Chelsea Dappen didn’t know where to turn after she was sexually assaulted on her college campus in Nebraska. She retreated into her dorm room, a shell of her former self for weeks, until her roommate realized what was going on and encouraged her to go to Planned Parenthood.

“A friend told me about her experience and how Planned Parenthood was very understanding and respectful, and had a certain sensitivity when she was in a similar situation,” Dappen said. “I don’t know if I could have gone anywhere else. I felt safe there.”

The staff at Planned Parenthood gave her a lifeline, she said, not only with the health care she needed, including STI screening, a pregnancy test and a general checkup, but by referring her to counseling and support groups that she still uses today, nearly six years later. She says those services have been critical in her recovery.  

The services Dappen utilized at Planned Parenthood were covered by Title X, a federal family planning program that may no longer be accessible to thousands of Nebraskans if lawmakers move forward with a budget that includes a proposal denying Title X funds to any health center that performs, counsels about, or refers for abortion services. It’s a move that would block access to care for nearly 28,000 Nebraskans who rely on Title X for family planning and reproductive health care.

Republican Gov. Pete Ricketts put the provision in the state’s budget for the second year in a row, saying it was a reflection of the state’s “pro-life” values. Last year the provision was struck down after pushback across the political spectrum.  

President Trump in April 2017 cleared a path for state lawmakers to more easily block Planned Parenthood from public funds by rescinding an Obama-era rule that stated a qualified provider could not be excluded “for reasons other than its ability to provide Title X services.” Should Nebraska lawmakers approve the state budget with Ricketts’ provision, it would be the first direct attack on Planned Parenthood’s Title X funds since that move by the Trump administration, which has sought to undermine reproductive health care in myriad ways. 

“For the second year in a row, Governor Ricketts and Lieutenant Governor [Mike] Foley are taking aim at people’s rights and access to care through Title X,” said Meg Mikolajczyk, associate general counsel and senior public affairs manager for Planned Parenthood of the Heartland. “Title X  is meant to assure every person can access basic preventive health care regardless of where they live, how much money they make or whether they have health insurance. We have to keep fighting to make sure everyone gets the health care they need without politicians controlling when, how, or where they get their care.”

Ricketts’ proposal would not only jeopardize Planned Parenthood, but would harm other family planning health centers in the state, potentially setting them up to violate federal law, said Danielle Conrad, executive director of the American Civil Liberties Union (ACLU) of Nebraska. The proposal excludes Title X funding from any entity that provides information about or referrals for abortion care. However, federal Title X regulations require providers to give information about abortion to any patient who asks.

“When it comes to patient care and ethics, when a patient expresses to you a need for additional information, you need to be able to have a candid conversation without the heavy hand of government in the middle of that private and personal conversation,” Conrad said.

The Title X family planning program was created in 1970 to fund preventive health services for people with low incomes. Title X services include breast and pelvic exams, pap smears, HIV testing, pregnancy testing, cancer screenings, and birth control. Eighty-nine percent of Title X recipients are women, the majority of them younger than 30 and living at or below poverty level.  

Planned Parenthood makes up about 5 percent of all Title X providers in Nebraska, yet in 2015 saw more than one-third of all Title X patients. Ninety-three percent of Planned Parenthood patients in Nebraska rely on Title X services.

“We know that women and men in Nebraska and across the country trust Planned Parenthood and rely on Planned Parenthood, and other family planning providers to meet their basic health care needs,” Conrad said. “Really the crux of this issue is the government saying if you have the means to choose your doctor you are allowed to go to a family planning clinic or Planned Parenthood or a private practitioner. But if your income is such that you rely on Title X or Medicaid to access these life savings programs, we’re going to tell you which doctors you can or can not go to.”

This is something with which Dappen identifies, telling Rewire.News she went to Planned Parenthood because she trusted them, and she would not have been comfortable with another provider.

“It takes a lot of trust between a patient and their doctor, especially when you have experienced trauma, so to take away that from from me in choosing my health care provider, I just don’t think that’s right,” she said.

Under federal law, neither Title X nor Medicaid funds can be used for abortions, yet anti-choice legislators across the United States have tried for years to strip Planned Parenthood of public funds. Between July 2015 and the end of 2016, mostly Republican lawmakers in 24 states have tried to and those in 15 states have succeeded in adopting some kind of funding restriction on Planned Parenthood, according to the Guttmacher Institute. Many of those funding restrictions, however, have been tied up or struck down in court and therefore are not currently in effect.

Conrad said the ACLU is lobbying against Ricketts’ proposal and “exploring all of their options,” including litigation should the proposal pass. The GOP-majority Nebraska legislature discussed the budget on Wednesday, during which legislators read from the Trump administration’s recent funding order that encourages funding go to abstinence-only providers. After extensive debate, legislators put the budget on hold. The legislation will need to be finalized by April 18, the last day of the legislative session.

Dappen has lobbied her legislators and said she hopes they listen.

“After giving out my story, it’s just something difficult and vulnerable, and if they choose to ignore that part of the issue, it will be difficult not to take it personally,” Dappen said. “It’s not just statistics. There’s a human side to this.”