Millennial Perspective: Title X is Vital, Efficient, and Largely Unknown

Photo by National Women's Law Center

Photo by National Women's Law Center

By Tarsi Dunlop

While many Americans probably haven’t heard of Title X, it plays an integral role in our public health system, particularly for low-income and uninsured patients. Funded by Congress through the discretionary budgeting process and administered by the Department of Health and Human Services’ Office of Population Affairs, Title X is the only federal grant program dedicated to family planning and reproductive health services. (Since it’s part of discretionary spending, it would see substantial cuts under the budget proposed by Rep. Paul Ryan – more on that below.)

Enacted by President Nixon in 1970, this highly effective program provides critical care to more than 4.7 million individuals each year through grant funded health centers. Services provided include pap tests, breast exams, STD tests, and confidential HIV tests. In fiscal 2012, the Title X budget totaled $294 million; 71 percent of the individuals served had incomes below the poverty line and 64 percent were uninsured. Title X operates at a significant cost savings for taxpayers; in 2008, every public dollar spent on contraceptive services yielded an estimated $3.74 in savings that would have been spent on Medicaid costs related to pregnancy care, delivery, and infants in the first year of life. According to law, Title X funding cannot be used for abortions. Despite its long and successful history, the program has come under attack in recent years.

In a 2013 white paper, Roosevelt Institute fellow Andrea Flynn argues that although the Affordable Care Act (ACA) was a significant achievement, especially for women and girls, Title X is still needed because it bridges critical gaps that are left by the ACA. In this economy, Millennials should defend efficient programs that fill critical gaps for themselves and fellow citizens. The U.S. spends two-and-a-half times more on health care per capita than any of the other OECD countries, and our citizens have worse health outcomes and less access to care and services overall. Communities that are poor and communities of color are particularly affected by these realities. Low-income women have an unintended pregnancy rate nearly four times that of high-income women and adolescent pregnancies are a leading factor in infant mortality, of which the U.S. has a higher rate than any other industrialized country. In 2008, nearly 30 percent of pregnant women in the U.S. did not receive prenatal care in the first trimester. To attempt to alleviate some of these problems, community health clinics (CHCs) provide critical primary services to underserved communities.

Community Health Clinics operate as nonprofit organizations under the auspices of Federal Qualified Health Centers (FQHCs), which means they receive federal funds and they must abide by comprehensive standards. CHCs are widespread: In 2011, 8,500 service delivery sites run by CHCs provided care to more than 20 million patients. Some CHCs receive Title X funding, but a majority do not, even though Title X funded CHCs are able to provide more than just minimal clinical care. Access to Title X funding allows CHCs to provide services at no cost to those at or below the federal poverty line, and on a sliding scale fee for those above. Lessons from Massachusetts suggest the demand for CHCs may rise even as the number of uninsured Americans falls due to the ACA.

Title X also has a mutually beneficial relationship with Medicaid, which serves as an insurance plan that helps pay for low-income patients to receive care at these facilities. Family services covered by Medicaid include four out of 10 births annually in the U.S. Medicaid also funds family planning programs that have resulted in improved contraceptive use, fewer unintended pregnancies, and more time between births. In terms of return on investment, for each dollar spent on family planning, $5.68 is saved in Medicaid expenditures. Medicaid may cover the actual services, but it does not support the infrastructure necessary to provide them, which is where Title X funding becomes critically important.

Despite Title X’s vital role in bridging gaps in the health system while demonstrating a high level of efficiency, Congress has continually attacked the program’s funding in recent years. Rep. Paul Ryan’s recently released budget continues this trend. It’s an all-out assault on domestic spending, which makes drastic cuts to Medicaid and repeals the Affordable Care Act’s Medicaid expansion. Overall it cuts $3.3 trillion over 10 years — a 69 percent cut — from vital programs serving our low-income population. Our current budget priorities may be somewhat out of alignment with what many working Americans need to get by, but Rep. Ryan disregards the importance of these programs to low-income citizens. In contrast, President Obama’s 2015 budget requests $286.5 million for the Title X program of out a total $1.005 trillion on health care spending overall. That’s down from fiscal 2010 but equivalent to the fiscal 2014 appropriation. It’s hardly robust, but at least it’s in line with previous spending. Americans use health care services in a confidential, efficient manner through Title X. By advocating for this program and standing behind it as a generation, Millennials can send a message of tolerance, understanding, and appreciation for women.

Tarsi Dunlop is the former Director of Operations for the Roosevelt Institute Campus Network and a member of Roosevelt Institute | Pipeline's DC Chapter. She currently works at an education nonprofit in Alexandria.