The Trump administration’s war on reproductive health care has expanded to include who controls the fate of his health department’s Title X family planning grants, heightening the risk that the U.S. Congress could shut down the government in just two weeks’ time.

Abstinence-only advocate Valerie Huber alone will determine which health-care providers will get awards from some $260 million in Title X funds, according to last month’s long-delayed grant solicitation or funding opportunity announcement. Before leading the Title X office within President Trump’s virulently anti-choice U.S. Department of Health and Human Services (HHS), Huber was “instrumental in attempts to remake ineffective abstinence-only-until-marriage programs into poverty-reduction programs,” Martha Kempner wrote for Rewire.News.

Huber’s ownership of the decision is new. Under President Obama, the Title X chief collaborated on it with other public health officials, according to a funding opportunity announcement from the prior administration.

Politico first reported the news on Tuesday.

The Trump-era Title X grant criteria are notable for prioritizing federal Title X dollars for providers that promote abstinence and natural family planning, Rewire.News reported in February. HHS omitted any mention of “contraception” or “contraceptives,” in stark contrast to the Obama-era criteria.

Caught in the crosshairs are 4 million Title X patients. Thirty percent self-identified as Black or African-American, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native; 32 percent self-identified as Hispanic or Latino; and 13 percent had limited English proficiency, according to the 2016 annual report on the program under Obama.

Power to Decide, an advocacy organization dedicated to preventing unplanned pregnancy, issued a warning last month about the grant criteria’s shift toward natural family planning, a far less effective form of birth control. 

“Already, more than 19 million U.S. women in need of publicly funded birth control live in contraceptive deserts, where they do not have reasonable access to a public clinic that offers the full range of methods in the counties in which they live,” Power to Decide CEO Ginny Ehrlich said in a statement. “Let’s not exacerbate this already challenging situation for millions more women.”

Planned Parenthood Patients Vulnerable

Planned Parenthood and its Title X patients could be particularly vulnerable to Huber’s agenda.

Planned Parenthood health clinics serve about one-third, or 1.5 million, of the Title X program’s 4 million patients. Upon the release of the HHS funding opportunity announcement, Huber told reporters that Planned Parenthood is “free to apply” for family planning grants. But the health-care organization is a perennial target of congressional Republicans and anti-choice HHS officials.

Last year, President Trump shredded Obama-era safeguards intended to stop state-level interference in federal Title X funding for family planning clinics, including Planned Parenthood affiliates—the real target of the GOP’s ire over the fact that Planned Parenthood provides abortion care with its own funds. More recently, HHS reportedly worked with a hate group to jeopardize Planned Parenthood’s separate Medicaid funding stream.

Huber, for her part, “has criticized American culture in general and Planned Parenthood specifically for ‘normalizing’ sex among teens and for glossing over the risks of sex before marriage,” Politico reported.

Dawn Laguens, executive vice president of parent organization Planned Parenthood Federation of America, blamed Trump and Vice President Mike Pence, an anti-choice ally, for empowering Huber.

“Valerie Huber has pushed to mandate abstinence pledges. Now, the Trump-Pence administration is handing her the future of the country’s program for affordable birth control,” Laguens said in a statement. “It is unprecedented to give decision-making power for millions of dollars in family planning funding to just one individual, let alone someone who promotes abstinence only until marriage.”

Will Capitol Hill Check Huber?

The Title X news comes as spending negotiations in Congress could determine Huber’s latitude to transform the program into her abstinence-only image.

Capitol Hill is divided on reproductive health care. Republicans in the House of Representatives for years have tried to zero out Title X money in their annual Labor, Health and Human Services, and Education (Labor-HHS) appropriations bill. Senate Republicans, by contrast, have worked with Democrats to at least maintain current funding levels for Title X in their Labor-HHS appropriations.

Last September, the Senate Appropriations Committee overwhelmingly approved bipartisan fiscal year 2018 funding for HHS, preserving $287 million for Title X and, in a new twist, directing the agency to administer both the Title X and Teen Pregnancy Prevention programs as they were under Obama’s presidency. In effect, Republicans and Democrats on the powerful committee ordered Trump administration officials like Huber not to take the money and use it for their own ends.

“I hope that Democrats and Republicans can continue to show President Trump that Congress won’t rubber-stamp his extreme, harmful agenda on women’s health,” Sen. Patty Murray (WA), the top Democrat on the Senate Appropriations subcommittee that crafted the Labor-HHS bill, said in a statement at the time.

Six months later, congressional negotiators are now trying to roll various appropriations bills, including Labor-HHS, into a massive “omnibus” spending package and pass it by March 23. CQ Roll Call on Monday outlined a “swath of sticky policy debates” over Planned Parenthood funding and other issues that could derail talks. Rep. Tom Cole (R-OK), who chairs the House’s Labor-HHS appropriations subcommittee, identified family planning funds as one of the holdups in a separate CQ report on Tuesday.

By midweek, a raft of reproductive health-care issues, including life-saving research on fetal tissue donated from abortions, erupted among lawmakers and raised the specter of a government shutdown, according to a Politico story. 

Both Cole and Sen. Roy Blunt (R-MO), chair of the Senate’s Labor-HHS appropriations subcommittee, said they could accept the same family planning language from the last fiscal year’s omnibus, according to a Bloomberg Government report. That would mean preserving Title X money, as the news outlet noted. But that would occur at the expense of the Senate Appropriations panel’s September demand that HHS continue administering Title X in the spirit of the Obama administration.

In other words, that trade-off could further empower Huber to disregard the Obama-era emphasis on highly effective forms of contraception and turn Title X into a bastion of abstinence and natural family planning.

A Senate Democratic aide expressed concern about Huber’s role in awarding Title X grants despite the bipartisan agreement on their side of the Capitol.

“Senate Republicans and Democrats have agreed these investments in helping women access affordable care and in preventing teen pregnancy should continue to operate effectively, as they have under past administrations—so it is concerning that President Trump and Mike Pence are continuing to undermine them as part of their harmful, anti-woman agenda,” the aide told Rewire.News.

Chitra Panjabi, president and CEO of the Sexuality Information and Education Council of the United States (SIECUS), urged lawmakers to check Huber’s power.

“Congress must speak out against this unprecedented move, and act quickly to ensure the integrity of a program that 4 million people rely on for sexual and reproductive health care remains intact,” the SIECUS head told Rewire.News.

“It is unconscionable to fund a program with federal dollars that will be ineffective at promoting the health and well-being of young people and women.”