Two-Year Budget Deal a Win for Women’s Health? Not If We Lose Title X

Cross-posted from our joint Raising Women's Voices campaign.

Today, the Senate is set to pass the two-year budget deal announced last week, clearing it for the president’s signature. The House passed the measure last Thursday, 284-189. The deal will suspend the debt ceiling through July 2021, eliminate the deep automatic spending cuts (known as “sequestration”) set to take effect in January, and increase the total amount of funding available for both domestic and defense priorities. House and Senate appropriators will then have two months to draft line-item spending bills to fund the government based on the new limits.

The Trump administration had been pushing to slash domestic spending while boosting defense spending through a budgeting gimmick that treats routine annual military spending as emergency war funding exempt from statutory caps. By setting topline spending numbers, the deal reduces the likelihood of a government shutdown when the current fiscal year ends on October 1 and increases the likelihood that core progressive priorities, from health programs like the Ryan White HIV/AIDS program to public education and housing assistance, are fully funded.

When congressional Democrats struck a similar deal in February 2018, we called it a “key win for progressives.” 

This time, it’s not so clear-cut.

Suspending the debt ceiling averts the risk of a first-ever, economy-crashing government-wide default on our debts that could leave many low-income households without Social Security checks or access to their health care benefits. That’s a win for good governance.

Lifting the debt ceiling through the remainder of Donald Trump’s current term and leaving it as a time bomb for Trump’s potential successor to cope with just six months into his or her first term? That maybe isn’t such a great win. 

In 2011, remember, Tea Partiers in Congress held the debt limit hostage and threatened default in the middle of the Great Recession in exchange for starving domestic priorities and creating sequestration. As the current deal shows, we’re still grappling with the fallout from that hostage-taking. There’s no reason to think that hardline conservatives have become more responsible since then.

Pelosi’s “Handshake” Deal and Women’s Health

But even more significantly for us—at least in the short-term—is the “handshake” deal that House Speaker Nancy Pelosi (D-CA) struck with the White House to win higher domestic funding levels. While the details are a closely guarded secret—the handshake deal isn’t part of the bill itself, rather it’s a gentlewoman’s agreement on the side—the speaker agreed to not to insist on any “new” “poison pill” policy provisions in appropriations bills. 

Riders, as they’re known, are policy provisions attached to appropriations bills that limit how the funds can be used. The Hyde Amendment, for example, isn’t codified into permanent law (though other federal restrictions on abortion are). It’s a policy rider that must be attached anew each year to the bill funding the U.S. Department of Health and Human Services. Other longstanding or frequent policy riders have limited the CDC’s ability to research gun violence and blocked the District of Columbia from using its own funds to cover abortion care. These riders are poisonous, but they aren’t considered “poison pills” because the two parties have collectively agreed to include them for years. 

What we know so far is that the deal was designed to prevent a fight over Hyde (even though House Democrats had already preemptively included it in the HHS appropriations bill they passed earlier this year) and stop Trump’s humanitarian critics from trying to impose new restrictions on his immigration policies. A faction of House Democrats had sought to add protections for children and other immigrants detained at the southern border and to limit Trump’s legal ability to transfer funds appropriated for other purposes to build his wall. 

But what about other core priorities? The appropriations process likely represents the best chance that women’s health advocates have to overturn dangerous Trump rules eviscerating the Title X family planning program and taking food away from millions of families through proposed red tape additions to the food stamp (SNAP) program. 

While the SNAP rule was just proposed at the end of July and won’t be finalized for months, the Title X rule is in effect NOW after a federal appeals court overturned lower court decisions blocking it from going into effect. The administration has announced that they won’t begin enforcement yet, though clinics must submit an action plan for compliance by August 19 and must show evidence of compliance by September 18.

Killing Title X and ‘Defunding’ Planned Parenthood—Unless We Stop Them

The new rules represent a significant fulfillment of abortion opponents’ dream of “defunding” Planned Parenthood, which is currently the single largest grantee and reportedly receives $60 million in Title X funding to provide family planning health services to low-income women and men. 

But the new rule won’t just affect Planned Parenthood clinics and is likely to be particularly devastating for independent clinics that lack Planned Parenthood’s clout or resources. The rules will force full-service clinics out of the program and shift federal funds to religiously-affiliated clinics that oppose contraception. In addition to the restrictions on referrals, the rules require any clinics that also provide abortion care to create a physically separate facility, a step that is medically unnecessary and very likely too expensive for most clinics to accomplish. The new rules also do away with the long-standing requirement that federally-funded clinics offer a wide range of contraceptives and agree not to impose coercion of any kind on their clients’ choice of contraceptive method. By doing away with that requirement, the administration has opened the door to religious facilities like the Obria Group, which teaches natural family planning and opposes contraception. 

While the courts have not yet even begun to debate the merits of the rule (court proceedings thus far have been focused on whether to block the rule while the cases are pending), we know we can’t rely on the Roberts Supreme Court to side with women’s health or even a plain reading of the statute. 

But Congress has the power to kill the rule for good on October 1—if we demand it. Earlier this year, the House passed an appropriations bill with a policy rider that would unwind the Trump changes and restore the program to its 2016 configuration, which received bipartisan support in Congress for years. 

We're making the case that riders overturning the new Trump rules in order to maintain the same status quo that Republicans have agreed to fund, year after year, shouldn't be excluded under the deal. These riders don't make new policy, they keep existing policies in place, policies that Republicans have already accepted. If the Hyde Amendment isn’t a “poison pill” because of its longevity, then a rider to maintain the longstanding Title X program isn’t either.

That’s why it’s time, once again, to CALL, EMAIL, and VISIT your Senate and House members!

After today’s vote, all of your federal representatives will be back in their home states for the August recess. They may be hosting town halls (search for town halls near you here or call and ask), visiting local events, or holding office hours. There’s still time to make your voice heard!

Tell them that refusing to include the House-passed Title X provision in the Senate HHS spending bill or in any final spending deal will “defund” Planned Parenthood and other women’s health clinics.

Sarah Christopherson, MA, is the Legislative Director for the social justice campaign, Americans for Tax Fairness, and the NWHN’s former Policy Advocacy Director. Her 10 years working for Congress and her deep knowledge of health policy and consumer protection make her the NWHN’s issue area expert on federal health reform implementation and defense, drug and device safety and efficacy, and sexual and reproductive health.

Read more from Sarah Christopherson.

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