Last week, the Biden administration announced it would be rewriting the Title X rules put in place by former President Donald Trump that banned health centers that provide abortions—or even refer their patients for abortions at other clinics—from receiving federal funds.
For reproductive health advocates, the news is cause for celebration: When the Trump rules went into effect in 2019, more than 900 clinics across the country lost their funding, forced to decide whether they would stop providing abortion services or sacrifice millions in government support. Major clinic networks like Planned Parenthood immediately dropped out of the family-planning program, as did six states. State health departments disburse the federal funds, and Illinois, Maryland, Massachusetts, Oregon, Washington, and Vermont exited the program all together.
In total, Title X providers serve some 4 million patients, most of whom are people of color, low-income individuals, and people who live in rural communities.
But these decisions also came with significant compromises. Many clinics had to make cuts to some of the services they provided, and two Planned Parenthood locations shut down. Others teetered on the brink of bankruptcy and closure, dipping into their own budgets to subsidize care for patients that the federal government would no longer fund.
“We had to scale back services,” said Mercedes Sanchez, the director of communications at Cedar River Clinics, a clinic network in Washington State. Though the clinics still provided the same breadth of services—birth control, STD testing, cancer screenings, and abortion care—they had fewer appointments available to their patient base under Trump’s Title X policy.
“The state subsidized some of the cost with its own family-planning funding,” she explained. “But since we’re very committed to making sure people get access, we also subsidized some of the costs ourselves. There has definitely been a big financial strain.”
The Women’s Health Center of West Virginia did the same. The clinic’s leadership felt they had no choice but to withdraw from the Title X program under the new rules: The health center is the only abortion provider in the entire state.
“While we were able to protect our patients from feeling the effects of the policy, we certainly felt them,” said Katie Quinonez, the clinic’s executive director. “We were providing the same services at the same costs to uninsured patients, and we were using our own operating funds to make up the difference.”
The new Biden rules are expected to ease some of that strain: Cedar River Clinics expects to be able to restore its services, and Sanchez says there are plans in the works to open a new telemedicine satellite office in eastern Washington, a more rural part of the state with fewer providers.
But while providers and advocates say that they are breathing a sigh of relief over the latest news from the Biden administration, it will take a while for some clinics to recover from the effects of the Trump rules.
“There’s no on/off switch to fixing the damage done under the Trump administration’s regressive program restrictions,” said Audrey Sandusky, the senior director of policy and communications at the National Family Planning & Reproductive Health Association (NFPRH). “So we expect a long road to recovery. There is no prescribed or assumed time frame when we can expect the network to be fully stabilized.”
Even with President Joe Biden’s commitment to making the program friendly to abortion providers again, clinics are looking at several months before they can reenter it. According to Politico, the administration has decided against immediately rescinding the policy in order to avoid a potential court battle. Instead, Biden’s Department of Health and Human Services has said it plans to propose “revised regulations substantively similar” to those in effect pre-Trump and open a public comment period no later than April 15.
The final version of the Title X policy is not expected to be issued until this December, and only then can clinics begin reapplying.
“We’re probably looking at a year out honestly,” Sanchez said. “We’re glad it’s happening, but we wish it would happen faster.”
The clinics that shuttered may not return. Once a clinic closes its doors, there are financial and logistical obstacles to reopening that can be insurmountable.
“Laying off a fabulous nurse, telling them they no longer have a job because of political interference, is one of the hardest things we’ve ever done,” Amy Hagstrom Miller, the CEO of the Texas clinic network Whole Woman’s Health, told Vice in 2019, recalling the difficulties she faced when a Texas law shut down two of her clinics. When staff gets laid off, she said, “they’ll have to get other jobs, making it very difficult to reopen and rebuild [later on]. It might not be something you can afford to do.”
Clinic providers say that’s why reinstating the old Title X rules is just one small piece of the battle to stay open and continue serving their communities. They hope the Biden administration keeps some of its other promises to abortion rights advocates, including his pledge to get rid of the Hyde Amendment—which prevents federal funds from paying for abortion services independent of Title X—and strengthening federal abortion rights.
“We’re really hopeful that we’ll be able to reenter the program relatively quickly, but we recognize that the fight doesn’t stop there,” Quinonez said. “It’s about working toward a health care system that doesn’t ban insurance abortion coverage, that doesn’t stigmatize abortion care.
“We’re lucky we had generous donors in the community who supported us and who helped us keep our doors open,” she continued. “But we shouldn’t have to be in the position to do that to make sure people get the care they need.”
Correction, March 23, 2021: A previous version of this article misstated how the Trump administration implemented the Title X changes.
