President-elect Joe Biden is expected to roll back several of the Trump administration’s changes to sexual and reproductive health programs, undoing a large portion of the president’s executive actions on abortion and women’s health.
Abortion rights and women’s health care advocates anticipate the Biden administration will act swiftly to reverse a myriad of Trump-era rules including ones that allow more employers to opt out of ObamaCare’s contraception mandate and ban the use of federal family planning dollars for domestic and foreign organizations that provide or promote abortions.
“We think many of these issues actually could be addressed day one, in an executive order that explicitly talks about the new administration’s commitment to sexual reproductive health care,” said Jacqueline Ayers, vice president of government relations and public policy for Planned Parenthood Action Fund.
“I think that this is a great victory but we know that we are going to have a lot of work to do because it’s not just about undoing the harm of the last four years, but really making sure that we’re moving the ball forward and advancing health care through really bold changes.”
The biggest challenge facing supporters of abortion rights going forward may be the mark that Trump has left on the nation’s courts. Trump appointed three justices to the Supreme Court in four years, including a replacement to the court’s liberal stalwart, Justice Ruth Bader Ginsburg.
Trump and the GOP Senate also filled lower-court vacancies at a furious pace, leaving a considerable conservative legacy. If the Senate remains in GOP hands, it may be difficult for Biden to leave as big a mark.
But Biden is expected to take action in his first days administratively.
One rule advocates are particularly ready to see go resulted in hundreds of thousands fewer people getting contraception and other services through the federally funded Title X family planning program, who are disproportionately people of color.
The rule, finalized last year by Trump appointees at the Department of Health and Human Services, prohibits Title X providers from promoting or performing abortions. It appeared to be aimed at Planned Parenthood, one of the largest Title X providers and a longtime target of Republicans.
The move, which was denounced by women’s health groups and the nonpartisan American Medical Association as interference in the doctor-patient relationship, resulted in 800,000 fewer people getting care from Title X in 2019.
“The Trump regulations have devastated the Title X network,” said Amy Moy, chief external affairs officer for Essential Access Health, the largest Title X grantee in California and the country.
Their network will serve less than 250,000 patients in California this year, a reduction of almost 75 percent after the regulations took effect.
“It’s our hope and expectation that very early in the new administration, there will be swift action to reverse the Trump era regulations and start to reset and address the harm that’s been done.”
Title X was created 50 years ago by Congress with bipartisan support to provide low-income women and men with contraception, cancer screenings and other services. It has become politicized in recent years.
While federal funds, including Title X money, cannot pay for abortions in most circumstances, conservatives argued that any funding flowing to abortion providers would indirectly support the procedure.
Dozens of state health organizations felt they could not comply with the new rules and left, resulting in the loss of 945 Title X service sites across the country. While the Trump administration argued it would find providers that would comply with the new rules, it failed to close the gap.
In 2019, it served 3.1 million people, down from the 3.9 million it served in 2018, before the rules took effect.
Six states now have no providers participating in Title X.
“It is essential a Biden administration act as expeditiously as possible, on day 1 or within 100 days, to get money flowing back to providers, particularly to jurisdictions that don’t have Title X services right now,” said Jessica Marcella, vice president of advocacy and communications for the National Family Planning and Reproductive Health, a membership organization for Title X providers.
Marcella said some providers that have left the program under Trump have struggled without federal funding and if they close, they are unlikely to reopen, leaving communities without clinics dedicated to family planning care.
“The reality is that health centers are holding on to the extent possible, recognizing a Biden administration values public health. Even right now, there are health centers on the brink of closing, just trying to hold on for a reversal of fortune and restoration of Title X’s integrity as a program they can participate in,” Marcella said.
While some states like Massachusetts and Vermont have filled in to help providers that had left the program, Marcella is worried whether the program will remain a priority as states face COVID-19 induced budget shortfalls.
Some providers like Planned Parenthood continue to serve patients it had seen through Title X, but have had to start charging co-pays for some services.
Advocates also hope having a Democratic president and Democratic House majority will mean an increase in funding for Title X, which hasn’t received a funding boost since 2014.
Biden has also promised to reverse a ban on global health aid for foreign organizations that provide or promote abortions. The so-called Mexico City policy — named for the city where former President Reagan first announced the ban — has become a game of political football, rescinded when Democratic presidents take office and reinstated by Republicans.
He will also reissue Obama-era guidance rescinded by the Trump administration that states can’t defund Planned Parenthood from their Medicaid programs.
Advocates also want Biden to rescind a Trump rule that allows health workers with moral or religious exemptions to certain procedures, like abortions, to refuse to provide those services.
Biden should also remove a requirement issued in 2011 that abortion pills only be prescribed in person at specific health care settings.
It’s not clear how high a priority reproductive health issues will be for Biden in his first days in office, but advocates argue it should be at the top of his agenda.
“Biden administration has been clear three of its main priorities are the economy, addressing COVID and racial inequality in the U.S., and sexual and reproductive health is tied to all three of those issues,” said Zara Ahmed, associate director of federal issues at Guttmacher Institute, a reproductive health policy organization.