The Department of Health and Human Services Department (HHS) will soon set the terms for obtaining grants under Title X, a federally funded family planning program long reviled by conservatives. Officials within HHS who have been critical of Title X in the past now have the opportunity to reshape the program to fit the anti-abortion views of the administration.  

Teresa Manning, the deputy assistant secretary of the office of population affairs at HHS, which oversees Title X, is a prominent anti-abortion advocate and a former lobbyist for the National Right to Life Committee. That group led the charge for restrictions on the program under President Reagan.

“This is the administration’s first attempt to really kind of redefine what they want the family planning program to look like,” said Audrey Sandusky, communications director for the National Family Planning and Reproductive Health Association (NFPRHA), which represents Title X grant recipients.  

“We anticipate some attempt to undercut the program,” she said.

Supporters of Title X worry the administration will freeze out clinics that also provide abortions, restrict the types of services performed at clinics, limit access to some types of birth control or reduce funding for the program.

Meanwhile, anti-abortion advocates are hoping the administration will resurrect Reagan-era regulations that banned Title X providers from offering abortion referrals and counseling and from encouraging, promoting or advocating abortion as a method of family planning. This would have to be done through the rulemaking process, which could take months.

“The best thing for health care and for women is that they receive [family planning services] in a setting that’s devoid of the possibility of Planned Parenthood pushing quote unquote options, when what they’re doing is referring them to the abortion facility,” said Steve Aden, chief legal officer and general counsel at Americans United for Life, an anti-abortion advocacy group in D.C. 

“It might be next door, it might be across town. But virtually all of these clinics have affiliated abortion providers and they refer over. The best atmosphere for women would be one free of that kind of pressure.”

The Trump administration’s intent will be clear when HHS issues a funding opportunity announcement for the Title X grants. The conditions are expected to differ from the ones that were set by the Obama administration, perhaps significantly.

The amount of money at stake is significant.

The nonpartisan Congressional Budget Office estimated that Planned Parenthood and its affiliates receive about $60 million a year through the Title X program. In 2017, Congress appropriated $286 million total for the grants.

Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, which supports abortion rights, said it would be naive to think the Trump administration wouldn’t take the opportunity to “put a flag in the ground” on Title X.

“The administration has shown its cards to some degree in its opposition to abortion and providers who offer or are affiliated with abortion.” 

President Trump signed a bill earlier this year allowing states to defund Planned Parenthood for political reasons, reversing a last-minute rule signed by former President Obama. The Trump administration’s fiscal 2018 budget request also would have excluded Planned Parenthood affiliates from all forms of federal funding, but that provision has yet to pass Congress.

That leaves Title X as the most plausible route for the administration to crack down on abortion providers. While federal dollars, including Title X grants, can’t be used to pay for abortions, critics argue that the money is fungible and could still indirectly support the procedure if it goes to groups that perform abortions like Planned Parenthood.

That’s the argument for resurrecting Reagan-era restrictions requiring a physical and financial separation between Title X projects and abortion services, including separate waiting and examination rooms, separate staff and separate accounting records. 

“That’s been a really big concern I think in the pro-life community,” said Melanie Israel, a research association at the conservative Heritage Foundation. 

“Ultimately, money is fungible, and at the end of the day, those regulations were really important to make sure there was truly some separation there.” 

The Reagan-era regulations were upheld by the Supreme Court but were never fully implemented due to time-consuming legal challenges. Former President Clinton officially lifted the restrictions in one of his first executive orders. Restoring these regulations could take months, but Heritage and other groups that support them say it would make certain that absolutely no federal funds go toward abortion.

“We think the administration should be interested in ensuring that taxpayer dollars aren’t subsidizing abortion entities,” said David Christensen, vice president of government affairs at the Family Research Council.   

“Doing this would not prevent organizations like Planned Parenthood necessarily from getting Title X funds. It would mean though that the Title X family planning program would have to be physically and financially separate from an organization’s abortion activities.”

Guttmacher’s Kinsey said the possible changes to Title X would have a big impact on women, especially those living in underserved communities.  

“Any attempt to undermine this program or the providers or women’s access to affordable care would be a huge setback and would definitely impact these women in these communities and represents a really unacceptable disruption of the program.”