The Federal Family Planning Program Has Not Recovered from Trump Era Restrictions

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The number of family planning clients served by the Federal Title X program has not yet recovered from the 2019 Trump Administration regulations that resulted in a mass exodus of sites from the program according to new data issued by the HHS. This program continues to be the focus of litigation and targeted by House Republicans. If Trump is re-elected, his Administration would likely reinstate the very regulations that weakened the network five years ago. 

In 2019, the Trump Administration issued new regulations that prohibited Title X clinics from referring for abortion services and required physical separation of family planning and abortion services, effectively disqualifying all family planning clinics that also provided or referred their patients for abortions. This policy resulted in the withdrawal of 1,000 clinics from the program and 6 states being left without a Title X network. Title X had consistently supported around 4,000 clinics and 4 million low-income or uninsured clients, which in 2020 plummeted to 3,031 clinics and just 1.54 million clients, losses that were compounded by the pandemic. The Biden Administration quickly reversed the Trump era regulations in November 2021, but it has taken time to bring grantees and clinics back into the network. In 2023, the number of clinics in the network approached the 2018 level, but only 2.8 million clients were served by the program, a million fewer than before the Trump Administration regulations went into effect.

Although inflation has risen rapidly in the past few years, the program has been level funded at $286.5 million since 2015, which is effectively an erosion in the actual value of the funding. The most recent House Appropriations Committee draft bill would eliminate Title X funding altogether.

Project 2025, a proposal from an array of conservative groups, calls for the reinstatement of the Trump Administration regulation. Several states that ban abortion are challenging the Biden Administration rules that require counseling and referrals for abortion, contending that their states should be eligible for grants without complying with these rules. While this program has not been making headlines under the Biden Administration, the structure of the program could be reshaped by a future administration as well as the Supreme Court in the near future.