AAFP Pushes for Legislative Fix for Harmful Title X Rule

July 17, 2019 11:08 am News Staff

The Academy is continuing its fight to protect the physician-patient relationship and safeguard access to comprehensive care for millions of family physicians' patients.

[young woman talking with physician]

In a July 3 letter(2 page PDF) to leaders of the Senate Appropriations Committee and the Senate Subcommittee on Labor, Health and Human Services, Education and Related Agencies, the AAFP and 19 other health professional organizations called for intervention against the final rule(www.govinfo.gov) governing the federal Title X family planning program that was issued this year.

"Federally funded Title X facilities provide access to health and cancer screenings, well-woman exams, contraception, and testing and treatment for sexually transmitted infections," the letter said. "It is of utmost importance that the integrity of the Title X program is preserved and that Congress reject any efforts that limit access to medically accurate information or interfere in the patient-provider relationship."

The AAFP and other signatories asked senators to protect the program by allocating no funding in the fiscal year 2020 Labor, Health and Human Services and Education Appropriations bill to implement the final rule.

Story Highlights
  • The Academy this month joined 19 other health professional organizations in asking Senate leaders to not fund 2020 implementation of a Title X final rule issued this year.
  • The rule jeopardizes comprehensive primary care for millions of patients.
  • The AAFP also joined amicus curiae briefs in two lawsuits related to the rule.

The move would allow some 4 million(www.kff.org) low-income, uninsured and underinsured patients each year to maintain access to comprehensive family planning and preventive health care services. As it stands, the final rule puts more than 40 percent of Title X patients at risk of losing that access, the letter stated.

An appropriations bill passed in the House(appropriations.house.gov) already contains the provisions sought in the July 3 correspondence.

The push for legislation to defend Title X became more crucial last week, following an unfavorable ruling(thehill.com) by the 9th U.S. Circuit Court of Appeals in lawsuits that the Academy had joined.

The AAFP was among several parties in a pair of amicus curiae briefs supporting separate plaintiffs who were suing the administration to block implementation of the rule while it was being challenged in court.

One of the briefs, filed in late June,(34 page PDF) objected to the rule's mandate that health care providers that receive federal funding not refer patients to facilities that provide abortions. That stipulation, argued plaintiffs who included the state of Oregon and the AMA, amounted to a gag clause that put medical professionals "in a precarious and ethically compromised position by forcing them to subvert the needs of their patients to the directives of the final rule."

Also signing that brief were the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the California Medical Association, the Society for Adolescent Health and Medicine, and the Society for Maternal-Fetal Medicine.

The second brief(29 page PDF) -- filed July 9 in support of an emergency injunction brought by the state of California, Essential Access Health and others -- also challenged the administration's position that the final rule does not bar nondirective counseling on abortion.

"HHS argues that the nondirective provision is limited to 'pregnancy counseling,' a term that does not apply to referrals," that filing said. "This assumption underlying HHS' position -- that counseling and referral are distinct -- is fundamentally at odds with medical guidance for clinical practice and longstanding principles of medical ethics."

The Academy's co-signers on that brief were the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Physicians, the California Medical Association, the Society for Adolescent Health and Medicine and the Society for Maternal-Fetal Medicine.

The court filings expose the shaky legal scaffolding of a final rule that may violate its congressional mandate.

"The essential feature of nondirective pregnancy counseling, as required by Congress, is that it is necessarily patient-directed," both briefs said. "Nondirective counseling thus requires that the patient be fully informed about the appropriate courses of care relevant to the patient's particular situation and expressed needs."

Preempting relevant care that terminates a pregnancy, however, is the opposite of nondirective counseling. And among the potential consequences for delay or failure to refer a patient for appropriate treatment is an increase in medical malpractice claims.

The letter to senators and both filings were in step with the Academy's ongoing opposition(1 page PDF) to the rule as a threat to millions of women who receive maternity and preventive care thanks to Title X coverage.

The 9th Circuit's upholding of the rule, the June brief warned, would leave patient care "severely compromised."

"The result will be devastating to the particularly vulnerable patient populations who rely on Title X for health care," it said.

Related AAFP News Coverage
AAFP Joins Supreme Court Filing Against Louisiana Law
Amicus Brief Says Law Creates Burden Without Improving Safety

(6/11/2019)

Fresh Perspectives: Our Maternal Mortality Rate Is Shameful
(3/5/2019)

Title X Change Would Threaten Evidence-based Care, AAFP Warns
Women's Health, Doctors' Ethics at Stake

(7/30/2018)