On Monday, Planned Parenthood withdrew from the Title X Program in response to new administrative rules implemented by the Trump administration, which prohibit organizations that provide or refer patients to abortion services from the program’s federal funding. Despite abortion being lawfully barred from Title X funding.
Opponents of Trump’s rule change call it a “domestic gag rule,” and not out of any fondness for hyperbole. The label refers to the “global gag rule,” which has been a partisan football upending U.S. federal foreign aid in developing countries since anti-abortion activists began flexing political muscle in the early 1980s. The Reagan administration shifted aid away from funding family planning and contraception abroad, replacing the strategy with a rule that prohibited federal assistance to any organizations “which perform or actively promote abortion as a method of family planning.”
“In dozens of aid-dependent countries around the world family planning providers, demographers and medical researchers are being forced to pretend that abortion does not exist,” a Population Crisis Committee report lamented at the time. Then-Senator Robert Taft Jr. (R-Ohio) similarly criticized the rule change, describing it as the “adoption of a fundamentalist, know-nothing political philosophy.”
Ever since, the aim of federal aid has changed alongside the political stripes of whatever administration occupies the White House, rendering any long-term efforts in humanitarian aid unstable at best, functionally hopeless in application.
Trump has decided to bring the “gag rule” home, setting a devastating precedent that forces U.S. health clinics and health-based organizations to “pretend that abortion does not exist” or be stripped of funding.
It’s a big hit to Alaska, which came the same day as another hit landed via prerecorded internet video: Gov. Mike Dunleavy (R-Alaska) wiped out $77 million in Medicaid funding from the 2020 budget – after the legislature restored the funding, after he vetoed it the first time. It’s a fail atop a fail that will result in less health care coverage, family planning, and preventative care for a lot of Alaskans.
“The loss of Title X funding on top of the budget cuts to Medicaid will have detrimental impacts in people’s ability to access cancer screenings, birth control, and basic health care, especially for the most vulnerable people in Alaska,” Alaska State Director at Planned Parenthood Votes Northwest and Hawaii, Jessica Cler, responded in a Monday press release.
Title X, part of the Public Health Services Act, passed Congress with bipartisan support largely extinct today; it passed the U.S. Senate unanimously and enjoyed a 298-32 margin in the House. Alaska’s delegation supported the measure, which President Richard Nixon signed into law in 1970. In 1972, Congress passed a second law allowing funds to be drawn from states’ Medicaid programs to subsidize family planning and care to the tune of a 90 percent federal reimbursement rate. Nearly half a century later, the Title X program provides nearly $300 million annually in federal grants nationwide supporting comprehensive family planning and preventative health services. That translates to about $1.6 million in funding, every year, for much needed health care access in cash-strapped Alaska.
It is the only grant program of its kind in the United States and has provided care for millions of women and children – a large percentage of whom do not have access to any alternative. And the financial investment is quantifiable: The Guttmacher Institute, a reproductive rights advocacy and research group, estimated in 2015 that Title X clinics prevented more than 822,000 unintended pregnancies nationally, “thus preventing 387,200 unplanned births and 277,800 abortions.”
In 2010, Planned Parenthood noted that the annual grant, totaling $1.9 million, provided service for 9,701 patients and prevented 1,700 unintended pregnancies, two cervical cancer cases, 14 gonorrhea cases, and 130 chlamydia cases – representing an estimated $17.9 million in savings. That’s a lot of money where there isn’t a lot of money. That’s a lot of healthier people in a state that’s ranked 15th for highest teen birth rate, second highest for gonorrhea cases, and has had the nation’s highest chlamydia rate for a decade.
Despite national and state-specific data clearly showing that Title X funding reduces the incidences of abortion while providing needed medical care, the rule change is motivated predominantly (put mildly) by anti-abortion animus. Because the new regulations require recipients of Title X funds to be “both physically and financially separate from any entity that provides or refers for abortions,” as Anna North wrote for Vox last month, “all Planned Parenthood centers would be barred from getting Title X funding” because some Planned Parenthood clinics (including in Alaska) provide abortion services and/or referrals.
Dunleavy’s anti-abortion motivation for vetoing Medicaid funds trumps Trump. The governor’s position has been an emphatic point throughout his career in politics, and his attempts to legislate Planned Parenthood out of existence have been as numerous as they have been unsuccessful. They would be laughable if he still was resigned to the same powerlessness enjoyed by Rep. David Eastman (R-Gilead), but Dunleavy keeps managing to fail upward. That’s less funny.
Most notable in Dunleavy’s extensive resume of failed anti-Planned Parenthood battles was the 2015 legislative session, when Dunleavy served in the Senate. That year, Rep. Charisse Millett (R-Anchorage) sponsored House Bill 44, named “The Alaska Safe Children’s Act,” with a goal of addressing the state’s sexual assault epidemic through creation of age-appropriate curricula in schools to “educate and provide resources for students, staff, and parents about how to recognize the warning signs of child sexual abuse.” It sailed through the House and passed with bipartisan support, 34-6.
Dunleavy didn’t like it, mostly because many of the education materials and instruction would come from Planned Parenthood – because they were the only ones offering. As chair of the Senate Education Committee, he sat on HB44 until session expired. Gov. Bill Walker (I-Alaska) supported Millett’s bill and included it in the special session docket, sending it back before Dunleavy’s committee, where he used it as an opportunity to insert one of his more absurd bills into HB44 and hope it would slide through. It did not.
Dunleavy’s rewrite of “Alaska’s Safe Children’s Act” sought to require written permission from parents before a student could participate in any instruction pertaining to sexuality or human reproduction and allow parents to opt students out of any such classes. It restricted medical professionals (read: Planned Parenthood) from teaching, providing materials for, discussing, or being present during any sex education. He tried to hijack Millett’s bill and use it as a vehicle against itself.
Aside from being an inherently counter-intuitive idea, the language Dunleavy added to Millett’s proposal was so poorly written, it would have opened the State up to litigation as endless as it would have been expensive.
“It’s not simply a problem of trying to get to a constitutional goal through unconstitutional means. The bill itself violates the Alaska and U.S. constitutions,” ACLU of Alaska’s director, Joshua Decker, would testify the following year when Dunleavy unsuccessfully reintroduced the idea as a standalone bill. “If a cardiologist from a hospital goes to a school and teaches students about CPR, the hospital itself would be fined $5,000 per student... and the teacher who knew the cardiologist was going to teach CPR would lose his job.”
Dunleavy stared blankly while the reports provided by the Office of Children’s Services were read aloud in committee: in 2014, there were 2,640 allegations of child sexual abuse with 2,110 unique victims; from January to March 2015, there had already been 783 allegations of sexual abuse among 667 victims. He ignored his own constituents, Butch and Cindy Moore, whose daughter was murdered by her boyfriend a year previous, and who were present every day in which the bill was up for discussion, pleading for its passage.
Dunleavy knew how bad the epidemic of sexual violence in Alaska was then, and is now, and he tried to make it worse in an effort to promote his entirely unrelated war against abortion. He knew it would be deemed unconstitutional, let alone impractical, but that didn’t cause any hesitation.
That’s the guy we elected.
In his first year as governor, Mike Dunleavy has punished the Supreme Court for disagreeing with his position on abortion, and now he’s trying to make it harder for Alaskans to access basic health care and preventative services. Simply because Planned Parenthood is involved. No back up plan, no alternative; instead, a vague statement accompanying his veto of Medicaid funding says only that the Department of Health and Social Services is “looking at all available options to ensure eligible Alaskans can access the Medicaid program” despite him literally axing the one and only available option for thousands of Alaskans.
“Medicaid coverage offers comprehensive, accessible and essential health services for over 210,000 Alaskans across the state. The program ensures children, expectant mothers, and low-income Alaskans are able to access the health programs they need to remain in or return to school or the workforce,” Rep. Tiffany Zulkosky (D-Bethel), co-chair of the House Health and Social Services Committee told The Press Tuesday, calling it a pillar of Alaska’s health care system and economy. “Unfortunately, the Governor’s short-sighted and ideological cuts discount the bipartisan efforts and public-private partnerships that have worked toward this collective goal. These cuts are not just a numbers game, they will have real, wide-ranging ripple effects in the lives of Alaskans seeking access to basic care, threaten the solvency of critical access health systems and many impacts we may not be able to anticipate at this time.”
“We’re doing everything we can to offer the same care to all of our patients, but know that’s not sustainable,” Jessica Cler said Monday, adding: “At a time when the federal government is directly attacking health care across this country, especially reproductive health care, we can’t afford this inept governor.”
Beyond being crass, partisan politics, what’s happening right now is insane. It is insane to sacrifice the public welfare for a personal moral objection to an unrelated matter that the Alaska and U.S. Supreme Courts have repeatedly determined is a constitutionally protected right. Dunleavy has made a career out of taking good ideas and contorting them into “fundamentalist, know-nothing political philosophy,” and, while that might earn a comfy seat representing the valley, it’s no way to represent the State of Alaska, and is a grave injustice haphazardly inflicted upon the constituents he swore to represent. It needs to stop, and that’s up to us.