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MOORHEAD, MINN. – There are places in Minnesota where you can get thousands of dollars' worth of affordable, accessible birth control without paying thousands of dollars.
For now, at least.
President Donald Trump campaigned on a pledge to defund Planned Parenthood, and he's following through, one spool of red tape at a time.
"It would be heartbreaking to see them defunded," said Jenika Rufer, a graduate student at North Dakota State University, who paid nothing for the IUD she received at the Planned Parenthood clinic here.
There are 18 Planned Parenthood clinics scattered across Minnesota. Seventeen of them — the 17 where you can't get an abortion — receive federal family planning funding through a program known as Title X. Those grants give cash-strapped college students like Rufer and other low-income Americans access to things like birth control and reproductive health care.
Planned Parenthood Minnesota, North Dakota, South Dakota gets about $2.67 million in Title X funding, and about 25,000 patients rely on those funds to offset all or part of their care. Nationwide, about 40 percent of the 4 million men and women who get access to family planning services through Title X grants each year do so at a Planned Parenthood center.
Rufer, who is no longer covered by her parents' health insurance, has been going to the Moorhead clinic for three years. When she came in for her IUD — a form of long-term birth control that could have cost more than $1,000 if she were paying on her own — a nurse held her hand through the whole procedure.
"So many men and women would be affected," she said, if something happened to the clinic, which served 4,567 patents last year, most of them drawn from nearby Minnesota and North Dakota colleges. "It's terrifying to think about and something I think we can prevent."
Title X grants have been around for almost 50 years. The program, tucked into the Public Health Service Act just as Roe v. Wade was about to start working its way through the courts, was signed into law by President Richard Nixon, championed by future President George H.W. Bush and passed by Congress with overwhelming support, back when there were still a few policies both parties could get behind.
"We need to make population and family planning household words," then-Congressman Bush said in 1969. "We need to take sensationalism out of this topic so that it can no longer be used by militants who have no real knowledge of the voluntary nature of the program but, rather are using it as a political steppingstone. If family planning is anything, it is a public health matter."
Nothing about public health or family planning seems to be bipartisan these days. Congress made an effort to cut Planned Parenthood's federal funding last year and now the Trump administration is planning changes to the way the Office of Population Affairs awards Title X grants.
The proposed rule change would bring back a Reagan-era policy that tried to cut off family planning grants to organizations that provided or referred women for abortions.
Groups like Minnesota Concerned Citizens for Life are cheering the prospect. Planned Parenthood is the leading provider of abortion services in the state and the nation, and while federal law already prohibits the use of federal funds for most abortion services, opponents say there is no way to ensure where those family planning dollars end up.
"Any organization performing abortions should not be funded with taxpayer money," said MCCL spokesman Bill Poehler. "The goal is not to withhold birth control or family planning from women. It's to separate those funds from abortion."
Critics say there are plenty of other organizations out there that could serve patients like Rufer. Planned Parenthood is already suing the administration over new rules that would steer Title X grants to faith-based groups that emphasize abstinence.
But for the staff of the clinics, the prospect of losing Title X funding is personal. Laura Wilner, a nurse practitioner at the Moorhead clinic, sees the look on patients' faces when they arrive at the clinic. Most of them are between 18 and 25 and navigating the health care system for the first time. Many of them hesitate when she asks if they need birth control.
If they can't afford it, there's no cost, she tells them. "The look of relief on their face," Wilner said. "They had no idea that they could afford it. If there wasn't Title X funding, some of those people really would fall through the cracks. … There are some people who are making decisions about buying food for their kids, and birth control falls way down on that list."
The Department of Health and Human Services is taking public comments on its Title X plans through the end of July. You can comment online at www.federalregister.gov.
