A few months ago, I visited a family planning clinic in Lincoln and got to know some of my neighbors who use the Title X program. I met a single mom with three kids who works at an assisted living home and who does not have health insurance. She has been going to the clinic for three years and doesn’t know any other doctors she could go to if her clinic loses Title X funding. Title X was established in 1970 and is our nation's signature family planning program which provides grants to healthcare providers who provide well-woman exams, lifesaving cancer screening, STD testing and treatment, and contraception. The federal grants pass through the state budget and go directly to healthcare providers. Title X money cannot be used for abortion-related services or for abortion.
Sadly, Governor Ricketts has included a proposal in the state budget to end Title X as it has stood without controversy for decades by defunding Planned Parenthood and by inserting his political agenda into the private conversations between doctors and their patients. There are a variety of legal and policy problems with the Governor’s proposal. For example, the provision does not carry any direct costs or savings to the state budget, so it should be dealt with outside of the budget; the proposal conflicts with existing federal law; the proposal violates medical ethics; and the changes risk the health and wellbeing of almost thirty thousand Nebraskans who rely on these lifesaving services.
Federal Title X regulations require clinics to offer patients “neutral, factual information and nondirective counseling” on the full scope of pregnancy options, including parenting, adoption, and abortion. Title X providers must also offer a “referral upon request” for services if requested by the patient. The Title X proposal in the state budget would put local providers in between a rock and a hard place when having to decide whether to comply with state or federal law when providing their patients’ health care.
Additionally, patients are entitled to accurate information from their health care providers. Informed consent and meaningful referrals are part of medical ethics. According to the American Medical Association, “Physicians should always make referral decisions based on the best interests of their patients”. For example, if a Title X patient has an ectopic pregnancy, a physician must refer her for treatment. Sadly, the Governor’s ban on referrals has no exception for the life or health of Nebraska women or in any way respects patient centered care when a woman decides to terminate her pregnancy. The Governor’s proposal puts his political ideology before the health of Nebraska women and above the medical ethics of our local doctors.
Other states have implemented the same short-sighted agenda targeting Planned Parenthood in their family planning or Medicaid programs. The result has been closed clinics, increased unintended pregnancies, and more abortions. The Nebraska health care providers provided clear testimony about this proposal at the committee level that they do not have the capacity to pick up the patients who rely on Planned Parenthood and that the Governor’s proposal risks their ability to provide these services. While this front-line perspective has been ignored thus far there is still time for the Legislature to listen to these voices and to get it right.
We recognize Nebraskans of goodwill hold different positions on abortion, but prevention and education are the areas that Nebraskans find common ground on when navigating these difficult issues. We call on our policymakers to recognize that cancer screenings, well-woman exams, and prevention services are too important to play politics with in our state budget. Additonally, we ask them to reject the Title X language, like they did last year, so they can focus budget deliberations on education, tax relief, economic development, and natural resources that benefit all Nebraskans.
J.D. Legal and Policy Counsel ACLU of Nebraska