courts do not block this unlawful rule, the nation should expect decreased access to high-quality, compassionate care for low-income patients and for patients of color, who are disproportionately represented in the Title X patient population.

 So, some CHF members are fighting back. NFPRHA, jointly with one of its Washington state-based members, Cedar River Clinics, as well as PPFA, jointly with the American Medical Association, have filed lawsuits, including motions for preliminary injunctions, seeking to block the rule from taking effect. This is in addition to separate litigation filed by the Title X grantees in California and Maine and the attorneys general representing Washington, California, the city of Baltimore, and Oregon, the last of which is joined by 19 states and the District of Columbia.

 Both public health experts and the medical community are on the side of barring the Trump-Pence administration from moving forward with these egregious policies. Moreover, an array of stakeholders are working together to raise awareness about the dangers posed by this rule and to mobilize our champions in Congress to speak out against this attack and support bold policies that strengthen the network, including increased funding to meet the needs of people across the country. The response has been tremendous - in the last month, 197 members of the House of Representatives and 42 members of the Senate have signed Dear Colleague letters in support of increased funding for Title X in the FY 2020 appropriations process. Clare Coleman, NFPRHA’s President & CEO, also testified about the need to support the current network of providers in front of the Labor, Health and Human Services, and Education Subcommittee of the House Appropriations Committee. Blocking the rule and strengthening investments in Title X annually will help the program deliver on the nation’s imperative to ensure that the people are able to access affordable birth control and preventive to care, which in turn supports their ability to fulfill their goals.

 NFPRHA and PPFA urge you to join us in support of Title X and the millions of patients who rely on it. For more information about fighting the Title X rule, please contact Lauren Weiss at lweiss@nfprha.org and Jack Rayburn at jack.rayburn@ppfa.org.  

 The National Family Planning & Reproductive Health Association (NFPRHA) is a non-partisan 501(c)3 membership association that advances and elevates the importance of family planning in the nation’s health care system and promotes and supports the work of family planning providers and administrators, especially in the safety net.

 Planned Parenthood (PPFA) is the nation’s leading women’s health care provider and advocate and a trusted, nonprofit source of primary and preventive care for women, men, and young people in communities across the United States. Each year, Planned Parenthood’s more than 600 health centers provide affordable birth control, lifesaving cancer screenings, testing and treatment for sexually transmitted diseases (STDs), and other essential care to 2.4 million patients. We also provide abortion services and ensure that women have accurate information about all of their reproductive health care options.

 

 

Fighting the Funding Cliff

By Ben Corb, Board Member, Coalition for Health Funding

Co-Chair, NDD United

Director of Public Affairs, American Society of Biochemistry and Molecular Biology

There are a lot of expectations for the 116th Congress. In the public health and health research communities, many of us are advocating for more funding for programs, projects, and activities at the Department of Health and Human Services and for good reason. In recent years, many of these activities have seen cuts or watched their buying power erode as their funding failed to keep pace with inflation.

However, all of this advocacy will be for naught if Congress does not pass legislation to avoid a steep, $55 billion funding cliff for nondefense discretionary (NDD) programs scheduled to take effect at the end of this fiscal year. Without another bipartisan budget deal to #RaiseTheCaps, it will be all but impossible for the House or Senate to maintain funding for health programs, let alone provide the resources necessary to begin to make up for years of cuts.

NDD United, founded and co-led by the Coalition for Health Funding, has been successful in advocating for two other two-year deals to raise the budget caps, which means that the most extreme funding levels were only allowed to be implemented in one year since the law’s enactment. As a result that year, there were significant reductions in funding for every program, project, and activity across the discretionary landscape. For health, this meant significantly fewer grants for research, fewer patients receiving care, fewer future healthcare providers trained, fewer public health officials monitoring and responding to threats, and much more. (Learn more about the impacts of budget cuts on health here).

 It would be devastating for Congress to allow for the current cap for fiscal year 2020 to take effect. Thus, the Coalition for Health Funding has once again joined 850- national, state, and local organizations from all different sectors to call on Congress to “Raise the Caps.” The letter, with all signatures, is available here.

Last week, House Budget Chair John Yarmuth took the first steps in preventing the enactment of the 2020 cap by introducing the Investing for the People Act, which would raise nondefense discretionary caps for two years. In 2020, it would provide $34 billion over current levels and maintain the parity principle by providing comparable increases to defense and nondefense caps. It also would allow for further adjustments to the caps for the big ticket items including the 2020 Census. Despite the need for relief, however, there are inter and intra party struggles on both sides of the aisle that make the bill’s passage uncertain.

With a divided Congress and growing deficits, the path to #RaiseTheCaps this year is not clear, and advocates must realize that bipartisan budget deals don’t just happen. It will take the advocacy of people and organizations across the nation to again avoid harmful cuts. We hope you will continue to engage with us in both the #RaisetheCaps and #FUNdHealth campaigns to keep the drumbeat going.

 

We encourage groups to continue to stay engaged with NDD United throughout the year as Congress continues conversations about topline funding by following them on Twitter at @NDDUnited or signing up for the distribution list on www.nddunited.org.

2019 State of the Coalition

By Craig Kennedy, President

Next year, the Coalition for Health Funding will celebrate its 50th Anniversary marking five decades of working together to protect and promote federal investment in the public health continuum. As the new President of the Coalition, I am proud to continue the work of Donna Meltzer, Don Hoppert and all our previous Coalition presidents to work with all of you to improve the health of people across the country.

Having now served on the Board for six years and a Coalition member for 20 years now, I have seen first-hand how this Coalition continues to grow and lead the national conversation about health funding. From our humble roots at the American Association of Medical Colleges, we have grown to more than 90 members representing over 100 million patients and consumers, health providers, professionals, and researchers.

Our signature educational events, including the Public Health Fair and Public Health 101 congressional briefing, have helped to educate hundreds of lawmakers and advocates across Capitol Hill about the role the federal government funding plays in protecting and improving Americans’ health. Our leadership of the NDD United campaign resulted in THREE deals to raise the austere budget caps, and we successfully advocated for emergency supplemental funding for public health crises such as Ebola and Zika. Further, we proactively educated our members and the public through thousands of daily “Member Updates,” hundreds of statements, and more one-pagers than we could count. If you don’t believe me, check out what we did in 2018 alone in our new Annual Report!

Still, our work is not done. Already this year we have experienced the longest shutdown in American history, and we are facing the return of austere budget caps, a debt ceiling debate, and numerous other health funding cliffs. The public health community must continue to speak with one voice in order to overcome these challenges together. Thus, it is my personal goal to grow this Coalition to more than 100 organizational members in order to further strengthen the voice of the Coalition, of public health, and our entire community in the upcoming funding debates.

This Coalition leads the way on the broad funding issues that affect federal funding for health programs. As we look ahead to the remainder of the 116th Congress, I believe that, due to the strength of the alliance among our members, the Coalition will to continue to be the leading voice for public health funding and I look forward to working with all of you to ensure the best is yet to come!

Thank you very much, and I am honored to serve you and the entire Coalition during my term in office.

CHF: Putting the FUN in Health Funding

Posted by: Emily J. Holubowich, Executive Director, Coalition for Health Funding

Allow me to welcome you to the Coalition for Health Funding (CHF), our new website, and our new blog!

It was nearly 10 years ago that the Board of Directors selected me as CHF’s new Executive Director—among the greatest honors of my career. Since then, CHF has done more than I ever would’ve dreamed. We nearly doubled our membership and tripled our revenue, expanded our member offerings, secured three budget deals to #RaiseTheCaps by founding and leading the NDD United campaign, and created a respected brand identity in Capitol Hill and beyond. Perhaps most importantly we’ve had fun doing it, as our members will attest in these testimonials.

If you are not currently a member, now is a great time to join CHF. Every June, our dues are reduced by 50 percent. Since Congress never wraps up the budget appropriations process on time by October 1 (the last time they did so was more than 20 years ago…sadly before my time) there are plenty of CHF activities and services that will help you get more than your money’s worth between now and the end of the calendar year:

1.     We will host our third annual Public Health Fair on September 12, where every member is invited to host a booth for free. This event draws more than 250 attendees, including Members of Congress and many congressional staff.

2.     Our daily e-newsletter, the “Member Update,” will keep you up to date on all the latest breaking health and appropriations news in a convenient format. You can also advertise your congressional briefings and other free events, as well as sign-on letters and publications to a listserv of more than 300 public health and health research advocates.

3.     We will lead delegations on agency tours of the Centers for Disease Control and Prevention (CDC) in Atlanta and the National Institutes of Health (NIH) in Bethesda. These tours help members gain a deeper understanding of the missions of these agencies by visiting with agency officials and exploring labs.

4.     We will host members-only meetings featuring senior administration officials, Members of Congress, committee staff, and experts.

The overarching goal of CHF’s strategic plan is to be the “biggest, best coalition around.” If you’re not already a member, we hope you will consider joining us. If you are a member, I thank you for your continued your support. We couldn’t do what we do without you.

Together, let’s keep putting the FUN in health funding!