May 13, 2025 • 45 mins
Title X, under the Public Health Services Act, allows for a family planning and reproductive health-based pool of funding that government agencies and nonprofits can apply for and use to support patients. Providers who receive Title X funding see all patients regardless of insurance status and income level. Clare Coleman, President and CEO of the National Family Planning and Reproductive Health Association (NFPRHA), sits down to talk with us about the recent and extremely harmful changes to Title X announced by the new administration.
At the beginning of April 2025, the government announced the withholding of 22 Title X awards. These awards, given consistently to projects who are years into their research, were rescinded with one day’s notice. On an annual basis, this impacts about $66 million in Title X funds-- about a quarter of all Title X grants. As of today, there are no Title X funded services in eight states, and 15 other states have lost either some or most of their Title X funding. About 842,000 people were served under these grants, and the number of health centers that are affected totals 865. These changes will impact access to care (particularly for young people and those with low incomes), affordability, and contraceptive choice.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (00:03):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice. [music intro]Hi rePROs, how's everybody
doing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So y'all, it is, like, lovelyideal spring in DC and it's,
like, have -windows -open -all-the -time weather and going out
(00:27):
for walks and enjoying the likelow humidity and just, like,
perfect temperature weather.
It never lasts for very long inDC.
It always , like, immediatelyturns to unbearably humid and
gross and don't -want -to-go-outside weather.
But I am definitely enjoyingthis like short reprieve of
really delightful spring weatherand I don't know if it was,
(00:52):
like, the spring weather or orwhat , it made me think of
making zucchini bread which issomething I couldn't tell you
the last time I made it, like,it has been years and years.
It just never occurs to me tomake it.
And so, I made some thisweekend and it was so good but
(01:12):
my brain immediately took meback to my Grandma Kind.
And now, she's not askingactually my grandma—back in the
day, before I remember it, shewas my mom's secretary.
And their grandchildren didn'tlive in the area.
So, Ruth and Elmer, they hadadopted me as their honorary
(01:32):
grandchild.
Since all of my grandparentswere a little bit further away,
they were close, but not rightin town.
So, Ruth and Elmer were verymuch my honorary grandparents.
And I made this zucchini breadand just...
it was just like this immediatememory of like sitting at their
kitchen table while grandmawas cooking and having zucchini
(01:58):
bread.
I don't know.
It's weird how your brain doesthat with foods and smells and
things like that.
Like I know...
my grandma Wetter used to havea lot of, like, rose scented
potpourri or soaps or lotionsand stuff.
And so, as soon as I smellthat, like, I just immediately
think of my grandma Wetter andbeing in their house.
(02:21):
It's just wild that your braindoes that and smells and foods
and stuff are all connected toall of these memories.
So, it was really nice.
I hadn't thought about myGrandma and Grandpa Kind in a
while.
They've been gone for quite a along time.
So it was just a really nicememory to think of her.
And now it just makes me thinkthat I need to make zucchini
(02:43):
bread a little more often in herhonor.
I have a couple things of hersthat I make quite frequently,
but that's one that has reallyfallen off my radar.
I wonder if my mom has herrecipe somewhere.
Mom, if you're listening tothis, send me Grandma Kind's
recipe.
I use the King Arthur one.
I bet you she has a good onelying around somewhere in a
(03:03):
recipe box that we might have.
Anyway, with that, there's alittle bit of bad news we need
to talk about.
Last week, the Supreme Courtallowed the transgender military
ban to go into effect.
That's just absolutelydevastating.
It is still working through thecourt system, but they decided
that it could go into effectwhile it is working through the
(03:26):
court system.
So, in just absolutelydevastating news, it is going to
be going into effect.
And my heart goes out to transservice members who are just
trying to serve their countryand they are being demonized and
being treated as dishonorable.
That is unacceptable.
And we need to just rememberthat trans rights are human
(03:48):
rights and we need to stand withthat the trans community right
now in so many ways as theadministration continues to
attack their rights on so manylevels.
So, I'm sure we'll be doinganother episode soon with
another slew of ways that theadministration is going after
transgender rights because itdoes really seem to be unending.
Yeah, sorry y'all that's alittle bit of a bummer to end
(04:12):
the intro on but that's reallysomething I've been thinking
about recently is just how muchthis administration is going
after the trans community.
And it's really hurting myheart.
Okay.
Moving on to another area wherethey are attacking, we are
going to talk about theadministration's attacks on
(04:33):
Title X that have been happeningrecently.
And there could be no betterperson to talk to about what the
administration is doingsurrounding Title X than Clare
Coleman, who is the executivedirector of NFPRHA, the National
Family Planning andReproductive Health Association.
I'm so excited to have Clareon.
We had her on way back in theday on the podcast, and I am so
(04:57):
excited to have her on again totalk about Title X, to let you
all know exactly what it is andget familiar with all of the
providers and what they do, andthen to talk about the ways that
Title X is currently underattack.
Okay, with that, let's go to myinterview with Clare.
Hi, Clare.
Thank you so much for beinghere today.
(05:18):
Nice to be back, Jennie.
Great to see you.
I'm so excited to talk to youabout all things related to
Title X.
Before we get started, though,would you like to take a second
and introduce yourself andinclude your pronouns?
Clare (05:30):
My name is Clare Coleman, she/her/hers.
I am the President and CEO ofthe National Family Planning and
Reproductive HealthAssociation, often referred to
as NFPRHA.
The organization was founded in1971 to represent providers and
administrators of contraceptionand sexual health care all
(05:51):
across the country.
And today we represent upwardsof 970 government agencies,
private not-for-profits, andindividuals working in
contraception and sexual healthcare programs all across the
country.
Jennie (06:05):
I'm so excited to talk to you today about Title X.
It has been way too long sincewe have talked.
So, maybe before we get startedinto what is currently
happening, let's just take aminute and talk about: what is
Title X?
Clare (06:19):
Title X refers to a section of federal law called
the Public Health Services Act.
And that's an umbrella law thatincludes a lot of really
important federally fundedprograms, such as the Federal
Community Health Center Program,also known as the Federally
Qualified Health Center Program,Rural Health Care, Migrant
Health Care, and FamilyPlanning.
(06:39):
Public Health Service Actprograms are unique in that the
government offers significantfederal subsidy to underwrite
care, but also underwriteinfrastructure.
So, Public Health Service Actprograms are not like an
insurance program, even Medicaidinsurance or commercial
(07:00):
insurance.
It's a program of subsidy.
So , in the Title X FamilyPlanning Program under the
Public Health Services Act,government agencies and private
not-for-profits can apply in acompetition to get a certain
share of the federal Title Xfunds.
And when they apply, they applywith a detailed work plan about
(07:23):
the area of the country theyintend to serve down to how many
people they think they'll beable to see in a year.
They'll talk about the numberand range of contraceptive
methods that will be offered.
They'll talk about theeducation programs that they'll
offer both inside health centersand out in the community.
And they'll also detail howthey'll use funds to support
(07:45):
everything that makes a healthcenter system run.
So, you can use Title X tosubsidize clinician salaries and
benefits.
You can use Title X to pay rentand utilities.
You can use Title X funds todevelop educational materials
and have them reviewed by folkswho are living in your
community.
So again, the Title X programis invisible in a lot of ways,
(08:08):
right?
If you walk into UnityHealthcare here, or in D.C.,
there's not going to be a TitleX label on the door or in the
exam rooms, but it essentiallyis a pool of funding that is
used to open those doors everyday.
Most of the money goes directlyto patient health care, but as
I mentioned, there are all theseother things that can be
(08:30):
supported under a Title X grantthat the government approves.
Jennie (08:34):
That's so important, one that it covers both services,
but also the buildings and theproviders, because that is a
huge expense.
So, making sure that thoseprograms can keep running and
put as much of the funding asthey can towards patients, it
seems like a really great way toensure as many people as
possible are getting access tothese services.
Clare (08:55):
I think the government understood in the Public Health
Services Act that if you wantservices in medically
underserved communities, inplaces in the country that are
either underserved or populationsparse, population dense—it
works both ways—you need to givesome support to just the costs
of doing business in those areasof the country.
(09:16):
You know, lots of local healthdepartments participate in Title
X.
As I mentioned, all the otherproviders are private
not-for-profits.
So, a lot of them are workingon very, very thin margins.
They are serving verylow-income people.
And under the Public HealthService Act, we have to see
everybody.
So you can't ask people if theycan pay their bill.
(09:36):
Youknow, those of us with the privilege of commercial insurance may
have had the experience ofcalling a clinical office to
make an appointment, and thefirst question they ask you,
even before they ask you yourname, is they ask you what
insurance that you have.
Because that can end aconversation in a doctor's
office if you don't have theright insurance.
Under the Public Health ServiceAct, Title X providers don't
(09:59):
ask that question.
They have to see everybody,regardless of their ability to
pay, regardless of where theylive, regardless of any other
factor.
They come through the door.
We have to see them and servethem.
Jennie (10:09):
Man, I feel that hard.
I was in grad school and for ashort time worked at an OBGYN's
office and was in reception.
And yes, that was absolutelythe first question that I was
required to ask.
And then also thinking of whothese programs target, like
growing up in a rural area,there weren't a lot of options
(10:30):
for where I could go to getcare.
Luckily, I didn't live too farfrom like a city where I could
go get care.
But thinking of a lot of peoplewho lived a lot more rural than
I did, that can be a realproblem, getting access to
quality healthcare.
Clare (10:44):
Yeah, having access points where people are living
is incredibly important.
Now, in many cases, those sitesmight not be open five days a
week, right?
They might have more limitedhours, but to give people a
place to go where they're nottraveling far is a really
important thing.
Now, there are lots of towns inthis country where there isn't
a grocery store.
So, people are traveling allthe time, but they may not have
(11:05):
access to public transportation,ready ability to get a ride.
So, keeping the services aslocal as possible is one of the
real benefits of Title X fundingbeing in every state.
Jennie (11:17):
Okay, so now that we know how amazing Title X is, and
I've been lucky enough to meetlots of providers by attending
your conferences and so can talkabout how wonderful the
provider community is.
I also know the flip side thatthere have been a lot of threats
to Title X recently.
I mean, the most recent one waswhen I was at your conference
and the new administrationannounced some changes.
(11:40):
Can you talk a little bit aboutwhat is happening right now?
Clare (11:43):
So, our Title X network is in crisis at this moment and
we are 38 days in to anextraordinary situation.
On April 1st, which is thebeginning of the Title X year—
new federal spending arrivesevery year on the 1st of
April—the day before, March31st, the government announced
that it was going to withhold 22Title X awards.
(12:06):
These awards were madecompetitively through a very
clear and articulated processback in the spring of 2022.
And so, these grants and theorganizations that run these
grants were about to start yearfour.
So, well-established in theirproject period working to
improve.
(12:27):
And they were notified the daybefore that they would not get
their year four awards.
This impacts on an annual basisabout $66 million in Title X
funds.
That is about a quarter of allTitle X grants.
There are 16 agencies that holdthose 22 grants because you can
have more than one Title Xgrant.
(12:48):
All of the agencies are privatenot-for-profits.
Nine of them are PlannedParenthood affiliates.
The other seven are members ofthe Family Planning Councils of
America.
So, as of today, there are noTitle X funded services in eight
states.
And in another 15 states, thestates have lost either most of
(13:12):
their Title X or some of theirTitle X.
We estimate that under thesegrants in the last year for
which there are data, about 84042,000 people were served and
the number of health centersthat are affected is about 865.
So it's having an immediatenegative impact.
(13:34):
The grantees that wereaffected, as I said, had less
than a business day of notice.
about the government's decisionto withhold these dollars.
Nothing like this has everhappened before.
It's, as I mentioned,unprecedented and it's
incredibly reckless.
Jennie (13:53):
Yeah, I can't imagine, like, you were
expecting the money for thegrant that you have already
signed and are in year four ofto arrive the next day and then
to find out you're not gettingit.
There's no ability to havetried for other funding or any
number of things.
It's just all of a sudden youdon't have the money to serve
(14:14):
this community who relieson you.
Clare (14:16):
I really can't say enough about the staff and the leaders
in these affected agencies.
Many of them were on site withNFPHRA at our national
conference when they receivedthese notices.
The just remarkable composureand focus that they showed under
extraordinary pressure.
You know, all of these folkshave staffs.
(14:39):
They have volunteer boards.
They have a network of healthproviders that they sub grant
funds to in order to getservices out into that network
in the community.
They had so much thinking to doand so much communicating.
And the, you know, justemotional weight of sharing this
kind of devastating news, youknow, continue to be knocked out
(15:02):
by these leaders.
It's a tragedy that they're putin this situation.
And I think they're doing theirvery, very best to make the
next right decision at a verycomplicated time.
Jennie (15:14):
Yeah, this makes me think of, you know, I work on
the global side, so we often seesome of these same things
playing out around like theglobal gag rule.
And, you know, I think so manypeople think that the money
stops but restarts at anothertime and everything's fine.
All the services are back, allthe people come back, and that's
(15:35):
not really...
how this works.
If patients go to a providerand the provider can't help
them, the patient may not comeback, even if the funding comes
back, because some of that trustis broken that that's a service
that's a provider they can relyon.
So, it has such broader impactsthan just that immediate impact
(15:56):
of not being able to access theservice.
Clare (15:58):
Absolutely.
I mean, you might be in asituation where you come into a
health center where you'vegotten free care or subsidized
care in the past, and now theremight be a minimum fee.
You might have to cover the entire cost of your services. That's prohibitive for many, many, many of the folks who seek care in Title X funded settings. That's why they come to those settings. They know they can get good quality care, a provider they can trust, someone who's going to meet them where they are, address their needs and their values, and they're gonna do it in a way that doesn't make cost a prohibitive factor. But these agencies cannot sustain operating like that without federal support.
(16:33):
And as I said, we're in day 38of this emergency.
Some of the agencies haveshared that staff has begun to
be furloughed.
We have some health centerclosures that have been
announced.
I think we're just seeing thebeginning of what I think will
(16:57):
be a catastrophic impact onaccess.
Healthcare in general is notterribly elastic, meaning when
you close down an access point,it's very, very difficult to
reopen it again.
Staff find other roles, theymay move out of sexual and
reproductive health because it'snot a steady place to be.
There's a huge healthcareshortage in almost all of the
(17:19):
countries.
So, these providers are veryheavily recruited and sought
after.
So, if you lose your staff andyou close that access point,
it's not gonna reopen.
And Jennie, I wanna say, that'snot a hypothetical to me.
Before I came to NFPRHA, I rana Title X funded health agency
(17:39):
in my home state of New York,where we saw roughly 35,000
people a year in 13 healthcenters.
And in my time in the job, andI wasn't there all that long, we
closed four health centers, welaid off three rounds of staff.
And I will never forget sittingacross from somebody I laid
them off from a good job andwith benefits, and they had to
(18:03):
go get two jobs to make up forwhat they had lost in our
organization.
The impact here, not only onpatient access, but on the
communities, it is sodevastating.
I mean, the folks who work inthese health centers and these
grantee organizations—these aretheir hometowns.
They grew up in these places.
They're absolutely committed toserving people in their home
(18:27):
states, in their communities.
They may have come through aspatients or educators in the
systems as well.
So, there's such a fiercecommitment to keeping care
local, keeping it high quality,keeping it trusted.
This is such a violation of allthe things that folks who work
in these systems have built overmany, many years.
Jennie (18:52):
I think it's also really important to make the
connections, right?
This isn't happening in a silo.
We are also hearing aboutproposed massive cuts to
Medicaid, which will alsofurther restrict people's
ability to access broaderhealthcare, but also family
planning services.
And you're also seeing all ofthe attacks on abortion care.
So, people may not then be ableto get family planning
(19:16):
services, that they were gettinga Title X clinic.
They may have an unintendedpregnancy.
Abortion could be banned intheir state.
All of these things areinteracting and putting pressure
on people's lives and thedecisions they're able to make.
Clare (19:29):
Absolutely.
And another thing to add tothat is the government's now
proposing significant cuts inSTI screening and treatment.
So, the follow-on impacts onsexual and reproductive health,
on women's health, on LGBTQhealth, on transgender people's
health, on adolescent health.
I mean, the impacts areincredible.
(19:51):
You mentioned Medicaid, and I'dlove to stay there for a moment
because the cuts that are beingdebated in Congress right now
are absolutely catastrophic.
You know, 70 million Americansrely on the Medicaid program.
It's grown substantially in thelast decade and a half.
And it has been, since the 80s,the largest payer of family
(20:13):
planning care in the country.
And on average, it's paying forabout half the births in the
United States.
So, millions and millions ofpeople of reproductive health
age rely on Medicaid for theirhealth insurance.
And those health centers have avery big Medicaid population
they are serving.
Again, just referring to my ownexperience when my time in New
(20:38):
York, about 30% of our patientshad Medicaid coverage.
50% of our patients had noinsurance at all.
So, they were on a sliding feescale or getting free care
subsidized by Title X.
And then just about 20% of ourfolks had insurance.
So, if you think about thesituation that some of these
affected grantees are in rightnow, if you lose your Title X
(21:01):
money and Congress moves aheadwith these massive Medicaid cuts
and the president signs theminto law, you can't stay in
business.
There is no business plan.
There is no contingency.
There's cash on hand.
There's cash in the bank.
And when you're out of cash,you're done.
And that is why I'm so, soconcerned about closure, about
(21:24):
losing access points in thecountry.
Because what we'll see, I thinkvery quickly, is something like
what we're seeing for folksseeking abortion care.
So, contraception willtechnically be legal, but it
will not beavailable. And you know you'll see people, in my judgement, doing one of two things. The first is they're going to slide down the ladder of contraceptive preference. There are methods that work for people in different points of their lives. That tends to change. Sometimes the more effective methods are the most expensive methods and they can only be accessed in a health care settings. So, if you don’t have a place to go or a provider to rely on, or they’re there but you can’t pay the fees, then you're gonna slide down
to the cheaper methods, right?
(22:08):
And again, those methods may bequite effective for you with
good consistent use, but thatmay not work as well.
So, people aren't actuallygetting what they need, what
works best for them.
So, I think that's one thingthat will happen.
The other thing that I think isvery likely, and this seems
incredible, just three yearsafter the Dobbs decision leaked,
(22:30):
I think people are going tostart traveling for
contraception.
And the idea that that's wherewe are in the United States in
2025, that people are going tocross state lines to access
contraceptive care.
We always said that it wasn'tgoing to end with criminalizing
and banning abortion.
I think a lot of folks didn'tthink it would move this
(22:52):
quickly.
And I think we are facing avery rapid collapse in access to
all sexual and reproductivehealth care, contraceptive care,
STI care, and it's incrediblyscary.
Jennie (23:06):
Yeah, it makes me think of what we've talked about in
other scenarios of like whenthey like worries about
requiring mifepristone in personwhere we talk about like there
is just not the ability toabsorb that and ensure that
people are getting the care ifthey have to travel in person to
access care.
Now if we add in having totravel for contraception to
(23:27):
that, there's no way the systemcan support that at this time.
And I think the other point Ireally always try to make is a
lot of people, you may thinkthat Medicaid is not your fight,
like, that you don't getMedicaid, you're not on
Medicaid, but itis paying for so many things that are important to you.
(23:55):
Just to give an example, not to give too many details, but my mom is the chair of the board of the only public hospital in Southern Wisconsin. Iknow it is shocking the
conversations they are having ifthey lose the majority of their
Medicaid funding.
Hospitals near you may closebecause of losses of Medicaid.
And so you may not be onMedicaid, but the health
(24:15):
services you are relying on...
they may have to cut providers.
They may have to close ahospital.
This is everybody's fightbecause it is going to impact
how everybody is accessinghealthcare.
Clare (24:28):
Yeah, the federal investment in healthcare leads
to access, right?
If you want a local hospital,if you want a hospital with an
emergency department, if youwant to be able to deliver
locally instead of having todrive three hours to the nearest
maternity hospital, you needthe public money coming in.
(24:49):
The way we do healthcarefinancing in America is a mess.
It's a mess.
But when you pull on onestring, you unravel the whole
system because all the sourcesof financing are interdependent
and very complex, butinterdependent.
So when you pull out one sourceof financing, there's, you
(25:12):
know, the stool tips over rightaway.
And I think you're so right toencourage people to think about
not just their individualinsurance status, but think
about the infrastructure ofhealth resources that are
available to them.
And, you know, none of us knowwhen we might need emergency
care, something urgent comes up.
(25:32):
And that's why you need thisnetwork of, you know, local
providers, community-basedorganizations, hospitals, right?
That there's a reasonable Thisis a nested community.
And what they're, you know,what they're considering in
Congress is just catastrophic.
Jennie (25:48):
Okay, so I'm sure you can't talk details, but what are
you all doing to push back onwhat the administration is
doing?
So , we've been pushing along onthree tracks, I would say.
The first for me is showing upin every way we can for these
affected grantees.
I want to say flatly thatthere's nothing that these
grantees did that wasinappropriate or out of
(26:12):
compliance with Title X statuteregulations and program
guidance.
They are not different fromother grantees.
There's really no rhyme orreason to why these 16
organizations and theseparticular grants.
I think it's really importantto underscore that.
We have been working with themas a group and one-on-one
(26:33):
because they're all in reallydifferent circumstances.
They're all in an emergencybecause they can't access
federal funds.
But the initial step that theyeach had to take was when the
government suspended andwithheld their year four
payment, they also demanded asignificant amount of
information.
There were 10 or 11 elementsthat each agency was asked to
(26:54):
respond to the government on.
And they were only given 10calendar days to respond to
that.
And not only did they have torespond to the government's
requests, for their ownorganization, but they had to
respond for their entiresubrecipient network.
So, many of these organizationsrun health centers themselves.
They are direct serviceproviders, but they also give
(27:17):
money to a number of communitypartners to make a broader
network have more access points.
They had to go to each one ofthose agencies and say, the
government's asking us for thisinformation.
Will you give us thisinformation?
You know, most notably, one ofthe affected grantees is the
Title X grantee for the state ofCalifornia.
They have upwards of like 300service sites.
(27:38):
Like, they have dozens anddozens and dozens of
subrecipients.
So, this was a almostimpossible job.
Any request to the governmentfor more time or more
clarification was rejectedflatly.
So, the initial thing theseaffected grantees had to do was
respond.
So, and then I would say we'rein the second stage now, and I
(27:59):
would call this communicationand fundraising.
That's where the focus is.
So as I mentioned, these areall community-based
organizations with volunteerboards and community support,
big staffs, and then, you know,these tentacles out into the
community of subrecipientagencies and then the local
health center sites.
Everybody's got to hear thisstory, right?
They've got to understand whatthe government has done, the
(28:23):
degree of uncertainty andambiguity and threat that this
conveys.
And that's the job of thegrantee to be sharing that
information and trying to setsome expectation for this
network about what's gonnahappen.
Unfortunately, none of thesegrantees have heard a single
thing from the federalgovernment.
Again, we're on day 38 of thiscrisis.
There has been no reach backout to these grantees about the
(28:47):
material that they submitted.
They don't know who's doingthis investigation.
They don't know the timelinefor this investigation.
They don't know if there's away to pass this investigation,
right?
So, having to tell people thatyou have no information for
them, there's no end in sight,and then expect them to continue
to provide care is just areally, really difficult,
(29:10):
sensitive situation to findyourself in.
So, lots of time spent oncommunication.
And then equally so: fundraising, looking for (29:14):
undefined
community support, governmentsupport, if it's feasible.
And a lot of these agencies arein states where government
money is not gonna be madeavailable to them.
If you're in Missouri or you'rein Montana or you're in
Mississippi or you're working inTennessee, The government is
not likely to step in andprovide family planning support,
(29:36):
even in strongly supportiveenvironments.
State budgets are in veryserious crisis right now.
Lots of states running, youknow, looking at big deficits.
They have to run at even.
They have to balance.
Unlike the federal government,state governments can't run at a
deficit.
So, coming in at this stage instate budget cycles, typically
(29:57):
state budget cycles are for July1.
Come in in April and say, forexample, in Missouri, we lost
the equivalent of more than $8million in Title X support.
Missouri's not going toconsider something like that.
But even again, a stronglysupportive policy environment,
that's a very tall order to goin and say we're looking for
(30:17):
one-to-one replacement dollarsor our access points are going
to close.
So that's point one.
Support these affectedgrantees.
answer their questions, show upfor them.
The second thing we did is wesued the federal government.
So, on April 27th, we filed alawsuit in federal court because
the government has violated thelaw in these withholdings.
(30:39):
There is a process that thegovernment has very clearly
mapped out in statute and inregulation for bringing entities
that are out of compliance withfederal law into compliance.
There are a series of stepsthat have to be taken including
notifying the grantee, givingthem a chance to correct any
(31:02):
compliance issues voluntarily.
There's a notice period, etcetera.
The government didn't do any ofthose things.
They said they had a suspicionand an allegation and they
withheld the money.
That's against the law.
You've got to make a finding ofa violation.
Finding.
You have to come to aconclusion.
And then, as I said, you've gotto give that grantee an
(31:22):
opportunity to respond and curebefore you can move to withhold
money or terminate grants.
Government didn't do that inany of these cases.
So, we are pending in thefederal system.
I do want to say that unlike alot of lawsuits that have been
filed in the past and have beenfiled in the early days of this
administration, we are notseeking emergency relief.
(31:45):
And that is because in in earlyApril, the Supreme Court came
down with a ruling case relatedto education, Department of
Education grant making, wherethey allowed the government to
terminate grants while thelitigation was going forward.
And in the ruling that wasissued, it became clear that if
(32:07):
we were to seek emergencyrelief, meaning force the
government to put these Title Xfunds out to the affected
grantee organizations, if at alater stage in the litigation,
we were to fail, lose at anylater stage in the litigation,
the grantee organizations wouldbe responsible for paying the
(32:27):
government back millions ofdollars of grants.
So again, let's be clear.
Title X grants primarily go toprovide health care to poor and
low-income people.
There's no way that thosegrantees could collectively be
responsible for $66 million inrepayment to the government.
It was just too big a risk tothose affected agencies for us
(32:50):
to take such a step.
So, what we did is we're filingon the violation of the law.
We've said, you've done thiswrong.
You violated federal statutesand regulations.
There's a process that is clearand the government didn't take
any of the steps in the processbefore they withheld these
funds.
It's possible that we won'thave any movement in that case
(33:11):
until the latter part of June.
So again, that's really toughon these affected grantees.
They are trying to move theirway through a very complicated
series of decisions.
And I do expect layoffs and Ido expect closure.
So the last part of what we'reworking on is telling the story.
You know, as I said, when youwalk into a Title X funded
(33:33):
health center, there's no labelon the door.
So there's lots of folks whoare getting access to care,
subsidized care in a Title Xfunded health center.
They have no idea.
It's a really complex network.
It looks different in everystate.
The grantee networks aredifferent in every state.
So sometimes when people ask meto talk about Title X, I'll ask
them to pick a couple of statesso I can be as specific as
(33:57):
possible about how care isorganized and delivered in that
certain state.
But this is the story thatneeds to be told.
And there's been a lot ofinterest.
I'm thrilled to say folks seemto really understand the
immediacy of this impact thatyou can't just turn off federal
funding And these agenciessurvive.
Clearly, the federal governmentdoesn't care.
(34:19):
But our folks remain absolutelyunified and committed.
They're going to offer as muchquality care as they can.
They're going to keep open asmany health centers as they can.
And we're going to try to stayin this fight.
So, one of the things I've beenthinking about as we've been
talking that we haven't maybehighlighted as much is the role
that Title X plays in ensuringyoung people have access to
(34:42):
affordable contraception and theway that is also currently
under attack.
Clare (34:47):
Yeah, Title X is just a lifeline for adolescent health
under the Public Health ServiceAct program and under the Title
X statute.
As I said, we serve everyoneand we have to serve everyone
with confidentiality.
Our health centers do need toadhere to state law and our job
is to be there to meet the needsand the values of everybody who
(35:09):
comes through the door.
So, adolescents seekingeducation and seeking clinical
care are going to haveconfidential access to care in
the Title X system.
That's really the gold standardfor confidentiality across
federal health programs, and itis incredibly important.
One of the big setbacks in thelast couple of years has been
successful effort, at least inTexas, to undo that protection.
(35:33):
Right now in Texas, adolescentsseeking healthcare in Title X
funded systems do not haveconfidentiality, but that is an
aberration and we believe it isa misreading by courts of the
federal requirements.
So, protecting confidentialityfor everyone is absolutely
essential.
I've said many times beforethat intimate relationships
(35:57):
don't automatically get safewhen a legal adult.
So, every single person cominginto a health center deserves
confidentiality.
It may be more or lessimportant to you on any given
visit.
There may be certain servicesthat you think are sensitive or
certain tests that you think aresensitive, but it's up to you
(36:19):
to tell us what you need, whatyou value, and what you hold
dear.
And it's our health center'sresponsibility to make sure that
you're protected.
And that's another core value,I think, of the Title X program.
It's a commitment that ourworkforce has shared for 54
(36:40):
years.
Jennie (36:40):
Yeah, it just seemed like one of those really
important things to pull outbecause we have seen young
people be the opening wedge tobroader attacks.
We saw that with abortion.
We're seeing it now with, I'msure, gender-affirming care.
And I'm sure this is just thebeginning of the broader assault
on Title X as well.
Clare (36:59):
Yeah, I think it's so important to think about what
does it mean to be able to froman adolescent and meet their
needs.
You know, most kids are gonnaengage a trusted adult.
And typically, it's really amatter of timing, right?
They wanna choose which.
So, if they're in a two-parentsituation, there might be a
parent they feel morecomfortable having the
(37:21):
conversation with initially, andthey wanna choose when.
So, you know, this is not asituation where for younger
people don't have a trustedadult, whether they are a parent
or another caregiver or a lovedone who is there to talk it out
with.
There are some kids that arenot in that situation and they
have a lot of reason to fear.
(37:44):
And we know that mandatingparental or caregiver
involvement drives adolescentsaway from services that they
need.
That's not good for theirhealth.
That's not good for theirwellbeing.
So what we need to do is takethe barriers away and let people
just get the care that theyneed from the providers that
they trust whenever they needthat care.
(38:04):
There is another aspect to thisstory, which is the government
also made two awards.
to Oklahoma and Tennessee.
And those are the states thatwere terminated from the program
because they wouldn't counseland refer for abortion.
And that's an under-told pieceof the story.
I have been trying to get thatword out too.
(38:24):
I do want to say that both ofthose state health departments
are members of NFPRHA, but Ithink even they are bewildered
by the government sending themawards they didn't apply for.
And in fact...
some really fascinating stuffgoing on... so both of these
states were terminated fromTitle X in 2023, after a long
back and forth with the Bidenadministration.
(38:44):
They both have state abortionbans, and they were saying
because of their state abortionbans, they could not counsel or
refer for abortion.
And obviously, we have aconstitution with a supremacy
clause that says federallaw trumps state law, so they
were defying the program.
And so, they were terminated.
Both health departments suedthe federal government.
(39:05):
Both health departments so farin their litigation have been
unsuccessful.
One of those cases has beenappealed to the Supreme Court,
and the Supreme Court has notyet decided if they will take
that case.
And the other one is in thecircuit courts.
They have a request for a fullcourt review.
But they've lost at thedistrict stage, and they've lost
at least initially at thecircuit stage.
(39:25):
So suddenly, on the 1st ofApril, both Oklahoma and
Tennessee got Title X awards.
That's illegal.
They did not apply.
The government has said theyare being restored.
That's not a thing.
The grant letters also saidthat it was pursuant to a
settlement, but there haven'tbeen settlements in either of
(39:47):
these cases.
And so both Oklahoma andTennessee have filed papers in
their respective lawsuits beinglike, we got this money.
We don't really know what itmeans.
Are they going to let us notcounsel and refer?
Like, nobody will tell.
So it's a really crazysituation.
And yeah, so that's somethingwe're watching pretty closely
(40:10):
to.
Are they going to get away withthis?
Right.
Because if Tennessee are comingback to the program, we assume
they won't.
actually take the money unlessthey don't have to counsel or
refer.
That's a violation of thecurrent regulation, which the
Trump administration has notmoved to change yet.
So this is one of thesesituations that I think we'd be
(40:32):
getting a lot more attention ifall the other terrible stuff
wasn't happening.
But there's so much terriblestuff going on that this is kind
of sliding under the radar.
Jennie (40:41):
Claire, I always love talking to you and I can talk to
you for a really long time, butmaybe we should wrap it up with
what I always love to end with.
And that is what can ouraudience do?
How can our audience getinvolved in this fight?
Clare (40:53):
Well, I'd love to refer you to our NFPRHA website
because we have a landing pagewhere you can go and look at all
this information about theaffected grantees.
And that landing site includesinformation about each of the
agencies all across the countrythat are impacted.
And there are agencies in everypart of the country now that
(41:13):
are going without Title X funds.
We have links to pages ifpeople want to donate, support
one or more of these excellentagencies.
You can see statements from allthe agencies also on our
website.
And so, I want to say, youknow, we need to center people
who are most affected.
These are the folks who aremost affected today.
I also want to say that therisk to Title X looming is
(41:37):
terrifying.
The president last weekreleased an initial budget
proposal that eliminated Title Xentirely.
Proposes eliminating all themoney and the office and the
federal staff that support theTitle X program.
Congress is going to begin theprocess relatively soon of
working through what is fiscalyear 26 federal appropriations.
(42:00):
It's their role to decide whatmoney is spent in what basket.
Title X has not had a fundingincrease in 11 cycles but now
they're proposing just zeroingout the program entirely.
that will have massive impacton access to care.
So, folks who are ready toraise their voice, whether it's
(42:21):
directly with congressionaloffices or in their community
and networks or on social media,telling this story, we just
need access to contraceptivecare.
The government should step outof the way.
A lot of these folks doing thiswork in community have been
doing it for their entirecareers.
They're good at what they do.
They deliver excellent care.
They care deeply about thepeople that they're serving in
(42:44):
their communities, and they justwant to be able to do their
good work.
So , that would land me in onelast spot, which is if you can
find out where your Title Xagency is, and you can do that
by Googling, drop them a note,send an email to the info line.
Stop by and push a thank youcard through the front door.
These folks do not always get alot of attention.
(43:06):
They're not always on the news,but what they're doing in the
community is really valuable.
So, if you've had a goodexperience at a family planning
center in the past, or you're apatient now, let them know that
you're aware of what's going on,you support them and their
work, and that you're going tobe there for them in the
community.
I can't tell you what it wouldmean to folks around the country
(43:28):
if they started to hear fromfolks saying, hey, we know this
is happening and we think it'swrong and we support you and we
support access to contraceptionand you're our neighbors and
we're going to be there for you.
I think it would just mean theworld to the folks working in
this care.
Jennie (43:42):
Yeah, I always appreciate doing the little acts
of kindness for all theproviders.
Just a flag for anybody who'sthinking about doing that.
Don't send anything that's likea package unless they know
you're expecting it.
Just for safety reasons, theywould be concerned if they were
getting in a random package.
So, just that's one littleflag.
But like, letters and postcardsand all that stuff is greatly
(44:05):
appreciated.
Claire, thank you so much forbeing here.
As always, it was such apleasure to talk to you.
Clare (44:10):
I appreciate so much the work you do in the world,
Jennie, and how you lift up somany voices.
And thank you for giving us achance to tell this really
important story.
Jennie (44:19):
Hopefully we'll have you come back with some good news
at some point in the nearfuture.
We're going to fight.
We'll fight and we'll fight.
Thank you.
Okay, y'all, I had a great timetalking to Claire about all
things related to Title X.
As always, I learned somethings that I didn't know about
while we were talking, and Ialways learn so much from
Claire, so I'm so grateful forher for being on.
(44:41):
So thank you, Claire, and wewill see everybody next
week. [music outro]If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice. [music intro]Hi rePROs, how's everybody
doing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So y'all, it is, like, lovelyideal spring in DC and it's,
like, have -windows -open -all-the -time weather and going out
(00:27):
for walks and enjoying the likelow humidity and just, like,
perfect temperature weather.
It never lasts for very long inDC.
It always , like, immediatelyturns to unbearably humid and
gross and don't -want -to-go-outside weather.
But I am definitely enjoyingthis like short reprieve of
really delightful spring weatherand I don't know if it was,
(00:52):
like, the spring weather or orwhat , it made me think of
making zucchini bread which issomething I couldn't tell you
the last time I made it, like,it has been years and years.
It just never occurs to me tomake it.
And so, I made some thisweekend and it was so good but
(01:12):
my brain immediately took meback to my Grandma Kind.
And now, she's not askingactually my grandma—back in the
day, before I remember it, shewas my mom's secretary.
And their grandchildren didn'tlive in the area.
So, Ruth and Elmer, they hadadopted me as their honorary
(01:32):
grandchild.
Since all of my grandparentswere a little bit further away,
they were close, but not rightin town.
So, Ruth and Elmer were verymuch my honorary grandparents.
And I made this zucchini breadand just...
it was just like this immediatememory of like sitting at their
kitchen table while grandmawas cooking and having zucchini
(01:58):
bread.
I don't know.
It's weird how your brain doesthat with foods and smells and
things like that.
Like I know...
my grandma Wetter used to havea lot of, like, rose scented
potpourri or soaps or lotionsand stuff.
And so, as soon as I smellthat, like, I just immediately
think of my grandma Wetter andbeing in their house.
(02:21):
It's just wild that your braindoes that and smells and foods
and stuff are all connected toall of these memories.
So, it was really nice.
I hadn't thought about myGrandma and Grandpa Kind in a
while.
They've been gone for quite a along time.
So it was just a really nicememory to think of her.
And now it just makes me thinkthat I need to make zucchini
(02:43):
bread a little more often in herhonor.
I have a couple things of hersthat I make quite frequently,
but that's one that has reallyfallen off my radar.
I wonder if my mom has herrecipe somewhere.
Mom, if you're listening tothis, send me Grandma Kind's
recipe.
I use the King Arthur one.
I bet you she has a good onelying around somewhere in a
(03:03):
recipe box that we might have.
Anyway, with that, there's alittle bit of bad news we need
to talk about.
Last week, the Supreme Courtallowed the transgender military
ban to go into effect.
That's just absolutelydevastating.
It is still working through thecourt system, but they decided
that it could go into effectwhile it is working through the
(03:26):
court system.
So, in just absolutelydevastating news, it is going to
be going into effect.
And my heart goes out to transservice members who are just
trying to serve their countryand they are being demonized and
being treated as dishonorable.
That is unacceptable.
And we need to just rememberthat trans rights are human
(03:48):
rights and we need to stand withthat the trans community right
now in so many ways as theadministration continues to
attack their rights on so manylevels.
So, I'm sure we'll be doinganother episode soon with
another slew of ways that theadministration is going after
transgender rights because itdoes really seem to be unending.
Yeah, sorry y'all that's alittle bit of a bummer to end
(04:12):
the intro on but that's reallysomething I've been thinking
about recently is just how muchthis administration is going
after the trans community.
And it's really hurting myheart.
Okay.
Moving on to another area wherethey are attacking, we are
going to talk about theadministration's attacks on
(04:33):
Title X that have been happeningrecently.
And there could be no betterperson to talk to about what the
administration is doingsurrounding Title X than Clare
Coleman, who is the executivedirector of NFPRHA, the National
Family Planning andReproductive Health Association.
I'm so excited to have Clareon.
We had her on way back in theday on the podcast, and I am so
(04:57):
excited to have her on again totalk about Title X, to let you
all know exactly what it is andget familiar with all of the
providers and what they do, andthen to talk about the ways that
Title X is currently underattack.
Okay, with that, let's go to myinterview with Clare.
Hi, Clare.
Thank you so much for beinghere today.
(05:18):
Nice to be back, Jennie.
Great to see you.
I'm so excited to talk to youabout all things related to
Title X.
Before we get started, though,would you like to take a second
and introduce yourself andinclude your pronouns?
Clare (05:30):
My name is Clare Coleman, she/her/hers.
I am the President and CEO ofthe National Family Planning and
Reproductive HealthAssociation, often referred to
as NFPRHA.
The organization was founded in1971 to represent providers and
administrators of contraceptionand sexual health care all
(05:51):
across the country.
And today we represent upwardsof 970 government agencies,
private not-for-profits, andindividuals working in
contraception and sexual healthcare programs all across the
country.
Jennie (06:05):
I'm so excited to talk to you today about Title X.
It has been way too long sincewe have talked.
So, maybe before we get startedinto what is currently
happening, let's just take aminute and talk about: what is
Title X?
Clare (06:19):
Title X refers to a section of federal law called
the Public Health Services Act.
And that's an umbrella law thatincludes a lot of really
important federally fundedprograms, such as the Federal
Community Health Center Program,also known as the Federally
Qualified Health Center Program,Rural Health Care, Migrant
Health Care, and FamilyPlanning.
(06:39):
Public Health Service Actprograms are unique in that the
government offers significantfederal subsidy to underwrite
care, but also underwriteinfrastructure.
So, Public Health Service Actprograms are not like an
insurance program, even Medicaidinsurance or commercial
(07:00):
insurance.
It's a program of subsidy.
So , in the Title X FamilyPlanning Program under the
Public Health Services Act,government agencies and private
not-for-profits can apply in acompetition to get a certain
share of the federal Title Xfunds.
And when they apply, they applywith a detailed work plan about
(07:23):
the area of the country theyintend to serve down to how many
people they think they'll beable to see in a year.
They'll talk about the numberand range of contraceptive
methods that will be offered.
They'll talk about theeducation programs that they'll
offer both inside health centersand out in the community.
And they'll also detail howthey'll use funds to support
(07:45):
everything that makes a healthcenter system run.
So, you can use Title X tosubsidize clinician salaries and
benefits.
You can use Title X to pay rentand utilities.
You can use Title X funds todevelop educational materials
and have them reviewed by folkswho are living in your
community.
So again, the Title X programis invisible in a lot of ways,
(08:08):
right?
If you walk into UnityHealthcare here, or in D.C.,
there's not going to be a TitleX label on the door or in the
exam rooms, but it essentiallyis a pool of funding that is
used to open those doors everyday.
Most of the money goes directlyto patient health care, but as
I mentioned, there are all theseother things that can be
(08:30):
supported under a Title X grantthat the government approves.
Jennie (08:34):
That's so important, one that it covers both services,
but also the buildings and theproviders, because that is a
huge expense.
So, making sure that thoseprograms can keep running and
put as much of the funding asthey can towards patients, it
seems like a really great way toensure as many people as
possible are getting access tothese services.
Clare (08:55):
I think the government understood in the Public Health
Services Act that if you wantservices in medically
underserved communities, inplaces in the country that are
either underserved or populationsparse, population dense—it
works both ways—you need to givesome support to just the costs
of doing business in those areasof the country.
(09:16):
You know, lots of local healthdepartments participate in Title
X.
As I mentioned, all the otherproviders are private
not-for-profits.
So, a lot of them are workingon very, very thin margins.
They are serving verylow-income people.
And under the Public HealthService Act, we have to see
everybody.
So you can't ask people if theycan pay their bill.
(09:36):
Youknow, those of us with the privilege of commercial insurance may
have had the experience ofcalling a clinical office to
make an appointment, and thefirst question they ask you,
even before they ask you yourname, is they ask you what
insurance that you have.
Because that can end aconversation in a doctor's
office if you don't have theright insurance.
Under the Public Health ServiceAct, Title X providers don't
(09:59):
ask that question.
They have to see everybody,regardless of their ability to
pay, regardless of where theylive, regardless of any other
factor.
They come through the door.
We have to see them and servethem.
Jennie (10:09):
Man, I feel that hard.
I was in grad school and for ashort time worked at an OBGYN's
office and was in reception.
And yes, that was absolutelythe first question that I was
required to ask.
And then also thinking of whothese programs target, like
growing up in a rural area,there weren't a lot of options
(10:30):
for where I could go to getcare.
Luckily, I didn't live too farfrom like a city where I could
go get care.
But thinking of a lot of peoplewho lived a lot more rural than
I did, that can be a realproblem, getting access to
quality healthcare.
Clare (10:44):
Yeah, having access points where people are living
is incredibly important.
Now, in many cases, those sitesmight not be open five days a
week, right?
They might have more limitedhours, but to give people a
place to go where they're nottraveling far is a really
important thing.
Now, there are lots of towns inthis country where there isn't
a grocery store.
So, people are traveling allthe time, but they may not have
(11:05):
access to public transportation,ready ability to get a ride.
So, keeping the services aslocal as possible is one of the
real benefits of Title X fundingbeing in every state.
Jennie (11:17):
Okay, so now that we know how amazing Title X is, and
I've been lucky enough to meetlots of providers by attending
your conferences and so can talkabout how wonderful the
provider community is.
I also know the flip side thatthere have been a lot of threats
to Title X recently.
I mean, the most recent one waswhen I was at your conference
and the new administrationannounced some changes.
(11:40):
Can you talk a little bit aboutwhat is happening right now?
Clare (11:43):
So, our Title X network is in crisis at this moment and
we are 38 days in to anextraordinary situation.
On April 1st, which is thebeginning of the Title X year—
new federal spending arrivesevery year on the 1st of
April—the day before, March31st, the government announced
that it was going to withhold 22Title X awards.
(12:06):
These awards were madecompetitively through a very
clear and articulated processback in the spring of 2022.
And so, these grants and theorganizations that run these
grants were about to start yearfour.
So, well-established in theirproject period working to
improve.
(12:27):
And they were notified the daybefore that they would not get
their year four awards.
This impacts on an annual basisabout $66 million in Title X
funds.
That is about a quarter of allTitle X grants.
There are 16 agencies that holdthose 22 grants because you can
have more than one Title Xgrant.
(12:48):
All of the agencies are privatenot-for-profits.
Nine of them are PlannedParenthood affiliates.
The other seven are members ofthe Family Planning Councils of
America.
So, as of today, there are noTitle X funded services in eight
states.
And in another 15 states, thestates have lost either most of
(13:12):
their Title X or some of theirTitle X.
We estimate that under thesegrants in the last year for
which there are data, about 84042,000 people were served and
the number of health centersthat are affected is about 865.
So it's having an immediatenegative impact.
(13:34):
The grantees that wereaffected, as I said, had less
than a business day of notice.
about the government's decisionto withhold these dollars.
Nothing like this has everhappened before.
It's, as I mentioned,unprecedented and it's
incredibly reckless.
Jennie (13:53):
Yeah, I can't imagine, like, you were
expecting the money for thegrant that you have already
signed and are in year four ofto arrive the next day and then
to find out you're not gettingit.
There's no ability to havetried for other funding or any
number of things.
It's just all of a sudden youdon't have the money to serve
(14:14):
this community who relieson you.
Clare (14:16):
I really can't say enough about the staff and the leaders
in these affected agencies.
Many of them were on site withNFPHRA at our national
conference when they receivedthese notices.
The just remarkable composureand focus that they showed under
extraordinary pressure.
You know, all of these folkshave staffs.
(14:39):
They have volunteer boards.
They have a network of healthproviders that they sub grant
funds to in order to getservices out into that network
in the community.
They had so much thinking to doand so much communicating.
And the, you know, justemotional weight of sharing this
kind of devastating news, youknow, continue to be knocked out
(15:02):
by these leaders.
It's a tragedy that they're putin this situation.
And I think they're doing theirvery, very best to make the
next right decision at a verycomplicated time.
Jennie (15:14):
Yeah, this makes me think of, you know, I work on
the global side, so we often seesome of these same things
playing out around like theglobal gag rule.
And, you know, I think so manypeople think that the money
stops but restarts at anothertime and everything's fine.
All the services are back, allthe people come back, and that's
(15:35):
not really...
how this works.
If patients go to a providerand the provider can't help
them, the patient may not comeback, even if the funding comes
back, because some of that trustis broken that that's a service
that's a provider they can relyon.
So, it has such broader impactsthan just that immediate impact
(15:56):
of not being able to access theservice.
Clare (15:58):
Absolutely.
I mean, you might be in asituation where you come into a
health center where you'vegotten free care or subsidized
care in the past, and now theremight be a minimum fee.
You might have to cover the entire cost of your services. That's prohibitive for many, many, many of the folks who seek care in Title X funded settings. That's why they come to those settings. They know they can get good quality care, a provider they can trust, someone who's going to meet them where they are, address their needs and their values, and they're gonna do it in a way that doesn't make cost a prohibitive factor. But these agencies cannot sustain operating like that without federal support.
(16:33):
And as I said, we're in day 38of this emergency.
Some of the agencies haveshared that staff has begun to
be furloughed.
We have some health centerclosures that have been
announced.
I think we're just seeing thebeginning of what I think will
(16:57):
be a catastrophic impact onaccess.
Healthcare in general is notterribly elastic, meaning when
you close down an access point,it's very, very difficult to
reopen it again.
Staff find other roles, theymay move out of sexual and
reproductive health because it'snot a steady place to be.
There's a huge healthcareshortage in almost all of the
(17:19):
countries.
So, these providers are veryheavily recruited and sought
after.
So, if you lose your staff andyou close that access point,
it's not gonna reopen.
And Jennie, I wanna say, that'snot a hypothetical to me.
Before I came to NFPRHA, I rana Title X funded health agency
(17:39):
in my home state of New York,where we saw roughly 35,000
people a year in 13 healthcenters.
And in my time in the job, andI wasn't there all that long, we
closed four health centers, welaid off three rounds of staff.
And I will never forget sittingacross from somebody I laid
them off from a good job andwith benefits, and they had to
(18:03):
go get two jobs to make up forwhat they had lost in our
organization.
The impact here, not only onpatient access, but on the
communities, it is sodevastating.
I mean, the folks who work inthese health centers and these
grantee organizations—these aretheir hometowns.
They grew up in these places.
They're absolutely committed toserving people in their home
(18:27):
states, in their communities.
They may have come through aspatients or educators in the
systems as well.
So, there's such a fiercecommitment to keeping care
local, keeping it high quality,keeping it trusted.
This is such a violation of allthe things that folks who work
in these systems have built overmany, many years.
Jennie (18:52):
I think it's also really important to make the
connections, right?
This isn't happening in a silo.
We are also hearing aboutproposed massive cuts to
Medicaid, which will alsofurther restrict people's
ability to access broaderhealthcare, but also family
planning services.
And you're also seeing all ofthe attacks on abortion care.
So, people may not then be ableto get family planning
(19:16):
services, that they were gettinga Title X clinic.
They may have an unintendedpregnancy.
Abortion could be banned intheir state.
All of these things areinteracting and putting pressure
on people's lives and thedecisions they're able to make.
Clare (19:29):
Absolutely.
And another thing to add tothat is the government's now
proposing significant cuts inSTI screening and treatment.
So, the follow-on impacts onsexual and reproductive health,
on women's health, on LGBTQhealth, on transgender people's
health, on adolescent health.
I mean, the impacts areincredible.
(19:51):
You mentioned Medicaid, and I'dlove to stay there for a moment
because the cuts that are beingdebated in Congress right now
are absolutely catastrophic.
You know, 70 million Americansrely on the Medicaid program.
It's grown substantially in thelast decade and a half.
And it has been, since the 80s,the largest payer of family
(20:13):
planning care in the country.
And on average, it's paying forabout half the births in the
United States.
So, millions and millions ofpeople of reproductive health
age rely on Medicaid for theirhealth insurance.
And those health centers have avery big Medicaid population
they are serving.
Again, just referring to my ownexperience when my time in New
(20:38):
York, about 30% of our patientshad Medicaid coverage.
50% of our patients had noinsurance at all.
So, they were on a sliding feescale or getting free care
subsidized by Title X.
And then just about 20% of ourfolks had insurance.
So, if you think about thesituation that some of these
affected grantees are in rightnow, if you lose your Title X
(21:01):
money and Congress moves aheadwith these massive Medicaid cuts
and the president signs theminto law, you can't stay in
business.
There is no business plan.
There is no contingency.
There's cash on hand.
There's cash in the bank.
And when you're out of cash,you're done.
And that is why I'm so, soconcerned about closure, about
(21:24):
losing access points in thecountry.
Because what we'll see, I thinkvery quickly, is something like
what we're seeing for folksseeking abortion care.
So, contraception willtechnically be legal, but it
will not beavailable. And you know you'll see people, in my judgement, doing one of two things. The first is they're going to slide down the ladder of contraceptive preference. There are methods that work for people in different points of their lives. That tends to change. Sometimes the more effective methods are the most expensive methods and they can only be accessed in a health care settings. So, if you don’t have a place to go or a provider to rely on, or they’re there but you can’t pay the fees, then you're gonna slide down
to the cheaper methods, right?
(22:08):
And again, those methods may bequite effective for you with
good consistent use, but thatmay not work as well.
So, people aren't actuallygetting what they need, what
works best for them.
So, I think that's one thingthat will happen.
The other thing that I think isvery likely, and this seems
incredible, just three yearsafter the Dobbs decision leaked,
(22:30):
I think people are going tostart traveling for
contraception.
And the idea that that's wherewe are in the United States in
2025, that people are going tocross state lines to access
contraceptive care.
We always said that it wasn'tgoing to end with criminalizing
and banning abortion.
I think a lot of folks didn'tthink it would move this
(22:52):
quickly.
And I think we are facing avery rapid collapse in access to
all sexual and reproductivehealth care, contraceptive care,
STI care, and it's incrediblyscary.
Jennie (23:06):
Yeah, it makes me think of what we've talked about in
other scenarios of like whenthey like worries about
requiring mifepristone in personwhere we talk about like there
is just not the ability toabsorb that and ensure that
people are getting the care ifthey have to travel in person to
access care.
Now if we add in having totravel for contraception to
(23:27):
that, there's no way the systemcan support that at this time.
And I think the other point Ireally always try to make is a
lot of people, you may thinkthat Medicaid is not your fight,
like, that you don't getMedicaid, you're not on
Medicaid, but itis paying for so many things that are important to you.
(23:55):
Just to give an example, not to give too many details, but my mom is the chair of the board of the only public hospital in Southern Wisconsin. Iknow it is shocking the
conversations they are having ifthey lose the majority of their
Medicaid funding.
Hospitals near you may closebecause of losses of Medicaid.
And so you may not be onMedicaid, but the health
(24:15):
services you are relying on...
they may have to cut providers.
They may have to close ahospital.
This is everybody's fightbecause it is going to impact
how everybody is accessinghealthcare.
Clare (24:28):
Yeah, the federal investment in healthcare leads
to access, right?
If you want a local hospital,if you want a hospital with an
emergency department, if youwant to be able to deliver
locally instead of having todrive three hours to the nearest
maternity hospital, you needthe public money coming in.
(24:49):
The way we do healthcarefinancing in America is a mess.
It's a mess.
But when you pull on onestring, you unravel the whole
system because all the sourcesof financing are interdependent
and very complex, butinterdependent.
So when you pull out one sourceof financing, there's, you
(25:12):
know, the stool tips over rightaway.
And I think you're so right toencourage people to think about
not just their individualinsurance status, but think
about the infrastructure ofhealth resources that are
available to them.
And, you know, none of us knowwhen we might need emergency
care, something urgent comes up.
(25:32):
And that's why you need thisnetwork of, you know, local
providers, community-basedorganizations, hospitals, right?
That there's a reasonable Thisis a nested community.
And what they're, you know,what they're considering in
Congress is just catastrophic.
Jennie (25:48):
Okay, so I'm sure you can't talk details, but what are
you all doing to push back onwhat the administration is
doing?
So , we've been pushing along onthree tracks, I would say.
The first for me is showing upin every way we can for these
affected grantees.
I want to say flatly thatthere's nothing that these
grantees did that wasinappropriate or out of
(26:12):
compliance with Title X statuteregulations and program
guidance.
They are not different fromother grantees.
There's really no rhyme orreason to why these 16
organizations and theseparticular grants.
I think it's really importantto underscore that.
We have been working with themas a group and one-on-one
(26:33):
because they're all in reallydifferent circumstances.
They're all in an emergencybecause they can't access
federal funds.
But the initial step that theyeach had to take was when the
government suspended andwithheld their year four
payment, they also demanded asignificant amount of
information.
There were 10 or 11 elementsthat each agency was asked to
(26:54):
respond to the government on.
And they were only given 10calendar days to respond to
that.
And not only did they have torespond to the government's
requests, for their ownorganization, but they had to
respond for their entiresubrecipient network.
So, many of these organizationsrun health centers themselves.
They are direct serviceproviders, but they also give
(27:17):
money to a number of communitypartners to make a broader
network have more access points.
They had to go to each one ofthose agencies and say, the
government's asking us for thisinformation.
Will you give us thisinformation?
You know, most notably, one ofthe affected grantees is the
Title X grantee for the state ofCalifornia.
They have upwards of like 300service sites.
(27:38):
Like, they have dozens anddozens and dozens of
subrecipients.
So, this was a almostimpossible job.
Any request to the governmentfor more time or more
clarification was rejectedflatly.
So, the initial thing theseaffected grantees had to do was
respond.
So, and then I would say we'rein the second stage now, and I
(27:59):
would call this communicationand fundraising.
That's where the focus is.
So as I mentioned, these areall community-based
organizations with volunteerboards and community support,
big staffs, and then, you know,these tentacles out into the
community of subrecipientagencies and then the local
health center sites.
Everybody's got to hear thisstory, right?
They've got to understand whatthe government has done, the
(28:23):
degree of uncertainty andambiguity and threat that this
conveys.
And that's the job of thegrantee to be sharing that
information and trying to setsome expectation for this
network about what's gonnahappen.
Unfortunately, none of thesegrantees have heard a single
thing from the federalgovernment.
Again, we're on day 38 of thiscrisis.
There has been no reach backout to these grantees about the
(28:47):
material that they submitted.
They don't know who's doingthis investigation.
They don't know the timelinefor this investigation.
They don't know if there's away to pass this investigation,
right?
So, having to tell people thatyou have no information for
them, there's no end in sight,and then expect them to continue
to provide care is just areally, really difficult,
(29:10):
sensitive situation to findyourself in.
So, lots of time spent oncommunication.
And then equally so: fundraising, looking for (29:14):
undefined
community support, governmentsupport, if it's feasible.
And a lot of these agencies arein states where government
money is not gonna be madeavailable to them.
If you're in Missouri or you'rein Montana or you're in
Mississippi or you're working inTennessee, The government is
not likely to step in andprovide family planning support,
(29:36):
even in strongly supportiveenvironments.
State budgets are in veryserious crisis right now.
Lots of states running, youknow, looking at big deficits.
They have to run at even.
They have to balance.
Unlike the federal government,state governments can't run at a
deficit.
So, coming in at this stage instate budget cycles, typically
(29:57):
state budget cycles are for July1.
Come in in April and say, forexample, in Missouri, we lost
the equivalent of more than $8million in Title X support.
Missouri's not going toconsider something like that.
But even again, a stronglysupportive policy environment,
that's a very tall order to goin and say we're looking for
(30:17):
one-to-one replacement dollarsor our access points are going
to close.
So that's point one.
Support these affectedgrantees.
answer their questions, show upfor them.
The second thing we did is wesued the federal government.
So, on April 27th, we filed alawsuit in federal court because
the government has violated thelaw in these withholdings.
(30:39):
There is a process that thegovernment has very clearly
mapped out in statute and inregulation for bringing entities
that are out of compliance withfederal law into compliance.
There are a series of stepsthat have to be taken including
notifying the grantee, givingthem a chance to correct any
(31:02):
compliance issues voluntarily.
There's a notice period, etcetera.
The government didn't do any ofthose things.
They said they had a suspicionand an allegation and they
withheld the money.
That's against the law.
You've got to make a finding ofa violation.
Finding.
You have to come to aconclusion.
And then, as I said, you've gotto give that grantee an
(31:22):
opportunity to respond and curebefore you can move to withhold
money or terminate grants.
Government didn't do that inany of these cases.
So, we are pending in thefederal system.
I do want to say that unlike alot of lawsuits that have been
filed in the past and have beenfiled in the early days of this
administration, we are notseeking emergency relief.
(31:45):
And that is because in in earlyApril, the Supreme Court came
down with a ruling case relatedto education, Department of
Education grant making, wherethey allowed the government to
terminate grants while thelitigation was going forward.
And in the ruling that wasissued, it became clear that if
(32:07):
we were to seek emergencyrelief, meaning force the
government to put these Title Xfunds out to the affected
grantee organizations, if at alater stage in the litigation,
we were to fail, lose at anylater stage in the litigation,
the grantee organizations wouldbe responsible for paying the
(32:27):
government back millions ofdollars of grants.
So again, let's be clear.
Title X grants primarily go toprovide health care to poor and
low-income people.
There's no way that thosegrantees could collectively be
responsible for $66 million inrepayment to the government.
It was just too big a risk tothose affected agencies for us
(32:50):
to take such a step.
So, what we did is we're filingon the violation of the law.
We've said, you've done thiswrong.
You violated federal statutesand regulations.
There's a process that is clearand the government didn't take
any of the steps in the processbefore they withheld these
funds.
It's possible that we won'thave any movement in that case
(33:11):
until the latter part of June.
So again, that's really toughon these affected grantees.
They are trying to move theirway through a very complicated
series of decisions.
And I do expect layoffs and Ido expect closure.
So the last part of what we'reworking on is telling the story.
You know, as I said, when youwalk into a Title X funded
(33:33):
health center, there's no labelon the door.
So there's lots of folks whoare getting access to care,
subsidized care in a Title Xfunded health center.
They have no idea.
It's a really complex network.
It looks different in everystate.
The grantee networks aredifferent in every state.
So sometimes when people ask meto talk about Title X, I'll ask
them to pick a couple of statesso I can be as specific as
(33:57):
possible about how care isorganized and delivered in that
certain state.
But this is the story thatneeds to be told.
And there's been a lot ofinterest.
I'm thrilled to say folks seemto really understand the
immediacy of this impact thatyou can't just turn off federal
funding And these agenciessurvive.
Clearly, the federal governmentdoesn't care.
(34:19):
But our folks remain absolutelyunified and committed.
They're going to offer as muchquality care as they can.
They're going to keep open asmany health centers as they can.
And we're going to try to stayin this fight.
So, one of the things I've beenthinking about as we've been
talking that we haven't maybehighlighted as much is the role
that Title X plays in ensuringyoung people have access to
(34:42):
affordable contraception and theway that is also currently
under attack.
Clare (34:47):
Yeah, Title X is just a lifeline for adolescent health
under the Public Health ServiceAct program and under the Title
X statute.
As I said, we serve everyoneand we have to serve everyone
with confidentiality.
Our health centers do need toadhere to state law and our job
is to be there to meet the needsand the values of everybody who
(35:09):
comes through the door.
So, adolescents seekingeducation and seeking clinical
care are going to haveconfidential access to care in
the Title X system.
That's really the gold standardfor confidentiality across
federal health programs, and itis incredibly important.
One of the big setbacks in thelast couple of years has been
successful effort, at least inTexas, to undo that protection.
(35:33):
Right now in Texas, adolescentsseeking healthcare in Title X
funded systems do not haveconfidentiality, but that is an
aberration and we believe it isa misreading by courts of the
federal requirements.
So, protecting confidentialityfor everyone is absolutely
essential.
I've said many times beforethat intimate relationships
(35:57):
don't automatically get safewhen a legal adult.
So, every single person cominginto a health center deserves
confidentiality.
It may be more or lessimportant to you on any given
visit.
There may be certain servicesthat you think are sensitive or
certain tests that you think aresensitive, but it's up to you
(36:19):
to tell us what you need, whatyou value, and what you hold
dear.
And it's our health center'sresponsibility to make sure that
you're protected.
And that's another core value,I think, of the Title X program.
It's a commitment that ourworkforce has shared for 54
(36:40):
years.
Jennie (36:40):
Yeah, it just seemed like one of those really
important things to pull outbecause we have seen young
people be the opening wedge tobroader attacks.
We saw that with abortion.
We're seeing it now with, I'msure, gender-affirming care.
And I'm sure this is just thebeginning of the broader assault
on Title X as well.
Clare (36:59):
Yeah, I think it's so important to think about what
does it mean to be able to froman adolescent and meet their
needs.
You know, most kids are gonnaengage a trusted adult.
And typically, it's really amatter of timing, right?
They wanna choose which.
So, if they're in a two-parentsituation, there might be a
parent they feel morecomfortable having the
(37:21):
conversation with initially, andthey wanna choose when.
So, you know, this is not asituation where for younger
people don't have a trustedadult, whether they are a parent
or another caregiver or a lovedone who is there to talk it out
with.
There are some kids that arenot in that situation and they
have a lot of reason to fear.
(37:44):
And we know that mandatingparental or caregiver
involvement drives adolescentsaway from services that they
need.
That's not good for theirhealth.
That's not good for theirwellbeing.
So what we need to do is takethe barriers away and let people
just get the care that theyneed from the providers that
they trust whenever they needthat care.
(38:04):
There is another aspect to thisstory, which is the government
also made two awards.
to Oklahoma and Tennessee.
And those are the states thatwere terminated from the program
because they wouldn't counseland refer for abortion.
And that's an under-told pieceof the story.
I have been trying to get thatword out too.
(38:24):
I do want to say that both ofthose state health departments
are members of NFPRHA, but Ithink even they are bewildered
by the government sending themawards they didn't apply for.
And in fact...
some really fascinating stuffgoing on... so both of these
states were terminated fromTitle X in 2023, after a long
back and forth with the Bidenadministration.
(38:44):
They both have state abortionbans, and they were saying
because of their state abortionbans, they could not counsel or
refer for abortion.
And obviously, we have aconstitution with a supremacy
clause that says federallaw trumps state law, so they
were defying the program.
And so, they were terminated.
Both health departments suedthe federal government.
(39:05):
Both health departments so farin their litigation have been
unsuccessful.
One of those cases has beenappealed to the Supreme Court,
and the Supreme Court has notyet decided if they will take
that case.
And the other one is in thecircuit courts.
They have a request for a fullcourt review.
But they've lost at thedistrict stage, and they've lost
at least initially at thecircuit stage.
(39:25):
So suddenly, on the 1st ofApril, both Oklahoma and
Tennessee got Title X awards.
That's illegal.
They did not apply.
The government has said theyare being restored.
That's not a thing.
The grant letters also saidthat it was pursuant to a
settlement, but there haven'tbeen settlements in either of
(39:47):
these cases.
And so both Oklahoma andTennessee have filed papers in
their respective lawsuits beinglike, we got this money.
We don't really know what itmeans.
Are they going to let us notcounsel and refer?
Like, nobody will tell.
So it's a really crazysituation.
And yeah, so that's somethingwe're watching pretty closely
(40:10):
to.
Are they going to get away withthis?
Right.
Because if Tennessee are comingback to the program, we assume
they won't.
actually take the money unlessthey don't have to counsel or
refer.
That's a violation of thecurrent regulation, which the
Trump administration has notmoved to change yet.
So this is one of thesesituations that I think we'd be
(40:32):
getting a lot more attention ifall the other terrible stuff
wasn't happening.
But there's so much terriblestuff going on that this is kind
of sliding under the radar.
Jennie (40:41):
Claire, I always love talking to you and I can talk to
you for a really long time, butmaybe we should wrap it up with
what I always love to end with.
And that is what can ouraudience do?
How can our audience getinvolved in this fight?
Clare (40:53):
Well, I'd love to refer you to our NFPRHA website
because we have a landing pagewhere you can go and look at all
this information about theaffected grantees.
And that landing site includesinformation about each of the
agencies all across the countrythat are impacted.
And there are agencies in everypart of the country now that
(41:13):
are going without Title X funds.
We have links to pages ifpeople want to donate, support
one or more of these excellentagencies.
You can see statements from allthe agencies also on our
website.
And so, I want to say, youknow, we need to center people
who are most affected.
These are the folks who aremost affected today.
I also want to say that therisk to Title X looming is
(41:37):
terrifying.
The president last weekreleased an initial budget
proposal that eliminated Title Xentirely.
Proposes eliminating all themoney and the office and the
federal staff that support theTitle X program.
Congress is going to begin theprocess relatively soon of
working through what is fiscalyear 26 federal appropriations.
(42:00):
It's their role to decide whatmoney is spent in what basket.
Title X has not had a fundingincrease in 11 cycles but now
they're proposing just zeroingout the program entirely.
that will have massive impacton access to care.
So, folks who are ready toraise their voice, whether it's
(42:21):
directly with congressionaloffices or in their community
and networks or on social media,telling this story, we just
need access to contraceptivecare.
The government should step outof the way.
A lot of these folks doing thiswork in community have been
doing it for their entirecareers.
They're good at what they do.
They deliver excellent care.
They care deeply about thepeople that they're serving in
(42:44):
their communities, and they justwant to be able to do their
good work.
So , that would land me in onelast spot, which is if you can
find out where your Title Xagency is, and you can do that
by Googling, drop them a note,send an email to the info line.
Stop by and push a thank youcard through the front door.
These folks do not always get alot of attention.
(43:06):
They're not always on the news,but what they're doing in the
community is really valuable.
So, if you've had a goodexperience at a family planning
center in the past, or you're apatient now, let them know that
you're aware of what's going on,you support them and their
work, and that you're going tobe there for them in the
community.
I can't tell you what it wouldmean to folks around the country
(43:28):
if they started to hear fromfolks saying, hey, we know this
is happening and we think it'swrong and we support you and we
support access to contraceptionand you're our neighbors and
we're going to be there for you.
I think it would just mean theworld to the folks working in
this care.
Jennie (43:42):
Yeah, I always appreciate doing the little acts
of kindness for all theproviders.
Just a flag for anybody who'sthinking about doing that.
Don't send anything that's likea package unless they know
you're expecting it.
Just for safety reasons, theywould be concerned if they were
getting in a random package.
So, just that's one littleflag.
But like, letters and postcardsand all that stuff is greatly
(44:05):
appreciated.
Claire, thank you so much forbeing here.
As always, it was such apleasure to talk to you.
Clare (44:10):
I appreciate so much the work you do in the world,
Jennie, and how you lift up somany voices.
And thank you for giving us achance to tell this really
important story.
Jennie (44:19):
Hopefully we'll have you come back with some good news
at some point in the nearfuture.
We're going to fight.
We'll fight and we'll fight.
Thank you.
Okay, y'all, I had a great timetalking to Claire about all
things related to Title X.
As always, I learned somethings that I didn't know about
while we were talking, and Ialways learn so much from
Claire, so I'm so grateful forher for being on.
(44:41):
So thank you, Claire, and wewill see everybody next
week. [music outro]If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
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