Despite decades of being a relatively nonpartisan program, Title X -- the only federal grant program exclusively for family planning and reproductive health -- is gearing up to be front and center of a debate about abortion.
On Friday, the Trump administration will reportedly propose a rule that prohibits Title X funding from going to organizations that perform or support the procedure.
"Any grantees that perform, support, or refer for abortion have a choice -- disentangle themselves from abortion or fund their activities with privately raised funds," a Trump official told CNN.
Federal funds already can't be spent directly on abortions because of the 1976 Hyde Amendment. Any federal money that organizations like Planned Parenthood get is instead used for other women's health services. But the Trump administration's new rule would take the Hyde Amendment a step further.
Opponents call it the "domestic gag rule" because it's similar to the "global gag rule," which prohibits American aid money from going to overseas organizations that provide or support abortions.
Planned Parenthood's executive vice president says it would harm women's health overall.
"Under this rule, people will not get the health care they need. They won't get birth control, cancer screenings, STD testing and treatment, or even general women's health exams," Dawn Laguens told NBC News.
Groups against abortion applauded the proposal.
"This money will now be redirected to comprehensive family health and planning centers that don’t perform abortions and understand that abortion is not healthcare," said Jeanne Mancini, president of the March for Life, in a statement.
Most of the patients at Planned Parenthood and similar clinics are below the federal poverty level.
The proposed rule may not come as a surprise to some. The Trump administration started the Title X grant application process several months late this year and revamped the application. It eliminated the Obama administration's focus on all forms of contraception and instead emphasizes abstinence-only sex education and natural family planning methods -- neither of which had historically been part of Title X.
“They’ve moved away from the core tenet of Title X, which is nonintrusive care,” says Jessica Marcella, vice president of advocacy and communications at the National Family Planning and Reproductive Health Association.
That organization, as well as the American Civil Liberties Union and three Planned Parenthood affiliates, already launched a legal attack on those application changes, so it's likely that they will also fight this new proposal in court. This week, 20 state attorneys general filed an amicus brief in support of the lawsuit.
Because the Trump administration began the Title X application process late, some grants could expire before new ones are awarded. That could leave organizations scrambling to make ends meet.
Some states, however, are taking preventative action. In February, Massachusetts Gov. Charlie Baker, a Republican, announced $1.6 million in supplemental funds for Title X grantees in case their federal funding dries up.
But Title X isn't the only federal family planning program being targeted for cuts or changes.
Last summer, the Trump administration ended the grants for the Teen Pregnancy Prevention Program. Baltimore was one of the places to lose funding.
“The funds were [already allocated], and we received no explanation as to why. The teen pregnancy rate in Baltimore has fallen 61 percent [from 2000-2016], so we want to protect the gains we’ve made,” says Leana Wen, Baltimore’s health commissioner.
The health department sued, and a judge sided with the city last month, ordering the Trump administration to restore the grants. But soon after that ruling, the White House released new guidelines for the grants, with a focus on abstinence-only education.
To understand what happens when women's health clinics lose government funding, look no further than Wisconsin.
The Planned Parenthood of Wisconsin has been the Title X grantee for the state since the grant’s inception in 1970 and is one of the Planned Parenthood affiliates currently filing suit against the Trump administration. In 2011, GOP Gov. Scott Walker defunded Planned Parenthood from the state budget. As a result, five clinics closed across the state.
"One of the many lessons we’ve learned under Gov. Walker is that when we closed a clinic, no one stepped in to provide that care. So there’s a real gap now for women and children in Wisconsin," says Nicole Safar, director of government affairs and legal advocacy for Planned Parenthood of Wisconsin.
Up until now though, regardless of any decisions made by the state, Safar says they could always count on federal Title X and teen pregnancy prevention funds. The Trump administration's proposal now puts them in jeopardy.
Half of Title X grantees are state health departments. The once-bipartisan program was signed into law by President Richard Nixon and at the time was championed by President George H.W. Bush -- then a congressman. In 2007, his son, George W. Bush, signed the largest increase of Title X funding since the Clinton era.
Fast forward a decade, though, and 13 states have prohibited clinics that provide abortions from receiving Title X money -- despite the fact that no federal money directly pays for abortion services. Last month, Nebraska became the 14th state.
Just before Barack Obama left the White House, he finalized a rule that would have prohibited more states from withholding Title X money to centers that provide abortions. President Trump rolled back the rule during his first few months in office.
For Wen, the Baltimore health commissioner who is also a doctor, this issue comes down to what's most effective.
“We always have to follow evidence and science," she says. "We’ve implemented interventions in Baltimore that have worked."
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*This story has been updated to include a statement from March for Life.