PERSPECTIVE: PRESERVING TITLE X OF THE PUBLIC HEALTH SERVICES ACT
Title X of the Public Health Services (PHS) Act is a family planning program enacted in 1970 that requires physicians to recommend family planning services and related preventative health services to low-income and uninsured individuals. In 2016, more than four million patients, almost 90% of whom were poor or low-income, obtained care through the Title X program[1]. Per the Health & Human Services, Title X is intended to (1) advance health equity through the delivery of Title X services (2) improve and expand access to Title X services and (3) ensure health care delivery of the highest quality (cite)…..
The fiscal year (FY) 2018 Funding Opportunity Announcement (FOA) altered the criteria for the grant-making process of Title X. National Family Planning & Reproductive Health Association (NFPRHA), a non-profit organization that provides Title X-funded services, filed a motion in federal court requesting injunctive relief because the 2018 FOA undermines the objectives of Title X. The plaintiff argues the “requirement of directive counseling, the lack of any reference to biomedical family planning methods, the elimination of any mention of the recognized clinical guidelines, the minimizing of the importance of direct medical care, and other changes made by the 2018 FOA mainly favor grant applicants with little or no experience in providing high-quality family planning care[2].” The plaintiff’s claim is “unless defendants are enjoined from the 2018 FOA by this Court, NFPRHA’s physicians and the millions of patients they serve each year will suffer irreparable harm” because “Title X became, and remains, the only dedicated source of federal funding for family planning services in this country[3].”
Challenges by Planned Parenthood to the 2018 FOA were reviewed with this claim. The district court ruled against the plaintiffs citing the claim was not “reviewable” by the Administrative Procedure Act (APA). An appeal was filed and the United States Court of Appeals ruled because “the 2018 grant process has long since concluded, superseded by an amended 2019 FOA, no meaningful injunctive relief could be provided making the case moot and any declaration that the 2018 FOA was unlawful would amount to an advisory opinion.
The American Medical Association (AMA) contends the 2019 gag rule stemming from the 2018 FOA violates a code of medical ethics. The AMA states open and frank communication of what family planning services physicians can discuss with their patients is a tenant of quality care and any limitation to that rule diminishes medical standards. New motions for a preliminary injunction were filed by several states to block the 2019 gag rule from taking effect after being published in the Federal Register on March 4, 2019. The outcome of these legal challenges resulted in conflicting conclusions of the 2019 gag rule with no uniform consensus on the legality of the rule. Ultimately, a petition for certiorari was filed and the Supreme Court dismissed plaintiffs’ legal challenges to the gag rule because an amendment to the 2019 gag rule was enacted in 2021 allowing physicians more autonomy of what family planning services can be recommended or discussed with their patients.
[1] National Family Planning & Reproductive Health Association v. Azar, No. 1:18-cv-00756 (. filed Apr. 19, 2018).
[2] Id.
[3] Id.