Title X changes include new rules on what doctors can and cannot say to patients
March 22, 2019 (ACP) – The American College of Physicians and its allies are raising the alarm as the Trump administration pushes forward with plans to step into the doctor-patient relationship in a way that would create new burdens for medical personnel.
“We're standing together in opposition as new regulations threaten to impose a gag order on clinicians who provide family planning services that are funded by the federal Title X family planning program,” said Shari M. Erickson, ACP's vice president for governmental affairs and medical practice. “Both physicians and patients have a stake in protecting access to these important services.”
The Title X family planning program is the only federal program exclusively dedicated to providing vulnerable patient populations with important health care services, including cancer screenings, vaccinations and family planning services. Those eligible to receive Title X assistance have limited insurance coverage or none at all.
“According to the most recent data, 4,000 clinics nationwide received Title X funding, including specialized planning clinics like Planned Parenthood, state health departments, school-based clinics, and more,” Erickson said. “All the money goes to evidence-based medical care, and nothing is spent on abortion.”
She explained that the services funded by Title X are critically important for people who would not be able to afford them otherwise. “Access to these services allows vulnerable populations to better plan and take care of their families,” Erickson said.
However, the Trump administration has targeted the Title X family planning program, finalizing in late February a policy that essentially imposes a gag order on clinicians regarding their discussions with patients.
“The policy actually puts the government in the exam room with the physician and the patient,” Erickson said. “It specifies certain things that the physician and other clinicians can and can't say to their patients with regard to reproductive health planning, and the rules go beyond discussions about abortion services.”
In addition, she noted, the policy requires clinicians to document these discussions, adding yet another layer of administrative burden. There also are other new regulations, including ones that detail how clinics must physically separate certain kinds of services.
“The final rule contradicts ACP's long-standing health and ethics policy, which supports access to quality, accessible and affordable health care for all Americans,” said Dr. Ana María López, ACP's president. “As a physician, I know many patients who already have trouble accessing health care and may forgo preventive care services and treatment altogether in the face of uncertainty and lack of resources. ACP believes that limiting access to services and advice will put patients' health at risk.”
The regulations could force clinics to close, even when they're the only local sources of comprehensive cancer screening, vaccinations and family planning services, she noted. “Already strained community health centers are not able to take up the slack,” she said. “ACP's long-standing health and ethics policy supports access to quality, accessible and affordable health care.”
Though the new policy is now final, ACP plans to respond with a letter outlining its concerns. In conjunction with allied organizations, ACP will also explore options for advocacy, such as supporting legal challenges.
“We're deeply concerned about these new regulations,” Erickson said, “and we will work to overturn them as soon as possible in order to protect patients and physicians.”
ACP joined with 18 other health care organizations in issuing a joint statement voicing objections to the Title X policy changes.
The College also put forth its own public statement reacting to the Title X changes: “ACP Opposes Title X Rule Jeopardizing Women's Health Care Services.”
Back to the March 22, 2019 issue of ACP Advocate