HHS Proposal Would Increase Comprehensive Care Accessibility

Reflecting a policy recommendation the Academy offered the White House in January, the proposed rule would largely roll back the previous administration’s adjustments to the program, which provides family planning and other health services for low-income women.

The proposed rule “would restore the Title X program, advance health equity and facilitate access to comprehensive, patient-centered health care,” AAFP President Ada Stewart, M.D., of Columbia, S.C., said in an April 16 statement responding to HHS’ announcement and urging that the new rule be finalized.

The Academy objected to the 2019 rule when it was proposed and called for legislative intervention when it was finalized, arguing that it interfered with the physician-patient relationship. The Academy cautioned then that the program alterations also would exacerbate health inequities and limit access to comprehensive care for millions of family physicians' patients.

Data cited by HHS in the new proposed rule bear out the AAFP’s warnings and confirm that hundreds of thousands of patients lost access to care following the withdrawal of about one-quarter of all Title X family planning clinicians. Several states today have no participating Title X clinicians, a reduction that has disproportionately affected patients of color.

“More specifically, compared to 2018, 225,688 fewer clients received oral contraceptives; 49,803 fewer clients received hormonal implants; and 86,008 fewer clients received IUDs,” HHS notes. “Additionally, 90,386 and 188,920 fewer Pap tests and clinical breast exams respectively were performed in 2019 compared to 2018. Confidential HIV tests decreased by 276,109. STI testing decreased by 256,523 for chlamydia, by 625,802 for gonorrhea, and by 77,524 for syphilis. Furthermore, 71,145 fewer individuals who were pregnant or sought pregnancy were served.”

In another win for the AAFP, the proposed rule would revise prior regulations to include primary care physicians among referrals available to Title X sites “in order to promote access to services and provide a seamless continuum of care.”