The Biden administration is moving to reverse a Trump-era family planning policy that critics describe as a domestic "gag rule" for reproductive healthcare providers.
The proposal published on Wednesday would largely return the federal Title X family planning program to its status before Trump took office. The current rules, implemented in March 2019 under Trump, forbid any provider who provides or refers patients for abortions from receiving federal funding through Title X to cover services such as contraception and STD screenings for low-income people.
"As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings" for sexually transmitted infections, said the proposed rule published by the U.S. Department of Health and Human Services.
A 30-day public comment period for the proposed rules begins on the afternoon of April 15.
The Trump administration implemented the current rules in an effort to "defund Planned Parenthood," as he had promised supporters during both his campaign and his presidency. That prompted more than 1,000 health clinics in dozens of states, including but not limited to Planned Parenthood, to leave the program.
Planned Parenthood President Alexis McGill Johnson welcomed the policy reversal and said over the past two years, the Trump administration's approach "really did decimate access to affordable reproductive health care ... and it severely decreased the program's healthcare provider network, which puts more financial restraints on patients."
A report by the Guttmacher Institute, which supports abortion rights, estimated that the Trump rules reduced the capacity of the Title X network by 46% nationwide.
Under current law, federal funding for abortion is prohibited in most situations — although Biden and many other Democrats support ending that prohibition.
Polling by the Kaiser Family Foundation in 2019 found that 58 % of respondents opposed the Trump rules, and that Republicans were nearly evenly split in their opinion.
Abortion rights opponents argue that taxpayers who oppose abortion should not be compelled to support, through public funding, any organization involved in providing or referring patients for abortion. Many have advocated for shifting services to crisis pregnancy centers, which counsel patients against abortion, or public health clinics, which provide similar services but often struggle to meet patient demand.
Carol Tobias, President of the National Right to Life Committee, told NPR that she worries the Biden administration's proposal would make it "too easy" for providers to advise women to choose abortion.
"The agency that is getting the Title X funding can refer for abortion and tell them, 'Oh and by the way, we do abortions in this same facility if you want to set up the appointment,'" Tobias said.
Healthcare providers who've offered services through Title X say they are ethically obligated to offer pregnant patients a range of options based on their interest and need, which may include abortion or adoption.
"We are not coercing anyone into making the decision that's right for them," said Lisa David, President and CEO of Public Health Solutions in New York, which primarily serves low-income New Yorkers needing a range of healthcare services. "But we do want to provide information if they want it, and a referral if they want it."
David's organization, which does not provide abortions but refers patients for the procedure upon request, left the Title X program in response to the Trump administration rules. David said she's been able to temporarily cover costs through emergency state funding, and hopes to rejoin the program under new rules from the Biden administration.