Why does Title X funding still exist, post-Obamacare?

Last updated on: August 2, 2015 at 11:55 am by Jane the Actuary

Why does Title X funding still exist, post-Obamacare? 2015-08-02T11:55:45-06:00 Jane the Actuary

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Title X is, of course, the program that funds contraception, as provided by Planned Parenthood and others, for low-income women. Planned Parenthood is certainly not the only beneficiary of the program; as described by the HHS website,

The U.S. Department of Health and Human Services’ Office of Population Affairs (OPA) oversees the Title X program. OPA funds a network of nearly 4,200 family planning centers which serve about 4.5 million clients a year. Services are provided through state, county, and local health departments; community health centers; Planned Parenthood centers; and hospital-based, school-based, faith-based, other private nonprofits.

It’s difficult to find the exact amount spent on this program; Wikipedia’s information is outdated and inconsistent — is it $317 million or $2.4 billion? Either way, the figures are from 2010, though the share going to Planned Parenthood, 25%, matches what I’ve read elsewhere. According to the Wall Street Journal,

Planned Parenthood received federal and state grants and reimbursements of about $528.4 million last year, mostly from Medicaid, the federal-state health program for the poor.

Is this Title X money? The math is about right.

But I read a comment on facebook the other day, raising this issue: Title X was all about providing contraception to uninsured women, who weren’t able to go to a regular doctor’s office or pharmacy. Obamacare/the ACA has significantly reduced the number of poor women without health insurance, even if, for the most part, though expansion of Medicaid rather than through increased purchase of private or employer-provided insurance. True, not all states have agreed to expand Medicaid to the new eligibility level of 133% of the federal poverty level, but the majority have, including the most populous ones.

Which should mean that former Title X clients at federally-funded family planning clinics ought to be able to access the mainstream healthcare system, right? And, while Planned Parenthood has tried to reposition itself as a provider of healthcare, a chain of gynecologists, if you will, it would make much more sense for contraceptive services to be integrated into general healthcare services, and for women to be able to access ladypart-related medical services in the same manner as they access healthcare services for the flu or a sprained ankle. To a certain extent this is already the case: looking at the HHS website and searching for local locations, I found the ACCESS Community Health Network, a federally-funded sliding-scale network of clinics which receives Title X funds as well as other money to provide a full range of healthcare services.

In this context, does Planned Parenthood really make sense? Its defenders, such as the Guttmacher Institute, make the claim that Title X is needed “now more than ever” but I’m not particularly persuaded:

Now, millions more women can afford the most effective and often the most expensive methods of birth control. Yet, even with insurance, women need a place to go for services. Sustaining—if not strengthening—the Title X network of providers is critical so the newly insured can actually obtain high-quality care. Moreover, Title X sites are particularly well-situated to connect the uninsured to health coverage and to care for the people most likely to fall through the cracks of health reform.

It simply defies reason to say that, even as a substantial number of women are newly insured, programs aimed at giving contraceptives to uninsured women need to be expanded. Now, to be sure, I support sliding-scale clinics providing healthcare services in general, and these clinics have learned that they need to change their eligibility requirements to open up the sliding-scale fees to individuals who are insured, but with high deductibles (see here). But Planned Parenthood clinics?

Of course, a part of the “now more than ever” line is simply the desire never, under any circumstances, to lose government money. But, in the end, look at the name of the department providing the Title X money: the Office of Population Affairs. Its mission is not healthcare — not even under an expanded definition of “healthcare” in which, if nothing else, increasing the proportion of pregnancies which are intentionally planned improves the well-being of mothers and children. Its mission is apparent from the title “Population Affairs” — it was established in 1970 (see Wikipedia) back at a time of overpopulation worries.

So look: it’s easy to fix the whole Planned Parenthood funding issue: simply redirect Title X money to sliding-scale clinics that provide a full range of healthcare services, for men, women, and children.

But what’s the goal of this money: is it to provide for healthcare, or to reduce pregnancies? And what’s Planned Parenthood’s mission?

* Disclaimer: if you’re a reader of the Patheos Catholic Channel, in general, you’ll have recently been reading a number of number of blog posts by fellow bloggers on the subject of NFP, a subject I’ve steered clear of. Nonetheless, for purposes of this post, I’m going to acknowledge that the consensus opinion in the United States is that women (and men) who otherwise can’t afford it should receive governmental assistance to provide them with both contraceptives and health care more generally. I am discussing right and wrong ways to meet these goals. Whether there’s something fundamentally wrong with these goals — whether people should just refrain from sex if they can’t afford contraception and/or whatever children might come their way with or without efforts to avoid them; whether hormonal contraception is the right way to go; whether government or private charity is the right way to go — I’m not going to get into here.

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