Domestic Gag Rule Puts Politicians’ Opinions Above Patients’ Quality of Care

I’m sorry to report more terrible news out of the moldy old gynoticians club that is the Trump administration:

On Friday, the Department of Health and Human Services (HHS) issued the final rule Trump has been helping to sculpt with his tiny, chubby, old fingers since it was first proposed on June 1, 2018. The rule rewrites the stipulations on funding Title X—the nation’s family planning program for low-income individuals. Title X allows patients to receive services for free or on a sliding scale, depending on their income—ensuring that everyone has access to family planning, regardless of their financial situation.

Excerpts of some of the rule’s new requirements, and my outraged responses to each:

“Requiring clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning.”

Meaning that Planned Parenthood and other organizations that provide both family planning and abortion services will have to start operating separate programs in separate physical spaces with separate accounting and separate staff—a financially impractical proposition. Separation is normal and appropriate for homemade salad dressing, not for comprehensive health care services.

“Prohibiting referral for abortion as a method of family planning.”

In other words, providers cannot counsel their patients on the full range of pregnancy options, unless the patients instigate a discussion on abortion themselves—and even then, only if the patients aren’t seeking abortion as a method of family planning. It effectively has the Trump administration deciding whether someone’s reasons for wanting an abortion are okay. Horrifying.

“The final rule does not bar nondirective counseling on abortion, but eliminates the requirement that Title X providers offer abortion counseling and referral. It protects Title X healthcare providers so that they are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.”

So providers’ personal/religious beliefs outweigh the health and wellbeing of patients seeking a safe, legal medical procedure? Cool.

“Requiring clinics to encourage meaningful parent/child communication – and, as required by federal law, to encourage family participation, especially in a minor’s decision to seek family planning services – and to provide practical ways to begin (and maintain) such communications.”

Which is awesome if parents are open to the realities of teen sex and have their kids’ best interests in mind (and aren’t sexually abusing them). Not as awesome if parents go ballistic upon finding out their kids are sexually active, or if kids fear that they will—avoiding nonconfidential healthcare is a lot easier than dealing with a parental temper tantrum. Ergo unintended teen pregnancy and STI transmission. (Note: Encouraging parental involvement in minors’ care has long been part of Title X. What’s new in this rule is the requirement that clinicians document the various ways they attempted to involve parents.)

What’s Next?

The rule—dubbed the Domestic Gag Rule for its similarities to the Global Gag Rule—will go into effect 6o days after it’s published in the Federal Register, which should happen soon. (3/2/19 update: The rule was just introduced to the Federal Register for March 4, and will go into effect on May 3, barring a successful legal challenge.)

And like the Global Gag Rule, it’s a thinly disguised ruse to transfer public health funding from real providers to conservative religious organizations that refuse to provide accurate information and comprehensive care. It follows the clear pattern set in the earliest days of this administration: find a vulnerable population to target and act to make their lives harder and riskier.

Legal challenges are already being announced, so if there’s any justice, the new rule will be thrown out along with the empty jugs of prune juice and blister packs of hypertension pills that surely litter the HHS offices.

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