Trump Proposes Cutting Planned Parenthood Funds. What Does That Mean?
By Julie Rovner, Kaiser Health News The planned revival of a policy dating to Ronald Reagan’s presidency may finally present a way for President Donald Trump to fulfill his campaign promise to “defund” Planned Parenthood. Or at least to evict it from the federal family planning program, where it provides care to more than 40 percent of that program’s 4 million patients. Congress last year failed to wipe out funding for Planned Parenthood, because the bill faced overwhelming Democratic objections and would not have received the 60 votes needed to pass in the Senate. But the imposition of a slightly retooled version of a regulation, which was upheld by the Supreme Court in 1991 after a five-year fight, could potentially accomplish what Congress could not. The rules now under review, according to Trump administration officials, would require facilities receiving federal family planning funds to be physically separate from those that perform abortion; would eliminate the requirement that women with unintended pregnancies be counseled on their full range of reproductive options; and would ban abortion referrals. All those changes would particularly affect Planned Parenthood. Planned Parenthood, which provides a broad array of reproductive health services to women and men, also provides abortion services using non-federal funds. Cutting off funding has been the top priority for anti-abortion groups, which supported candidate Trump. “A win like this would immediately disentangle taxpayers from the abortion business and energize the grassroots as we head into the critical midterm elections,” Marjorie Dannenfelser, president of the anti-abortion Susan B. Anthony List, said in a statement. In a conference call with reporters, Planned Parenthood officials said they would fight the new rules. “We’ve been very clear, Planned Parenthood has an unwavering commitment to ensuring everyone has access to the full range of reproductive health care, and that includes abortion,” said Dawn Laguens, executive vice president of the Planned Parenthood Federation of America. Here is a guide to what the proposal could do and what it could mean for Planned Parenthood and the family planning program: What Is Title X? The federal family planning program, known as “Title Ten,” is named for its section in the federal Public Health Service Act. It became law in 1970, three years before the Supreme Court legalized abortion in Roe v Wade. The original bill was sponsored by then Rep. George H.W. Bush (R-Texas) and signed into law by President Richard Nixon. The program provides wellness exams and comprehensive contraceptive services, as well as screenings for cancer and sexually transmitted diseases for both women and men. In 2016, the most recent year for which statistics have been published, Title X served 4 million patients at just under 4,000 sites. Title X patients are overwhelmingly young, female and low-income. An estimated 11 percent of Title X patients in 2016 were male; two-thirds of patients were under age 30; and nearly two-thirds had income below the federal poverty line. What Is Planned Parenthood’s Relationship To Title X And Medicaid? Planned Parenthood affiliates account for about 13 percent of total Title X sites but serve an estimated 40 percent of its patients. Only about half of Planned Parenthood affiliates perform abortions, although the organization in its entirety is the nation’s leading abortion provider. Planned Parenthood also gets much more federal funding for services provided to patients on the Medicaid program (although not for abortion) than it does through Title X. Eliminating Medicaid funding for Planned Parenthood has proven more difficult for lawmakers opposed to the organization because the federal Medicaid law includes the right for patients to select their providers. Changing that also would require a 60-vote majority in the Senate. So that particular line of funding is likely not at risk. While opponents of federal funding for Planned Parenthood have said that other safety-net clinics could make up the difference if Planned Parenthood no longer participates in Title X, several studies have suggested that in many remote areas Planned Parenthood is the only provider of family planning services and the only provider that regularly stocks all methods of birth control. Texas, Iowa and Missouri in recent years have stopped offering family planning services through a special Medicaid program to keep from funding Planned Parenthood. Texas is seeking a waiver from the Trump administration so that its program banning abortion providers could still receive federal funding. No decision has been made yet, federal officials said. Why Is Planned Parenthood’s Involvement With Title X Controversial? Even though Planned Parenthood cannot use federal funding for abortions, anti-abortion groups claim that federal funding is “fungible” and there is no way to ensure that some of the funding provided for other services does not cross-subsidize abortion services. Planned Parenthood has also been a longtime public target for anti-abortion forces because it is such a visible provider and vocal proponent of legal abortion services. In the early 1980s, the Reagan administration tried to separate the program from its federal funding by requiring parental permission for teens to obtain birth control. That was followed by efforts to eliminate abortion counseling. Starting in 2011, undercover groups accused the organization of ignoring sex traffickers and selling fetal body parts. Planned Parenthood denies the allegations. What Happened The Last Time An Administration Tried To Move Planned Parenthood Out Of Title X? In 1987, the Reagan administration proposed what came to be known as the “gag rule.” Though the administration’s new proposal is not yet public, because the details are still under review by the Office of Management and Budget, the White House released a summary, saying the new rule will be similar although not identical to the Reagan-era proposal. The original gag rule would have forbidden Title X providers from abortion counseling or referring patients for abortions, required physical separation of Title X and abortion-providing facilities and forbidden recipients from using nonfederal funds for lobbying, distributing information or in any way advocating or encouraging abortion. (The Planned Parenthood Federation of America, the umbrella group for local affiliates, has a separate political and advocacy arm,
Trump announces plan to nominate Robert Wilkie for VA secretary position
In a surprise announcement during a prison reform summit Friday at the White House, President Donald Trump said he plans to name Robert Wilkie to fill the vacant position. “I’ll be informing him in a little while—he doesn’t know this yet—that we’re going to be putting his name up for nomination to be the secretary of the VA,” Trump said during the event. Wilkie was appointed as the acting secretary in late March after President Trump announced former White House physician Ronny Jackson would lead the agency. Wilkie previously served as undersecretary of defense for personnel and readiness at the Defense Department. Jackson withdrew himself from consideration one month ago amid allegations of mismanaged medication distribution and toxic workplace behavior. If confirmed by the Senate, Wilkie will replace former VA Secretary David Shulkin, who was fired by Trump in late March because Shulkin wasn’t aligned with Trump’s goal to quickly expand VA-funded healthcare options by tapping on resources in the private sector, according to a report on USA Today. The Department of Veterans Affairs is the second-largest federal agency, with more than 370,000 employees, and primarily handles allocating healthcare services for veterans along with other responsibilities.
For The Babies Of The Opioid Crisis, The Best Care May Be Mom’s Recovery
Sarah Jane Tribble, Kaiser Health News CARRBORO, N.C. — The halls at UNC Horizons daycare are quiet at 5 p.m. Amanda Williammee pauses at the toddler classroom window to watch 2-year-old daughter Taycee. “I like to peek in on her and see what she’s doing before she sees me,” Williammee nearly whispers. “I love watching her, it’s too funny.” There’s a dance party in progress and then Taycee spots her mom, screams and comes running to the door. “Did you dance?” Williammee says, leaning down to her daughter. It seems a typical preschool pickup, but it’s not. The University of North Carolina Horizons Program is a residential substance use disorder treatment center where mothers can bring their children. The kids attend school or daycare while mothers take classes and go to therapy sessions. Williammee, 25, has struggled with addiction since she was a 19-year-old college student. She injected opioids during both of her pregnancies, and her babies were born with neonatal abstinence syndrome, which includes withdrawal symptoms like tremors, irritability, sleep problems and high-pitched crying. She remembers that withdrawals were harder for toddler Taycee than they’ve been for 6-month-old Jayde. “It wasn’t just like we had this two-week period at the hospital of her being sick. Like, it went on for months because she did not sleep,” Williammee said, recalling that Taycee would sleep only for 20-minute stretches and needed constant swaddling. Sometimes, Williammee ran a warm bath for the baby to calm her. “She’d wake up and just be miserable,” Williammee said. On average, a baby is born every 15 minutes in the U.S. withdrawing from opioids, according to recent research. That staggering statistic raises concerns among doctors, social workers and mothers like Williammee who worry about how drug abuse while pregnant affects a baby’s health. Today, both Taycee and Jayde are developing normally. Still, Williammee wonders, how did the drugs affect their tiny bodies and brains? Research is just beginning to point toward the answers. A recent international multisite study tracked nearly 100 children and their mothers, who were in medically assisted treatment during their pregnancy, for 36 months. Hendrée Jones is executive director at UNC Horizons and co-authored the study. She offered reasons to be optimistic. “The children through time tended to score within the normal range of the tests that we had,” Jones said. Dr. Stephanie Merhar, a neonatologist at Cincinnati Children’s Hospital, released a separate study after growing increasingly worried the past few years as she treated children coming in for checkups. Her team reviewed the two-year charts of 87 infants who had been diagnosed with neonatal abstinence syndrome at birth. Each child had been given a standard test for 2-year-olds that evaluated cognitive, language and motor skills — the same assessment used in Jones’ study. What Merhar found was a call to action, she said. “Most of these children do well and they do within the normal range,” Merhar said. “But it’s important to know that there is a risk for some delays and that these children are monitored closely.” Still, exposure to opioids in utero does not appear to be as damaging as some other addictive substances. “It’s not like the fetal alcohol syndrome problem, where it really affects the brain,” Merhar said. “[Children with fetal alcohol syndrome] are at high risk of mental retardation and there’s significant developmental delays.” Merhar’s analysis found that about 8 percent of the children had been treated for strabismus, or lazy eye, by age 3. A number of the children that Merhar studied also scored at least one standard deviation below the mean in cognitive, language and motor abilities. The reason for those delays is unclear, though. Even more, the long-term outlook for the children is unknown, Merhar said. National experts like Dr. Jonathan Davis, who chaired a Neonatal Advisory Committee for the Food and Drug Administration, said the current research is reassuring but the essential long-term research isn’t being done yet. Davis, who is also chief of newborn medicine at Floating Hospital for Children at Tufts Medical Center, has passionately advocated for a national registry for babies exposed to drugs while in the womb. While current research doesn’t reveal any major motor, language, or cognitive delays, he said, it cannot answer questions like “How are these children going to function when they get to school? How are these children going to speak, socialize and interact?” Researchers are quick to point out that fear spread nationwide about the children of the crack cocaine epidemic of the 1980s and early ’90s. Dire predictions of developmental delays turned out to be grossly exaggerated, according to the National Institutes of Health. Dr. Lauren Jansson, director of pediatrics at the Center for Addiction and Pregnancy at Johns Hopkins Medicine, has treated mothers and babies since the early 1990s. When asked about how the babies will develop, she said, “The one solid thing we can say about children who are exposed to substances prenatally is that their mothers need treatment.” The children, she said, are more likely to have optimal development if the mothers receive treatment. UNC Horizons opened its program in 1993 because of the cocaine epidemic. Since then, Jones said, it has become clear that the lives of people with substance use disorders — whether involving cocaine or opioids — can be very chaotic, and that can affect children, too. “It’s incredibly difficult to make a simple linear cause and effect between there was a prenatal exposure to opiates and therefore, because of that exposure to opiates … we see this particular poor birth outcome,” Jones said. Most of the mothers at UNC Horizons took multiple substances when pregnant and also experienced trauma, abuse or neglect in their own childhoods. And, Jones said, that can be hard to overcome. “There’s oftentimes an unrealistic expectation by society. They’re supposed to automatically know how to quote, unquote … be good mothers, how to be nurturing mothers,” Jones said. “That’s like trying to teach somebody algebra when they’ve never even had