Warren Albrecht | United States
President Trump’s so-called Title X gag rule of medical staff from family planning clinics does nothing more than reduce abortion money. Planned Parenthood receives almost $60 million in Title X grant money. The mainstream media headlines are always about Planned Parenthood and the catastrophe if one clinic closes.
Today, the media testimony in support of Title X is discussed as women’s health. However, Title X is not designed for that result.
The Secretary of the Department of Health and Human Services oversees Title X activities and monies. All arguments against the recent Title X rule by the Trump Administration is about the interpretation of the “abortion” section of Title X. Section 1008 of the Family Planning and Population Research Act reads, “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.”
If the world is to collapse because of overpopulation, as was the concern of President Nixon and John D Rockefeller III, then Title X would be the single most important federal funding plan in the history of the world. Today, Title X is continually fought over as a money machine for abortion referrals.
The War Over Title X
The Discretion of the Secretary
Harris v. McRae (1980) supported the Hyde Amendment which essentially restricted Medicaid money for elective abortions. Williams v. Zbaraz (1980) said states could create their own Hyde type laws limiting how states use Medicaid money. Rust v. Sullivan (1991) supported the 1988 Secretary of Health and Human Services regulation in restricting employees at federally funded family-planning clinics from counseling on abortion. According to Rust, “an agency must be given ample latitude to adapt its rules to changing circumstances.”
The secretary can review regulations and make changes pertaining to Title X. An important term within this finding is “nondirective counseling”. Future Secretaries of HHS could make rules interpreting this differently as decided in Rust (1991). The Supreme Court, however, has made a decision. All media arguments are just for show. Any lower court decision that contradicts the Supreme Court is just an attempt to slow down the Trump administration.
In 1993, President Clinton sent a memorandum to the Secretary of HHS reversing the so-called “Gag Rule”. The administration believed that it “interferes with the doctor-patient relationship by prohibiting information that medical professionals are otherwise ethically and legally required to provide to their patients.”
Then, by the Bush administration in July of 2000, a new interpretation was given and discussed that the use of a form of the “Gag Rule” was present long before 1988. It discussed the non-directive counseling including abortion. It notes that no Title X funding will be used for abortion or any activities encouraging abortion. Even back in the 1981 guidelines, though non-directive, the counseling for pregnant women should be all-inclusive, including prenatal care with a discussion of infant care, foster care, adoption, and pregnancy termination. The counseling should not encourage or promote one over another.
You will see multiple liberal media articles referring to a strict interpretation of the Section 1008 of Title X as a “gag rule”, but the liberal interpretation tends to ignore Section 1008 as a “Federal Requirement”. This was the description of a decision letter (rule change) by then-Director of CMS for Medicaid, Vikki Wachino, during the Obama administration.
Trump’s Rule and the Stark Law
The Stark Law is named after Pete Stark, a Democratic congressman from California. This is in the federal code to act as a deterrent for physicians referring to facilities they may have a financial stake in. Further legislation has been proposed for similar issues such as the Promoting Integrity in Medicare Act (PIMA) of 2017, which was sponsored by Jackie Speier (D-CA).
Assume that a family physician has part ownership in an independent radiology, Lab X, which includes CAT scans and MRI scanning. There are a number of other options in town, but this physician sends everyone to Lab X. Now, the family physician is struggling with her reimbursement from the new CMS and Affordable Healthcare Act changes. She looks at new financial streams. She invests in an independent radiology, Lab X, to compete with the local medical center. One can see the ethical problems which arise. Will the physician send everyone to get CT scans? This may help in the diagnosis but could be overdoing it with the government paying for it. The Stark Law oversees this for Medicare and Medicaid.
The Trump rule, as the rules from Bush Sr, and Bush Jr., looks at self-referral inside the Title X Section 1008 prerequisite directing no money for abortions. Accounting gimmicks are used so Planned Parenthood can say no Title X money is used for abortions, but everyone understands that it is going into the same money pot. If the medical staff is supposed to follow non-directive counseling but instead of including infant care, foster care, adoption, and pregnancy termination, leans toward termination because the company sign is Planned Parenthood, then that is self-referral and “directive” counseling. With private money, anything may go. These referrals are the focus of any administration criticized for developing a “gag rule”.
Trump’s Rule is Not Gagging Anyone
The newest rule by the Trump administration discussed commenter’s responses. The media refuses to even adequately report on the document.
A physician is always obligated to place all options on the table and allow the patient to decide. The new rule admits that both the Title X program and Congress agree that the information and discussion between any health care provider and the patient is counseling as long as it is non-directive.
Is abortion actually family planning if it is after the pregnancy has started? Do the restrictions placed on Title X intend to define abortion not as family planning but as pregnancy termination? The Trump rule permits the patient to ask any questions and expects those questions to be answered. It must be acknowledged that Title X only takes abortion out of the umbrella of family planning. However, the media nor the president of Planned Parenthood will acknowledge this.
Title X and Government Cronyism
The language is clear, and this rule does not swing outside the boundaries of what has been maintained for decades. The new Title X language is not detrimental to women’s health. No statistics of improved female health with funding, or morbidity or mortality without funding, can be derived from any study pertaining to any organization receiving money from Title X. Title X has not decreased the number of cervical, uterine, ovarian, or breast cancer rates in females 15 to 44 years of age or those living below the poverty line.
The recent so-called “Gag Rule” by the Trump administration is nothing of the sort. The term is a propaganda and fundraising opportunity for Planned Parenthood. The fight for the Title X money and endless referrals for abortion will continue. There is no big money in condoms and birth control pills except for medical and pharmaceutical companies. Any deviation in wordage of Health and Human Services Title X rules by the Clinton or Obama administrations has been to support the possible referral process for abortion procedures and funding, especially for Planned Parenthood. The potential taxpayer dollars involved and the number of abortion referrals are worth the ongoing fight.
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