UPDATE, March 23, 2:00 p.m. The Senate passed the omnibus bill after midnight on Friday by a vote of 65-32. After initially issuing a veto threat via Twitter, President Trump held a press conference Friday afternoon and said he had signed the bill.
Top Republicans and Democrats in the U.S. Congress have negotiated a $1.3 trillion “omnibus” spending bill without including proposed attacks on reproductive health care. But the Trump administration could very well continue trying to undermine birth control access for millions of people with low incomes.
Republicans in the House of Representatives didn’t get their long-standing wish to eliminate Title X in the omnibus, which funds the government through the end of the 2018 fiscal year on September 30. The bill passed the House by a vote of 256-167 on Thursday and now proceeds to the Senate, which must pass it by Friday’s deadline to avoid a government shutdown.
The 2,232-page omnibus, unveiled Wednesday evening, ultimately funds Title X, the federal family planning program that helps provide contraception, breast and cervical cancer screenings and STI and HIV testing to a diverse, low-income population. Title X serves 4 million patients, the majority of whom are people of color and have incomes at or below the 2016 federal poverty level, according to the Obama-era annual report on the program.
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Congressional negotiators failed to include a bipartisan Senate agreement that would have sought to limit how Trump’s virulently anti-choice U.S. Department of Health and Human Services (HHS) could spend around $286.5 million in Title X money and $101 million in Teen Pregnancy Prevention money.
Republicans and Democrats on the Senate Appropriations Committee agreed last September to effectively order HHS to administer both the Title X and Teen Pregnancy Prevention programs as they were under the Obama administration, with its emphasis on evidence-based contraception and embrace of Planned Parenthood, Rewire.News reported. The Susan B. Anthony List subsequently rebuked Sen. Roy Blunt (R-MO), who worked with Sen. Patty Murray (D-WA) on the language, in a statement that perpetuated falsehoods about Planned Parenthood and the “abortion industry.” By early March, Blunt was open to dropping the bipartisan protection.
Now, Congress is about to hand over the $286.5 million designated in the omnibus for the program to Trump’s abstinence-only Title X chief, Valerie Huber. For the first time in three decades, Huber’s position will have sole decision-making power to award federal family planning grants, based on Trump-era HHS grant criteria that omitted any mention of “contraception” or “contraceptives.”
Power to Decide praised the omnibus for funding family planning programs. But the advocacy organization dedicated to preventing unplanned pregnancy expressed disappointment that Congress didn’t send a stronger message to the administration.
“We are concerned that the bill fails to include previous bipartisan Senate language, which made crystal clear the important role that Title X has historically played in providing high quality clinical contraceptive services,” CEO Ginny Ehrlich said in a statement.
Ehrlich was pleased that Congress maintained funding levels for both Title X and Teen Pregnancy Prevention. She urged the Trump administration “to honor the intent of these programs.”
Apart from Title X, the omnibus provides $25 million—$10 million more than the last fiscal year according to two different reproductive health advocates—to “exclusively implement education in sexual risk avoidance.” As Martha Kempner wrote for Rewire.News, abstinence proponents have rebranded their work as sexual risk avoidance amid evidence that the programs were “ineffective and even harmful.” But they rely on the “same tactics—using misinformation or questionable research—with an updated focus: reducing poverty.”
The omnibus indeed specifies that so-called sexual risk avoidance grants should emphasize “success sequencing for poverty prevention,” a related concept that Kempner debunked.
Details of the omnibus aren’t likely to change, especially after House passage. The massive legislation has the support of leaders in both parties and chambers. But some lawmakers expressed their opposition to it. Rep. Luis Gutiérrez (D-IL), for instance, vowed to vote against “funding that continues Trump’s war on immigrants,” including money for a border wall and excluding a deal for Deferred Action for Childhood Arrivals, or DACA, recipients. The Congressional Hispanic Caucus urged all members to oppose the omnibus.
Although Republicans control Congress, Democrats’ votes are needed on both chambers of the Capitol. House Speaker Paul Ryan (R-WI), as usual, couldn’t count on the GOP’s ultra-conservative wing to pass a massive spending package on a strict party-line vote. In the House, 111 Democrats voted for the bill. Meanwhile, Senate Majority Leader Mitch McConnell (R-KY) will need at least some Democrats to reach a 60-vote supermajority and avoid a filibuster.
Democrats may be more inclined to vote for the omnibus without the reproductive health-care concessions that Republicans unsuccessfully demanded.
The omnibus omits the Conscience Protection Act, which would have allowed a broadened swath of health-care providers to sue if they’re supposedly coerced into providing abortion care, or if they face discrimination for refusing to provide such care. A Rewire.News analysis found evidence that congressional Republicans and the religious right have been recycling the same purported conscience violations for years. The Trump administration is encouraging new allegations through its health-care discrimination wing.
A top Senate aide expected the Conscience Protection Act to be in the omnibus, according to Christian Broadcasting Network’s Abigail Robertson. But it wasn’t. Neither was a repeal of the Johnson Amendment, which could politicize churches.
House Republicans in early March wanted to use the omnibus to end all federal funding for Planned Parenthood and ban life-saving research on fetal tissue donated from abortions, according to a Politico story. Those provisions aren’t in the bill text.
Planned Parenthood, which serves 1.5 million Title X patients in largely rural and underserved areas, nevertheless remains exposed to Trump’s anti-choice health department. Huber, the Title X program head, previously told reporters that Planned Parenthood is “free to apply” for her office’s family planning grants. But the health-care organization is a perennial target of Republicans on Capitol Hill and Trump’s health officials.
Last year, at congressional Republicans’ behest, Trump delivered the final blow to the Obama administration’s Title X safeguards against state-level interference in federal Title X funding for family planning clinics, including Planned Parenthood affiliates. Planned Parenthood was the real target of the GOP’s ire over the fact that it provides abortion care with its own funds. More recently, HHS reportedly worked with a hate group to jeopardize Planned Parenthood’s Medicaid funding stream.
The omnibus, moreover, doesn’t expand discriminatory abortion restrictions into the private insurance market. The manufactured abortion crisis first erupted over an otherwise bipartisan Senate plan temporarily stabilizing the Affordable Care Act, or Obamacare, Rewire.News reported in December. This week, Sen. Lamar Alexander (R-TN) reneged on the bipartisan stabilization plan he crafted with Sen. Patty Murray (D-WA), turning to Sen. Susan Collins (R-ME) to craft a partisan alternative that included the abortion restrictions. Neither stabilization bill made it into the omnibus.
The Alexander-Murray stabilization bill could have lowered deductibles for people with low incomes, among other measures, Vox wrote last October. “But the health insurance landscape has shifted since last year, and simply adopting last year’s bipartisan bills, without significant changes, would do more harm than good,” the Center on Budget and Policy Priorities determined in early March. The landscape shifted in part after Trump signed the GOP’s regressive tax bill and repeal of Obamacare’s individual mandate into law.
“It’s unfortunate that Senator McConnell and Speaker Ryan have time and time again rejected bipartisan work on health care in favor of partisan health care politics, and chosen politically-driven show votes over getting a result for families,” Murray said in a statement on Wednesday.
Correction: Huber’s position, the deputy assistant secretary for population affairs, had sole discretion over awarding Title X grants from the program’s launch in the 1970s through 1987, according to a HHS spokesperson and a supporting document reviewed by Rewire.News.