Rule worries health clinics

Centers that perform or refer abortions would be denied funds

Baltimore health clinics fear a proposed federal gag rule that would prohibit money from going to centers that perform or refer patients for abortions would undercut their ability to care for the city’s most vulnerable residents.

The U.S. Department of Health and Human Services has proposed a rule that would withhold funding from the Title X Family Planning Program. The federal agency is taking public comments on the issue, which is being criticized by local lawmakers and health officials, until Tuesday.

At stake in Baltimore is $1.4 million that goes to 23 health centers — $560,000 in federal money and $850,000 in money from the state that is subject to Title X rules. Those health centers served more than 17,000 patients in 2016.

Local officials, including Mayor Catherine E. Pugh, Health Commissioner Dr. Leana S. Wen and the city’s entire congressional delegation, gathered last week to denounce the looming rule change. They criticized it as politically motivated and a threat to women’s health.

“We cannot let ideology drive our health care system,” said Sen. Chris Van Hollen.

Anti-abortion groups support the gag rule. There are plenty of health centers that provide comprehensive care without referring women to or performing abortions, said Therese Hessler, director of administration and legislation at Maryland Right to Life.

“It is not hurting health care because these services will still be provided,” Hessler said. “The funding is still there. It is just being redirected.”

Title X funding doesn’t pay for abortions, but it does help cover the cost for many other contraceptive and preventive care services, including cancer screenings and HIV testing.

The rule threatens access to health care for the neediest residents, the local officials warned last week at the city health department’s Druid Clinic, one of the centers that could be affected. One woman in three in Baltimore uses publicly funded health clinics for contraception, according to the health department.

“The people who are hurt the most are those who already bear the brunt of disparities and inequities,” Wen said. “These are women of color who are low-income; who already face many barriers to their care.”

Title X is the only federal program focused on reproductive health and screening services and has contributed to a historic low in teen birth rates, which fell 61 percent in Baltimore between 2000 and 2016, the lawmakers and Wen said.

“To even be discussing something like this at this particular point of time is really a step backwards in terms of health care,” Pugh said.

The rule change could force doctors and nurses to choose between funding and giving their patients the best medical advice, officials said.

Meagan Shipley, a nurse at Druid Clinic, said a change in the rule would prevent her from giving patients full counseling and letting them know all of their options if they are pregnant.

“I firmly believe it should be the women’s choice,” Shipley said. “Abortion is still legal and we should have the right to educate women about that legal choice. Not being able to do that is just morally wrong.”

Melanie Repert, 35, first went to a Druid Clinic with a friend who needed a pregnancy test 18 years ago. She surprisingly discovered she too was pregnant. Abortion was among the many options discussed with her at the clinic and, while she chose not to have one, she said she was glad to have the option.

Repert said cutting funding would be detrimental to women who can’t afford to go to the doctor. And they should be told all their options, she added. Repert, who works as a receptionist, still goes to clinics because she can’t afford the insurance offered by her employer.

“I think the gag order is a bad decision,” Repert said. “Women have a right to know their different choices.”

The Title X funding is a small portion of the budgets of many of the centers. But Wen said the cash-strapped health centers depend on every bit of funding they can get.

Planned Parenthood of Maryland, which serves all of the state except Montgomery and Prince George’s counties, gets about 16 percent, or $2 million of its funding from Title X. Such a loss of funding would cut into the medical services the organization provides, said Dr. Raegan McDonald-Mosley, the group’s chief medical officer.

“This would affect our ability to take care of patients,” McDonald-Mosley said.

At Family Health Centers of Baltimore Inc., Title X funding is just $40,000, or less than 1 percent of the total operating budget, but Antoine Boyd, its interim chief financial officer, said the gag order would still disrupt the health center.

If they accept the funding, providers wouldn’t be able to offer as much information as necessary to address all of the patients’ needs or concerns, Boyd said. It’s a difficult choice, he added.

It also could damage patients’ confidence in their local health centers, keeping them from coming for needed care, he said.

“Losing the funding may not be a large part of our operating budget, but it is a large part of being able to provide complete, accurate care to the most vulnerable population,” Boyd said. “The funding helps with staffing health educators who are able to educate patients on family planning matters which provides a lot of value, especially for the adolescent population.”

While the General Assembly passed legislation last session to protect funding if the Title X gag rule is implemented, Wen questioned whether that funding would be guaranteed.

“The problem is that the actual funding decision is at the discretion of the governor, and all of the other Title Xcenters would be subject to the ‘gag rule’ unless we turn down needed federal funding,” Wen said. “So that’s the choice that we face: Do we reduce our capacity to provide care for some of our city’s most vulnerable people, or do we knowingly censor our providers and force them to provide worse care?"

Amelia Chasse, a spokeswoman for Gov. Larry Hogan, said “the law requires that these programs be funded, so we would allocate any necessary funding accordingly.”

It is not clear when the federal health department will make a decision on the rule change.

U.S. Sen. Ben Cardin called the gag rule an abuse of federal power that indicates the administration of President Donald J. Trump’s stance on women’s health.

“It is an attack on women’s health care that we see all the time in this administration,” Cardin said.