Getting access to family planning and reproductive health care is already difficult for low-income Pennsylvanians in rural counties, but it could become more difficult under a pending rule from the Trump administration. The rule, which will go into effect May 3, makes sweeping changes to the federal Title X program.

The program – created during the Nixon administration – provides federal grants to help cover family planning and reproductive health care for low-income Americans.

“[Title X] plays an enormous role in the work that we do here at Planned Parenthood,” said Katherine Schott, lead clinician at Planned Parenthood of Western Pennsylvania. “That can be anything from breast and cervical cancer screening, to sexually transmitted infection testing and treatment, contraception, and a variety of other reproductive health issues.”

Planned Parenthood provides that care to 41 percent of Title X patients nationwide. The program does not provide funding for abortions – that’s illegal – but the pending rule will change the qualification requirements for clinics. Title X clinics that perform abortions would lose the grant money for everything they do, and would be barred from telling women they can get an abortion somewhere else.

“The gag rule really limits the patient-provider communication,” Schott said. “[It says] that as a health care provider, I am not permitted to discuss with you all possible options regarding your pregnancy.”

According to the Pennsylvania Attorney General’s office, Planned Parenthood is the only Title X provider in four counties: Bucks, Cambria, Monroe and Somerset. Those counties stand to lose access to free or low-cost reproductive health care.

But there’s already a lack of Title X clinics in most of Pennsylvania, which has the third largest population in the country that qualifies for the funding. Providers tend to cluster around big cities like Pittsburgh and Philadelphia.

Of the Commonwealth’s 67 counties, 14 currently have no Title X clinics at all, and 23 counties only have one provider.

Title X Patients May Not Know About Title X

“A lot of folks are going to find themselves without a place to go,” said Gina Deangelo, who has first hand experience with the Title X program. She went to Planned Parenthood during her last semester of college when she found a pea-sized lump on her breast.

“I freaked out,” she remembered. “I was working as a bartender, working my way through school, and I just remember pacing back and forth behind the bar, wondering, what am I going to do?”

Deangelo didn’t have insurance and qualified for free care under the Title X program. They gave her a voucher for a diagnostic mammogram. Luckily, the lump was benign. She was studying in Pittsburgh where there are a lot of options. But she wonders what will happen in rural areas.

“Are they going to take time off and try to travel to another town and see a doctor? Or are they going to just carry on as I was very tempted to do like nothing was wrong because they weren’t sure what to do about it?”

It’s likely that many patients in situations like Deangelo’s, aren’t aware they’re even benefitting from Title X.

“A lot of people don’t know what Title X is, even if you’re a recipient,” Deangelo said. “It’s not like they tell you at the door – ‘Hey this is why your care is covered.”

Planned Parenthood’s Katherine Schott said there’s probably a lack of community knowledge about where funding comes from.

“A lot of our patients probably hear the term ‘sliding fee scale’ instead of Title X,” she said. “We use them interchangeably here, because for us it’s the Title X money that makes that fee scale possible.”

A New Network of Providers

“[This] was certainly something we appreciated, seeing the rule coming down,” said Dan Bartkowiak, of the Pennsylvania Family Institute, which opposes abortion.

“I think there are better ways to invest in and care for women and families.” Bartkowiak pointed to the nearly 250 community health centers in the state, and said women can go there to receive care instead of organizations like Planned Parenthood.

But the four Pennsylvania counties that rely exclusively on Planned Parenthood for Title X services do not have any community health centers as a safety net, according to Pennsylvania Association of Community Health Centers.

Community health centers receive federal funding to provide primary care in underserved areas.

“They are literally family practice clinics that have been publicly capitalized,” said Professor Sara Rosenbaum of George Washington University, who has done research on community health centers and Title X. “So whereas a Planned Parenthood site or a general Title X clinic would be dedicated to one particular cluster of services, health centers have to manage a schedule that goes from newborns to elderly people.”

Rosenbaum believes the rule is meant to provide federal money to new network of providers, including groups that are opposed to abortion.

“The rule is structured to completely reinvent the Title X provider network,” she said. “You could have sites that offer pills or condoms, and then a bunch of sites that are just doing abstinence.”

Planned Parenthood says its doors will stay open no matter what, though they haven’t figured out how exactly they’d make up for the lost funding. The group and state attorneys general – including Pennsylvania’s Josh Shapiro have already sued over the rule.