Proposed Changes Would Dramatically Alter the Title X Program

The Title X Family Planning Program was created in 1970 to fund reproductive health and contraceptive services and remains the federal government’s only dedicated source of family planning funding. Since his first term in office, Trump and his administration have repeatedly targeted the Title X Program, most recently by changing the application process for funding. Clare Coleman, President and CEO of the National Family Planning and Reproductive Health Association (NFPRHA), joins us to talk about what the latest funding announcement means for Title X and its grant recipients, and the lawsuit that NFPRHA, the ACLU, and FHCCP are pursuing against the Trump administration’s blatant contradiction of the Title X statute. 

Title X-funded programs provide contraceptive services, STI and pregnancy testing, and other crucial preventative and reproductive health services. The new funding announcement changes the process of applying for Title X grants, undermining Title X’s statutory mission by giving political appointees the power to decide who even gets considered for funding. This politicization of family planning resources promotes the President’s narrow agenda and poses a threat to the millions who rely on Title X-funded clinics and resources. 

For more information, check out That Aged Well: https://pod.link/1446333312

Transcript

Jennie 0:59

Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health rights and justice. Hi rePROs, how's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So, y'all, I'm gonna start the episode with a little bit of housekeeping, mostly because I finally went and ordered a couple things from our Bonfire store. I mean, I have ordered things in the past, but I just ordered some new things that came and I was so excited. I got a tank top with the microphone design that says rePROs Fight Back, a podcast on all things repro. I love it. I had to not have anything with that design yet, so I'm so excited to have a tank top for the summer. And then I also got a mug that says Fund Abortion Fight Evil. That one has not arrived yet, but I am expecting it any day. So all that is to say, I love my merch that just came, and you should definitely check out our merch store. There's a link in the show notes, but otherwise you can find us on Bonfire. We have some really great designs done by Liberal Jane, and I love them all, and I am slowly adding to my collection. I have a couple t-shirts. I had a bag, but I gave it to somebody, so I need to get myself a new bag because I really love them. They're very cute. So, I need to get a new one. So I didn't get that this time. I ended up actually going and getting uh a bag from Patient Forward, which you should check out too. It says, "abortion bans are totes a scam." Love it. I saw it and was like, oh my god, I need this right away. So, I didn't get a new rePROs bag, but I did get that one, so you should check out their store too. But yeah, make sure if you want merch and want to support us, go buy stuff on Bonfire. And if you haven't already subscribed to the podcast or our newsletter, make sure you never miss episodes. So, you know, subscribe on whatever platform you're listening to. It's free. You know, just follow or subscribe, whatever it is. If you're not already subscribed to our newsletter to make sure you get an email when new episodes come out, or if we have reports or it has links to our bonfire store, make sure to sign up on our website for our newsletter. We would love to have you. Yeah, and if you really love the podcast, if you could rate and review us, that would also be wonderful. It helps other people find the episodes, and we really would love to have more people listening. We love our audience, but we feel like there's so much great stuff we talk about that there's more people should listen. Yeah, let's see here. I feel like this I I'm really looking forward to this weekend. I, for some reason, have been like so tired this last week. I don't know what is going on. I normally read before bed, I'm a huge reader and it is my like shut-down-my-brain routine at night, and I usually read for quite a while. And the last couple nights I have just been like reading like a page or two and like out. So I don't know. I clearly need to catch us up on some sleep this weekend or something. Yeah, I don't know. So that is my plan for the weekend is to have a very chill one. I also have been, I didn't want to bake over the 4th of July weekend because it was so hot in DC. So, I think I'm gonna bake something this weekend. I've been sitting on this recipe from Joy the Baker that was for chocolate and almond scones that sounds delightful. And then she encourages you to you know bake them as you want them, so to and then to freeze the rest of the dough. So I think that is what I'm gonna do, and like bake maybe two over the weekend and like freeze the rest and maybe bake the rest and take them into work next week. I don't know, we'll see. But yeah, I am I'm looking forward to that, and I'm really close to finishing the cross stitch project that I've been working on, so I'm gonna do that. It's so funny. I feel like my like Instagram algorithm has switched recently between like having badass cross stitch on and like following them and and all the things that I'm starting to get more crafty type things popping up. And one of the things that popped up recently was it's called a jelly roll rug that's like a quilt quilting type project, and I do not sew, I'm not a quilter, but my mom is, and I was like, Hey, are you looking for a winter project? So she's gonna make me one. I'm really excited. I'm gonna get one to go in my office, and I she asked what colors I wanted, and I asked her if she could do it in the Reprose colors. So I'm very excited to get this really colorful rug for my office. I will share pictures when I get it. It will be a while. It's gonna be like a five-foot rug, so it's definitely gonna take a while, and I'm sure it is still summer. She's got lots of outdoor projects that she is working on with the garden and all the things, so that I this is definitely gonna be like a winter project, but I will share a picture when I get one when I get it. Um, but I'm really excited. I don't know. I just saw it pop up in my feed, and again, I really kind of am loving this switch to to crafty or like creator content that is popping up in my feed. I love watching it, even if it's for things I don't do. I think I talked about the lampshade one. There's another one I'm getting that's like a guy in I think Kentucky who who does custom hats, and it's just so fascinating watching him do them. I don't know. I could watch it forever. I love watching those, and like I said, I got this jelly roll one. I really love seeing things be created and come together. I just find that really fascinating and a little bit of magic, like especially when it's things I don't think I can do, like it it just is magic. I feel like I've talked about that with like where I've had friends who've written books because I am such a reader, it is magic to me that I know people who have written books and like great books that I have loved, and it's so wonderful. I love that. So I am enjoying this new thing showing up on my Instagram. So if y'all have like crafty or people creating things that you follow on Instagram that you really love, like shoot me a note. I would love to see who I should be following that I am not already. Yeah, let me know. You can find me on socials at @JennieInDC on Bluesky mostly. I'm also on threads, so you know definitely hit me up there as well, especially with any of the creator type things, or if you have like Bookstagram people that you really enjoy, would also love that. I always take book recommendations, but yeah, this is a new one. If you have crafty type people I should be following, let me know. I would love to check them out. Okay, I think that's enough for now. I feel like I have been talking a lot. Let's go to this week's episode, and I'm just gonna give you like a little flag. We have a really great conversation, but there is, I think Claire has like a vent near her, and so there's a couple times where you can really hear the like her the blower in the background. We're doing the best we can to clean it up, so you'll probably still be able to hear it at a couple points. So, I hope it's not too distracting because it was a really great conversation, and I didn't want to redo it because you just never get the same conversation again, and I would really hate to have lost this. So we decided that there was enough we could do to make it still easy to listen to and not terrible, but that you just still might hear a little bit of uh like a hum in the background. So apologies, but it is a really a wonderful conversation. I have Clare Coleman with NFPRHA on. We are talking about the attack, new attacks that we have been seeing on the Title X network NFPRHA's lawsuit that they have fighting back against the administration's newest attack. So, with that, let's go to my interview with Clare. Hi, Clare, thank you so much for being here today.

Clare 9:12

Hi, Jennie, it's great to be back. Thank you so much for inviting me.

Jennie 9:15

It feels like it has been so long since you've been here, so I'm so excited to have you back.

Clare 9:19

It's been just about a year, I believe, uh, since the last time I was here when we were facing yet another type of challenge to the Title X Family Planning Network. We survived that one, and we're deep in the heart of our next challenge that I'm confident we're gonna get through as well.

Jennie 9:34

Okay, before we start talking about all the things, do you would you like to take a second and introduce yourself?

Clare 9:39

I'd be happy to do that. My name is Clare Coleman, and for almost 17 years now, I've been the President and CEO of the National Family Planning and Reproductive Health Association, which we and many in Washington call NFPRHA. NFPRHA was founded in 1971, just after Richard Nixon signed into law Title X of the Public Health Services Act. And Title X represents the only dedicated source of family planning funding coming from the federal government. There are lots of different sources of federal money, most notably Medicaid, paying for an extraordinary amount of contraception and sexual health care for folks living in the United States. But Title X has represented for 55 years, 56 years this year, sort of the gold standard of what contraception and sexual health care should look like. And the Title X program funds a network of healthcare providers in every state and most of the territories, and those health centers accept federal money in order to be able to subsidize access to contraception and sexual health care. So, depending on your income, you may pay absolutely nothing for your services, you may pay on a schedule of discounts or a sliding fee scale. These health centers also accept insurance. So, no matter what your source of payment is, you can walk into a Title X funded health center, and one of the things that you've been able to rely on is high-quality care. Clinical staff that are super focused on sexual and reproductive health have a lot of experience, can really meet people where they are and offer care according to the patient's needs and the patient's values. And we are very, very lucky at NFPRHA to represent the vast majority of the Title X funded network. I am a former executive director of a Title X funded agency in my home state of New York. That's what I was doing before I came to NFPRHA. And it's incredibly important to me that as a national association we keep a really close touch on what it is to be out there in the country working in the healthcare safety net, focused on low-income and poor people, trying to equalize access. That's what our members do, and we're incredibly lucky to support them and try to share their story around the country.

Jennie 12:02

Oh, I'm so glad you did the like what is Title X, because I always want to make sure that we're not just jumping in with like what the latest problem is. I think the framing of what it is and why it's so important is always the most important place to start.

Clare 12:16

It's also important because it's not going to be the case that when you walk into your local health center, which might be Adagio Health in Western Pennsylvania or Unity Healthcare in Washington, DC, or Converge in Mississippi or Tennessee, that you're gonna see Title X on the door. This is a funding source, right? It's not a brand identity. And so a lot of times when folks are seeking care in a local health department or at Maine family planning, they don't necessarily recognize the connection and the fact that there's a lot of federal grant money and Medicaid reimbursement that is keeping those health center doors open and keeping services available locally.

Jennie 12:57

And it just seems like it's such a great program. It gives people access to care, it gives people access to family planning. Like, it seems like it should be very non-controversial and you know, very supported by everybody. Like you said, it had bipartisan support when it was created, but that has not been the case, and Title X has been under attack. Like you said, we talked last year about the freezen funding, but this year's the the new attack we're seeing is very different. What are we seeing with this new notice funding opportunity?

Clare 13:32

Well, I want to step back before I step into that question because I think the distinction that I'd love for us to keep making is contraception, access to contraception in sexual health care is not controversial out in Americans' lives. Correct. The vast majority of Americans will use a method of contraception, often multiple methods of contraception throughout their lifetimes. Their needs and values change, their interest in achieving pregnancy or preventing pregnancy changes, their relationship statuses change. Like this is just part of how people manage, particularly women. The fact that you are fertile for a really long period of time, but most people do want to be controlling their childbearing for most of the time that they are able to achieve pregnancy, if they are able to achieve pregnancy. So what I find so discordant, right, is politically we have been wrapped up in this maelstrom about who's gonna have rights and who's gonna be able to make decisions about their lives, their values, the family that they may or may not want. But, you know, out in the world, out in our families, out in our friend groups, this is nothing controversial at all, right? People are managing whether or not they want to be having a family. And men and women are managing that. Everyone is managing that. This is not a this is not a one-gender issue, this is not a one-time of life issue, this is something that people are actively thinking about and making decisions about throughout the course of their life. But to get back to where we are, politically, at least at the at the federal level, what we have seen is a long but also increasingly more complicated siege against the access to sexual and reproductive health care writ large, right? The attacks on contraception were building before the Dobbs decision in 2022, but having achieved, after nearly 50 years, the elimination of the constitutional right to abortion, there was a very quick slide towards the constitutional right to access contraception, which was established in 1965 for single people and then achieved in 1972 for unmarried people. We still have a constitutional right to access and use contraception. It is built on the same pillars, or it actually was the pillar that helped create Roe and a number of other personal rights. Now that Roe has fallen, you are seeing, you know, a lot more suggestion, including from Supreme Court justices like Clarence Thomas, that it's time to go look at things like the Griswold v. Connecticut decision from 1965. So what we have is an opposition that at the heart of it, in my judgment, is about establishing fetal personhood, establishing the notion that sperm meets egg equals life. And what you have right now is an administration that is giving that movement the control of where uh federal policy is going to go. And this network of very talented, hardworking, highly qualified providers are going to have to withstand the assault from an administration that is essentially given the keys to federal uh reproductive health policy to folks who don't believe that you should have access to that care.

Jennie 16:53

Ugh, it just boggles my mind that with we are in this fight, and I feel like it's even more frustrating that we are having the same conversations we had around Roe of like they are coming for abortion and like they are trying to ban it, and everyone's like, that's never gonna happen, they're never gonna overturn Roe, and now we're like, hey, they are coming for birth control, and you're having that exact same, like seriously, you like you're chicken little screaming that the sky is falling, and and it's like no, but there were actually like lawsuits trying to like overturn parts of like young people's access to care and things like that, which is how we got to row was like starting with those groups of like we it's okay to have abortion bans for young people.

Clare 17:46

You're exactly right. They're using the same playbook that they use to ban abortion, and think of it not just in terms of who can access care, but also what care they can access, right? So in the fight to destroy the constitutional right to an abortion, they would select certain methods of abortion and say, you know, these are not these should not be tolerated, these should not be available, and then they'd switch to the to the groups of people side, right? And say, you know, not at this time in pregnancy, not for these reasons, not this group of vulnerable people, whether they be young people or others, poor people, people who get their health care through the government. You know, there were so many ways that the anti-abortion movement tried to separate and stigmatize and say, but not this, but not that. And that did lead a lot of people to not think about like what's the end goal here? And the end goal is no right whatsoever. And that is the direction that we believe the country is moving in terms of contraception. We joined you and many others in the wake of the Dobbs decision in 2022 saying it will move faster on contraception because they have established all of these mechanisms for you know using state law, using litigation, going to the federal government, you know, stigmatizing providers, stigmatizing procedures, stigmatizing people seeking care, right? Trying to other the folks who have abortion, who are parents in another point in their life for many, many people. So, you know, all the ways that folks have allowed and tolerated this idea of separating and stigmatizing and othering and coming up with reasons why there shouldn't just be a right to have the care that you need at the time that you need from the people that you choose to seek care from, which should be our standard, right? The best quality care from providers that you trust who are going to respond to your needs and your values. That's the standard we should hope for anybody, and that's what we're trying to protect now when it comes to contraception and sexual health, and trying to regain an abortion care. It's what they should have.

Jennie 19:55

So that is what people rely on Title X for is you get affordable access to a full range of contraceptions with knowledgeable counseling, patient-centered care. But this new funding announcement would basically completely change all of that. Can you talk a little bit about what how this new announcement fundamentally changes the Title X program?

Clare 20:18

So let's talk a bit about how Title X grants get made in the United States, and then we'll talk about this most recent opportunity to apply for federal money. So, unlike a lot of public health funds that typically flow from the federal government to a state health department and then out into local health units or city health departments, Title X, since its inception has been run as a competition. So, unlike getting like a let's say a formula grant that's based on population. So if you're a big state, you get a bigger chunk of public health money, or sometimes public health money is distributed on like a disease burden basis. So if you have higher rates of a particular condition, the federal money coming in to try to reduce those rates of incidence or prevent infections, let's say, are based on disease prevalence. Title X doesn't run that way. There's a pot of money approved by Congress every year, and then the federal government opens up on a scheduled basis, right now it's uh every five years, an opportunity for applications to come in. These are called competitions, and every governmental agency is eligible to apply, any private non-for-profit is eligible to apply. And in recent years, it's just been one big pot of money. They put the entire $386 million pot up for competition, and any applicant can come in and ask for any amount of money. Now there is an award ceiling and there is an award floor. So you can't go in and say, I want all $286 million. They don't allow that, but they also don't say, well, if you're applying from, let's say, Montana, you can only ask for $2 million. They don't do that. So if you go in with a big application, you ask for $5 million, ostensibly the government could award that amount. So what we are in right now is the last year of a five-year period of funding. It's a little bit longer than Title X grants typically are. They're usually run three years, but right now we're in a five-year project period, and the competition that has been announced is also for a five-year project period. This funding announcement is the government's guidance and gives a sense of what the priorities are that they will be seeking in applications. It also lays out in a very detailed way what you have to submit and what number of pages with what kinds of attachments or appendices that answer a hugely, hugely specific set of circumstances. That applicants are asked to address in their submissions. There are some incredibly troubling things in this new funding announcement. I'm going to walk through a few of what they are, and then we can talk a bit about what NIFRA is doing to try to protect the field from this kind of change in funding. So for the first time ever in a Title X competition, the government has introduced something they're calling an alignment review. This would come before a merits consideration. So typically, when Title X applications come in, they are distributed to a group of experts, some of whom work in the government. They might be career-appointed folks working in the Department of Health and Human Services, and from outside experts. So folks who work in other areas of public health, folks who teach in academic medical centers, folks who have worked in the Sexual and Reproductive Health Provider Network. Those folks put themselves forward to be independent expert reviewers. They submit their background and their qualifications. And then a contractor that works with the Office of Population Affairs, which oversees Title X, then selects what they call a merits review panel. And let's argue there's four or five people on that panel. Those folks are given a range of applications, as many as eight or ten applications that they have to read and they have to score them. They have to give them a rating based on 100 points. And the funding announcement itself delineates the scoring criteria. So everybody going into the competition and all the reviewers who come forward to read applications, they all know what the rules are. It's all a score out of 100, and the goal is that the higher you score, the applicant is likely to get the funding that they have requested. In this funding application, they introduce something called an alignment review, and it's explicit that this alignment review is going to be conducted by political appointees. And in fact, in a couple of places in the app in the funding announcement, they actually refer to presidential appointees, giving those folks control over which applications go to the merits review. So even before any expert reads the application, the application may never be read under this alignment review if political appointees determine that the applicant is not sufficiently aligned with the administration's priorities for health policy, public health policy. Now, we'll talk a bit about what some of those priorities are and how they set up a clash between Title X and this funding announcement. But just sticking with the alignment review for one minute, we believe, and we allege this in our litigation, that alignment review is in contrast to, it's contrary to the statute. The statute says the HHS Secretary shall consider certain factors when looking at applications, including the number of people to be served, the extent to which family planning care is needed in the area, the local area, the relative need of the applicant for funding, and its capacity to make effective use of any federal grant money. That's a shall come straight from the statute. This alignment review doesn't consider any of those things, right? The alignment is with the current administration's political priorities. It has nothing to do with what was in the statute that Congress passed. So this alignment review is in direct contradiction to the statute, and it's one of the key reasons why we chose to sue the government over this funding announcement. I mentioned that the funding announcement also sets up a number of clashes between the current Title X regulation, which was put into place in 2021, and these HHS priorities. And I want to call out two HHS priorities that are very heavily in play in this funding announcement. The first is HHS has adopted a version of the president's executive order on ending diversity, equity, and inclusion throughout the federal government. So the Title X regulation requires anti-discriminatory care, client-centered care, inclusive care, and it requires applicants, folks in the Title X program who are funded, to advance health equity. So you can't adhere to the regulatory requirement to advance health equity, have client-centered care, be inclusive, and not to discriminate, and also follow the administration's anti-DEI priority. The second example I want to mention is HHS has adopted a version of the president's, what they call, gender ideology executive order. The gender ideology executive order asserts that there are only two biological sexes and seeks to eliminate from anywhere in the federal government any recognition of LGBTQ people. The 2021 regulation, which is in place, again requires care to be inclusive, to be client-centered, to be non-discriminatory, and it explicitly mentions transgender people as folks who have historically been marginalized and need to be included in care. So again, if you're an applicant looking at this, you must follow the 2021 regulation. That's what the funding announcement says, but you equally must follow HHS priorities, which are antithetical to the reg. The reg has the force of law. The president's priorities do not. But this funding announcement sets up this clash and does not offer applicants any information about how you might reconcile these two. So these are really important examples to NFPRHA about how there's no way to write an application to do both. And so we have asked the federal courts to knock these pieces out so that the government can't use these criteria to stop applications from being read or to uh essentially set the table for applicants not to be able to win grants, to be awarded grants, because they can't reconcile regulatory requirements versus political priorities in this new administration.

Jennie 29:30

It is just mind-boggling to me, like, how like you you can't do both of those things at the same time. How are your members thinking about moving forward? It just feels like an impossible situation to be in. And then I guess the second part of that is like what is gonna be the impact on patients for these programs that get through.

Clare 29:57

I have been referring to this as a hijack, right? I think what you're seeing the administration attempt to do is use federal money to redirect where support is going in terms of provider groups. So, you've seen and you've done beautiful coverage on this, Jennie, a huge explosion in support, state support for "crisis pregnancy centers." There are more of them, they are more networked, they are better resourced than they ever have been before. This funding announcement might mentions contraception exactly once, and it's a disparaging reference tied to the administration's priority, which is to reduce over-medicalization in healthcare. We we read that to suggest, in line with some of their other priorities, that the administration wants to move away from Title X focus on contraception, which is the statutory intent of the program, and move it more towards fertility awareness, promoting marriage, reducing infertility, promoting sex among heterosexual couples, right? That's that all that stuff was in Project 2025, and you're starting to see, I think, in this funding announcement, a real articulation of how they want to use Title X funds. So, moving away from equalizing access to contraceptive care, making sure people are getting high-quality sexually transmitted infection, testing and treatment, right? We do work on helping people achieve pregnancy. I know a lot of people who got a uh wonderful news at a Title X funded health center about a very wanted pregnancy. And we think they want to move away towards what I might call favored applicants. So "crisis pregnancy centers" would be favored applicants of religiously controlled health systems, and you know, religious organizations control a lot of health care in the United States. I often talk about my home state of New York, and Fidelis is a major hospital provider, but also community-based provider in that state. And Fidelis health centers are required to follow Catholic health doctrine. So there are vast aspects of sexual and reproductive health care that you can't get in a religiously controlled environment. What I think you see this funding announcement doing, particularly because of the alignment review, is setting the table for the long-standing, very well-qualified Title X network, whether it be state government healthcare or private not-for-profit healthcare, for those folks to have no chance of winning. Because the administration is essentially picking the winners in the alignment review. I did want to mention one additional factor here that I think matters quite a bit. Talked a lot about this alignment review being knocked out before you can even get your application considered. But let's say for you know you get through alignment review and you go to merits consideration. The scoring criteria, again, is available in the funding announcement, it's public, it's a score out of a hundred. The most number of points of that 135, a third of those points, are about aligning with the administration's priorities. It weighs more than the statutory factors that I mentioned earlier, the number of patients to be served, your ability to use funds effectively, the need for services in your community. Those statutory factors don't count anywhere near as much as alignment with the administration's priorities. So, throughout the funding announcement, what you see is the government's finger on the scale. They want different applicants, they want different winners, and they're setting the system up so that they get to choose. That's not how federal grants work. Not just in the Title X context, but across the federal government. There is long-standing federal rules around how federal money is distributed and how competitions are run. And this is again another reason why we chose to bring suit against the federal government. You can't use the funding announcement to change the program. And that's what they're trying to do.

Jennie 33:54

Yeah, I mean, it's very clear they want the Title X program to not be the Title X program. Like it's basically almost the exact opposite.

Clare 34:02

But they want the money. Yeah. Right? So this, and this is interesting, right? The president for the last two years now has in uh had a budget proposal that eliminated funding for Title X. They didn't do that in President Trump's first term. They didn't attempt to zero out the program. I think that strategy to me is the White House Office of Management budget strategy. They're just looking to cut federal spending wherever they can. But when you come over to the HHS side, what you see is a very different agenda. That's why I call it a hijack. They actually want that federal money. They just want to be able to choose who gets it and what people use it for. So if you're talking about a crisis pregnancy center that doesn't offer any clinical care, doesn't believe in access to contraception, wants to promote pregnancy and taking pregnancies to term, if you're able to shift that provider network, then those folks who live locally will be, you know, the health center that you've gone to for a million years might still be there, but what won't be there is the subsidy for care, the way you can't we can't refuse to serve people, the broad range of methods that are available on site the same day, all of the things that Title X money facilitates, of a staffing plan that has services available and nights and weekends, right? If that money goes away, those health centers might be there. Not all of them will survive it, but some of those health centers might be there. But all the things that actually facilitate access for people who struggle to afford health care, which many, many millions of people in this country do, that will not be there. So, and where the money might be is down the street or around the corner, but it's gonna be working to a very different purpose, right? It's not gonna be there to say, what are you here for today? Are you interested in a contraceptive method? What's been your experience? How can I support you in making the best decision right now? That's not gonna be what this federal money is there to do if the administration is able to succeed with this funding announcement.

Jennie 36:05

So you've already previewed this, but you're suing the federal government. So let's talk about the lawsuit.

Clare 36:12

So, three weeks ago on June 18th, NFPRHA, represented by the ACLU and the ACLU in Pennsylvania, joined with one of our members. It's a Title X grantee in Harrisburg in the central part of Pennsylvania. It's called Family Health Centers of Central Pennsylvania. Family Health Centers of Central PA has been in the Title X program since the inception. And they serve a huge number of people through their network in central Pennsylvania. We have worked with them very closely over the years. They run a really strong program that includes many things outside of Title X. So, they're pulling together lots of streams of state money and federal money to do services throughout their area in Central PA. And they were willing to step forward to help us tell a fuller story. So, NFPRHA obviously represents the vast majority of the Title X network, and we are able to speak sort of collectively to the impact that this funding announcement might have. But it's really important when you go into litigation to try to tell a really focused story of harm. And it's the Family Health Center of Central PA that can come in and specifically speak in the court papers to the judge about what the impact of this announcement would mean for them and for the health centers that they fund and the people that are served in those health centers. So we're very grateful to the Family Health Center of Central PA for being willing to partner with us. We went in as co-plaintiffs. So, we're both telling the story. NFPRHA telling the national story and Family Health Centers of Central PA, talking about what the impact looks like. And we're before a judge in that part of Pennsylvania. So the judge will be familiar with the communities that are being served and the terrain that this grantee is covering in the state of Pennsylvania.

Jennie 38:02

It's so exciting to see this lawsuit going forward and fingers crossed that everything goes well. I love like I don't like to end focusing on problems, even if the end was like, we're there's a lawsuit so we could see real change. But I like to talk about what the audience can do. So in this moment, what can the audience do to help?

Clare 38:25

Well, I'd like to say a couple of things about that. First, I want to note that the goal of litigation goes beyond winning, which we hope to do. We think we have very strong arguments to be made here, and we're making them as best we can. But when an organization like NIFRA sues the federal government, that requires the government to respond. So right now you're in a situation where a funding announcement came out in early April. There has been no communication from the federal government to potential applicants. We're now in the early part of July. So we are three months in and there has been no information. There's a webinar scheduled for the middle of September, which obstensibly would be the first time that applicants could query the federal government about some of the clashes and contradictions that I've mentioned in this conversation. But when you sue, the government is forced to respond. And they are forced to respond to the court about the issues that we are raising. So we are hopeful that ahead of that mid-September webinar, we are going to have responses from the federal government that, of course, will be under oath in front of the judge that we can then be able to communicate out to potential applicants. You know, the government might be forced to explain things that are confusing. Maybe things will be clarified in a helpful way. We also think it's incredibly important that this administration understand that advocates and providers are watching what they are doing and we're not going to let them get away with something. I wanted to mention that uh earlier this year I mentioned the president's budget request. Administration officials, after the president's budget request goes up to Capitol Hill, a huge number of administration officials go up and testify. And HHS Secretary Kennedy was up on the Hill testifying about the president's budget request for HHS. And he was asked a series of questions by uh Senator Josh Hawley, who is a Republican from Missouri, he's anti-abortion, and he was criticizing Kennedy and the administration because abortion providers like Planned Parenthood had been given year five Title X awards, current year awards. And I thought we thought it was incredibly telling that Secretary Kennedy's response was that, you know, they tried to pause the grants, which is what they did last year, and they looked at the litigation risk, and their Office of General Counsel advised Secretary Kennedy and others that the litigation risk was very, very high. And he said that's why we paid those grants. So that's NFPRHA's lawsuit from last year that the Secretary is referring to. And so we see litigation as a tool for accountability, a tool for clarity, and a way to hold this administration to account. We also sued the administration in its first term over a funding announcement, and once we sued them, they never tried to do that again. So we think about risk all the time, we think about benefits to access to care, to the providers that we represent all the time. But there are reasons why litigation is a super important tool in a hostile environment for organizations like ours that represent the vast majority of providers of care to be able to use. Now I want to move to what you asked me about how people can engage, what they should be thinking about, and what's something they can take action on. And I want to step back and take sort of a broader view for a moment. I mentioned in the early part of our conversation that a lot of different sources of funding come in to support a Title X funded health center, and that Medicaid is a huge driver of access to contraception and sexual health care around the country. That's actually been true since the 80s. And so one thing I would think about when I think about how can people stay involved and stay vigilant, last year Congress passed really significant cuts to Medicaid. I know that you have covered this, and states are beginning to implement new rules that are going to help them cut their Medicaid budgets. And so one thing folks can do is be in touch with their state-elected officials, hold them accountable for minimizing coverage losses, push for these state officials to maximize use of family planning eligibility expansion. They can do that, they can expand at the state level the number of people who are eligible for Medicaid family planning care. We've seen a lot of states do that. It's made a huge difference for access. And I think that's something that a lot you'll see, folks, wherever you're living in the country, you're gonna start to see a lot more coverage about how these federal cuts to Medicaid are going to have a devastating impact, not just on community-based care, but on hospital-based care, on access to birthing centers and things like that. We're seeing a lot of coverage of that now. It's only gonna ramp up. And so one thing that people can do is think about how everything is sort of linked together. And, you know, if you're in a situation where you can't access Medicaid reimbursement or the reimbursements are really inadequate, that takes one leg of your stool and just knocks it out. Makes keeping your staff together, not laying people off, and keeping your health centers open just a lot harder. And that's happening now, right? The litigation is something that you know we're sort of watching, right? It's playing out according to the processes that are required when you go into litigation. But this kind of advocacy and engagement is something that people can be thinking about and doing right now. It's gonna be enormously important for folks to raise their voices about cuts to Medicaid and the impact that it's going to have. The other thing that I always want to speak to, Jenny, when I speak to you and I think about your audience, is there is an opportunity for your listeners to know your provider network better. And this is an easy thing to Google. You can Google, "Title X Clinic Locator" that links you to a government website, and you can search by town, by zip code, you can look at a whole state, and you can see all of the health centers that currently receive Title X grants. And this directory is updated six or eight times a year, so it's you know pretty close to accurate, it's never entirely accurate. But I think it's so important, no matter where you live in this country, to understand where this Title X money is going and what that money means, right? It means we see everyone, we see everybody confidentially, we see everybody according to a nationally recognized clinical standard of care. So you're getting evidence-based high-quality care, you're getting it from providers who are expert, who see a huge number of family planning cases and conditions. You're seeing people who are there to center your needs and values. And they're doing that because the federal money binds their care to those standards. Having an awareness of where in the community this care is available could be helpful to you individually, could be helpful to somebody in your family or friend group, but it also gives you the opportunity to raise up their profile in your conversations on your social media. Be out there visibly and vocally talking about the importance of having access to high-quality contraception and sexual health care as close to your house as possible.

Jennie 45:42

I love having good, concrete answers, and we will have links in the show notes so people, if you don't didn't get a chance to write down the clinic link that Clare shared, we'll have it in the show notes so that you can have easy access to it. Clare, as always, it is such a pleasure getting to talk to you. I remember having our very first conversation, which would be almost nine years ago, which is wild to believe. And you've been a joy to interview ever since then.

Clare 46:10

Thank you so much for having me. Can I do a little- I want to dump a teaser on you and in the hopes that you might might do something on this in the future. So, in addition to this funding announcement that the federal government put out, they've been dropping a whole bunch of other funding announcements recently, and I want to call your attention to something that I haven't seen a lot of coverage on yet, but I think it would be really incredible for you to dig into. So, the federal government has a very small program that's about increasing awareness of what's called "embryo adoption." So, these are embryos that are generated in the course of people's assisted reproductive technology. If you're trying to achieve pregnancy and you struggle in one way or another, or like me, you're a single person who's seeking to have a baby by themselves, as I did, you need access to assisted reproductive technology. And in some cases, after a course of IVF, there may be additional embryos that a family then chooses to offer for other folks to adopt. It doesn't happen all that often, and this is a tiny program, it's about a million dollars a year. And it's been running at HHS under the Office of Population Affairs since the 80s. This year, the government, this summer, the government put out a new competition for the embryo adoption program. So this is a you know regular procedure as it would be for Title X grants, but what they've done with this announcement is something really, really scary. So, the funding announcement asserts that embryos are, and I'm quoting, children who already exist and are in need of a family. So what you've got here is the federal government taking a position that embryos are people with the full rights of born persons. And the program announcement goes on to talk about how people who are seeking to adopt these already existing children, these embryos, would have to go through processes that are very, very similar to the processes that potential adoptive families go through. Background screening, home visits, all the types of things that folks who have sought to adopt or have adopted know very, very well. Very complicated procedure in order to be screened as a potential adoptive family. This program, they also double it from one million to two million, again, really low. But I don't think the point is the money. I think the point is the assertion that these are children already born, already existing, and in need of a family. Interestingly, this funding announcement gives you extra points in the scoring if you've never gotten a grant before. So I think again, that indicates how much the federal government is trying to find new providers, different providers, to be getting federal money. So, I just wanted to flag this for you because, again, I haven't seen it in very many places. I believe that at heart the anti-abortion, anti-contraception coalition is fundamentally about establishing fetal personhood and imposing a rigorously heteronormative and very conservative vision of what family building should be, what a family is, and who among us should have the rights to make decisions about what those families look like. And both as an advocate, a person who's been in this field 25 plus years, and as a solo parent to a kid I had with IUI, this is intensely, intensely scary and really something I'd like to see more attention brought to.

Jennie 50:02

Thank you so much for raising that. We actually have an episode that we are working on planning around IVF, so we'll make sure to also see if we can work this in uh a little bit into that episode as well. Thank you so much for being here. As always, it was a pleasure to talk to you.

Clare 50:20

Jennie, I always love talking with you, and thank you for your advocacy, your vision, your leadership. We really appreciate it.

Jennie 50:27

Okay, y'all. I hope you enjoyed my conversation with Clare. I hope the the hum wasn't too annoying. Like I said, we did the best we could to clean it up, and it was a good conversation, so I didn't want to have to redo it because again, it never happens the same way. Or I run into the like, did we already talk about this? Was that this time we talked, or was it last time? And like then things get missed, and so it's really this fine balance of like when we should redo it versus when we should keep the magic of the conversation because yeah, it just never happens the same way, and then I always have the doubt of like we already had this conversation, was it today or was it like a couple days ago when we did this interview the first time? So, yeah, that's that's the balance I try and strike. So, I hope you all enjoyed it. And yeah, send me any of your crafty recommendations. I would love to know who else I should be following. And with that, I will see everybody next week. 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 or at rePROs Fight Back on Facebook and Twitter, or @reprosfb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com.