Trump administration’s proposed changes to Title X could leave millions of low-income Americans without reproductive healthcare

By Ivy Kaplan

 Upon Donald Trump’s election to the presidency in 2016, the decision to get an intrauterine device (IUD) as soon as possible was a no-brainer for American University senior Julia Weigel.

Despite being on her parent’s health insurance plan, Weigel felt uncomfortable receiving the birth control implant from her conservative, longstanding family doctor.

Seeking medical autonomy while also on a budget, Weigel turned to Planned Parenthood.

“I decided to go to Planned Parenthood so I could just kind of be my own individual and not necessarily use the same gynecologist that my mom uses,” Weigel said in an interview. “Also, because I knew that it would be the most affordable option.”

Subsidized through a federal program called Title X, community health centers like Planned Parenthood serve millions of low-income patients each year. However, under the Trump administration’s conservative agenda, the future of the Title X program currently hangs in the balance.

 Changes to Title X health centers under new Trump proposals

 Created in 1970 to serve low-income individuals who either lack health insurance or who are uninsurable, Title X is the only federal program dedicated solely to providing Americans with comprehensive family planning and related preventative healthcare.

On June 1, the Trump administration proposed a series of new regulations to Title X, reviving restrictions on reproductive healthcare that date back to the Reagan era.

If passed, the rules would eliminate the requirement that women with unintended pregnancies be counseled on abortion as one of their possible reproductive options; would prohibit medical staff from issuing any abortion referrals; and would ban federal funding from going to any Title X provider that also provides abortions.

In addition to abortion-related services, Title X centers offer patients cervical and breast cancer screenings, different types of contraceptives, and sexually transmitted disease testing, all services that would also be wiped out if the new rules take effect.

According to a recent report by the Department of Health and Human Services, Title X recipients provide care to some of the nation’s most socioeconomically-vulnerable communities.

In 2017, Title X-funded sites served over 4 million patients. Approximately nine out of every 10 of these patients were female, 65 percent were under the age of 30, and 67 percent had family incomes at or below the federal poverty guideline of $24,000 for a family of four.

 

 

According to the Department of Health and Human Services, in 2017, approximately 2/3 of patients serviced by community health centers fell below the federal poverty guideline of $24,000. Infographic created by Ivy Kaplan.

Almost half of the people who used Title X-funded services in 2017 also did not have health insurance, either because of its cost or because of their ineligibility to receive it due to their status as undocumented immigrants.

What these regulations mean for Title X centers and their patients

 Since the announcement of the proposed regulations, anxiety among Title X healthcare providers in the DMV area has been high.

By reimplementing Ronald Reagan’s global gag rule, the part of Trump’s proposed regulations which forbids medical practitioners from discussing abortions with their patients, some believe it would no longer be possible to foster trustworthy patient-provider relationships.

“One of the things that the proposal essentially does… is that it makes it really difficult for providers to have an open and honest conversation with their patients because they’re scared about what they can and cannot say,” Angelica Journagin, vice president of planning and external affairs for Unity Healthcare, said in an interview. “That’s a huge concern for us.”

As one of the largest Title X grant distributers for the District of Columbia, Unity Healthcare services 30 community health centers within D.C. The funding it receives from Title X allows Unity subgrantees to offer long-acting reversible contraceptives (LARC), pregnancy counseling, abortion referrals and other services within the realm of family planning for its patients.

The potential for forced closures of Title X centers could also further perpetuate a void of medical resources in low-income areas within the District.

“If you have access to private health insurance through a job, or your parent’s job, or through your school, you have a lot of options in Washington, D.C. about where you can go,” Journagin said. “If you are low-income living in wards seven and eight, your options are extremely limited. If you live in certain parts of ward eight it can take you over an hour and a half on a bus … to get health services.”

Funding cuts are another large source of stress for Title X providers right now. Although Journagin said Title X funding only makes up around one percent of the operating budgets of community health centers, because these nonprofit health centers already run on extremely tight budgets, cuts would disallow them from subsidizing patient visits.

According to Dara Koppelman, the chief nursing officer at Mary’s Center—a subgrantee of Unity, all federally qualified health centers are required to utilize and charge patients in accordance with a sliding fee scale.

“We assess people’s level of income and the number of families in their household, and then they are put onto the fee scale at a lower level appropriate with that income and family size,” Koppelman said in an interview. “So, if they’re at the lowest income level it would be donation only, all the way up to the highest level which is about $150.”

However, because so many Title X patients are low-income, Koppelman said the revenue generated from these visits does not even come close to funding the materials, medical equipment and staff members that are necessary for operation. Therefore, these budget cuts could put current service offerings at risk.

At Community Clinic, Inc. (CCI), a Title X recipient that operates out of seven locations in Maryland, federal funding rollbacks would make the elimination of these services practically inevitable.

“Funding cuts would be really terrible because, at least for CCI, we weren’t getting a lot of money already,” Emma Hernandez, the previous clinical programs manager for CCI and a current staff member at the National Partnership for Women and Families, said in an interview. “I could see a lot of damage occurring with being short staffed or providers having to go part-time instead of full time. A lot of things like that.”

While Title X health centers in the DMV area have traditionally served low-income, minority and immigrant populations, new restrictions placed on the Affordable Care Act by the Trump administration are also sparking a new wave of patients to come through their doors.

Filed in October, these regulations rolled back the Affordable Care Act’s birth control mandate which required employers to cover all FDA-approved contraceptives, allowing any employer with a religious or moral justification to opt out from providing contraception for its users. Since then, Title X health centers have been forced to spread their existing resources and funding even thinner.

“We have seen folks coming in with health insurance, but for whatever reason … their insurance wouldn’t cover their birth control, so they would still come in to our sites seeking Title X and contraception services,” Hernandez said. “It’s another way that a lot of folks fall through the cracks of health care.”

D.C. resident Claire Russell falls under this category. Although she had health insurance, two years ago, Russell struggled to find a reproductive healthcare provider that was covered by her insurance network in the District.

Since visiting the Planned Parenthood location in NOMA for same-day birth control and STD testing, Russell has yet to turn back.

“I have really enjoyed going there,” Russell said in an interview. “They walk you through everything and they’re really kind. Obviously they’re working on some touchy subjects whenever you go in, and they tell you beforehand that ‘if you’re not comfortable with any of this you can tell me and we’ll stop.’”

Reproductive climate under the Trump administration in general

By rolling back provisions to the Affordable Care Act, while simultaneously cutting funding for more affordable Title X health centers, many view the Trump administration’s actions as a direct attack on women’s reproductive health.

“Obviously it’s really contradictory,” Russell said. “Everyone has a right to a form of health care and if you’re saying that employers can object to funding contraceptives, but then [Title X health centers] can’t help you with reproductive rights in general either, then that’s a huge issue.”

Weigel said the restrictions could also damage female empowerment in the U.S., especially by taking away women’s ability to choose if and when they would like to start a family.

“I think I’m very privileged, so I haven’t really felt the repercussions of having Trump in office yet,” Weigel said, “but I know that for people who are less privileged than me, it’s really harmful because you might not be able to get an abortion; you might not be able to access birth control or to treat an STI, or whatever it might be.”

According to Koppelman, Title X funding recipients are not just sitting idly by, waiting for the proposed restrictions to be enacted.

“With the proposed changes in Title X, we would definitely see some changes in reproductive rights for women in terms of being able to access the care they need when they need it,” Koppelman said. “I can say that subgrantees have responded to the proposed changes in writing, talking about how they would negatively impact us and our patients.”

So far, despite taking advantage of public comment periods following the proposal of the new regulations, the objections from Mary’s Center and other Unity subgrantees have garnered no response from the administration.

For Hernandez, the administration’s refusal to treat reproductive health care like any other preventative health service shows how out-of-touch it is with patient populations in the U.S.

“I think that says a lot about the administration and it says that they’re not in tune, or probably want to be in tune, with the needs of women and men,” Hernandez said. “I would definitely give [reproductive rights in the U.S.] an F right now if I had to grade it.”

The public comment period on the proposed regulations ended on July 31. Since then, HHS has been reading through thousands of submitted comments and altering the proposed regulations accordingly. Once complete, it will submit its updated regulations to the Office of Management and Budget, where the new rules could take anywhere from weeks to months to emerge.

Religious exemptions, lack of information by universities on contraceptive offerings prompt student frustrations

By Ivy Kaplan

In light of recent proposals by the Trump administration to expand religious and moral exemptions for birth-control coverage, concerns are rising among some college students that access to contraception from their school-provided student health insurance plans could soon be cut off.

The new regulations, filed last week with the Office of Management and Budget, would roll back the Obamacare birth control mandate that required employers to cover all FDA-approved contraceptives. Instead, nearly any institution with a religious or moral justification would be allowed to opt out of providing contraception for its users.

At most colleges and universities, students are required to enroll in school-provided health insurance plans if they can’t provide proof of coverage by a comparable alternative. For some colleges within the D.C. area, these proposed regulations could have more dire consequences for students enrolled in school-provided healthcare plans than others.

Sufficient contraceptive coverage, but information hard to find

At two D.C. area universities, students say it’s not the coverage that’s the problem; it’s the lack of transparency regarding which services are provided.

American University currently offers students a plan by UnitedHealthcare StudentResources. The plan includes benefits for up to a 12-month supply of prescription contraceptives, subject to deductibles, copayments and certain limitations.

David Reitman, the medical director of the student health center at American University, did not respond for comment by deadline on what other types of contraceptive services besides prescription drugs fall under the category of “benefits.”

Charlotte Morse, a senior and public health major at American University, is currently enrolled in AU’s healthcare plan. Although Morse has taken advantage of the plan’s contraceptive offerings in the past, she said making appointments and finding information about them is challenging.

“AU does not do a good job at making information about its health care accessible,” Morse said, noting that information on contraceptive offerings is particularly difficult to find. “I’ve had so many problems setting up my account and getting referrals. It has really been a struggle.”

At George Washington University, the student health plan is provided by the Aetna Life Insurance Company and contraception is fully covered at preferred, in-network providers.

Although the GW student health insurance office also did not respond to comment by deadline, based on the plan benefits summary, covered contraceptives include female contraceptive counseling services, as well as female contraceptive prescription drugs and devices that are provided, administered or removed by a physician during an office visit.

Tessa Coughtrey, a senior at GW and the co-president of the pro-choice group GW Voices for Choices, said while the contraceptives offered by the plan may be comprehensive, the vague language that describes them makes it hard for students to know.

“The last time I looked at the website it just said ‘birth control counseling and options,’ or something along those lines,” Coughtrey said. “I think it would be beneficial to the student body for them to elaborate on what they mean because I know I hate walking into a doctor’s appointment and thinking I’m going to get one thing and then being told that that’s not really an option.”

Religiously-affiliated institutions face different challenges

If Trump’s proposed expansions on which nonprofit institutions could be exempt from the Obamacare birth control mandate go into effect, students at religiously-affiliated schools will likely be hit the hardest since their schools can use religion as a means of getting an exemption.

The student healthcare offerings at Georgetown University differ significantly from the others. As a Catholic, Jesuit university, the premier plan funded by UnitedHealthcare exercises a religious accommodation, meaning that Georgetown will not arrange, make referrals or pay for contraceptive coverage.

According to the Georgetown student health services website, since the Georgetown student health insurance office also did not respond by deadline, students enrolled in the plan may only receive hormonal contraceptives at an out-of-pocket cost for medically indicated reasons such as acne, irregular periods and cramps. Contraceptives for pregnancy-prevention or the morning after pill are never provided, and condoms are not allowed to be sold anywhere on campus premises.

Kory Stuer, a senior at Georgetown University and the vice president of the reproductive justice group H*yas for Choice, said these restrictions on getting contraceptives foster an environment of dishonesty in order for students to obtain the prescriptions they need.

“You have to come in and know what to ask for and know how to say it, which also, unfortunately, encourages people to lie when they’re talking to their provider because they need access to this,” Stuer said.

In Stuer’s opinion, colleges should not be able to use religion as a justification for denying contraceptive services to students, especially when they tout religious diversity as a hallmark of their student body.

“Georgetown, as the nation’s oldest Catholic and Jesuit university likes to talk a big game about religious diversity and about the value of having different faith communities on campus … and then when it comes to sexual and reproductive health, throws the Catholic church’s doctrine at students who it might not even be relevant for.”

Stuer’s opinion, however, is not shared by many other members of Georgetown’s student body.

According to Caroline Willcox, a senior and the president of the Georgetown University Right to Life group, Georgetown’s religious affiliation absolutely guarantees them the right to exclude contraceptive services from its student health care plan.

“We have a religious exemption and rights to that, so I think if [contraception is denied] for religious reasons then I think a private institution should be able to make that decision,” Willcox said.

Students call for greater transparency

At each D.C. area school surveyed, students expressed a desire for greater transparency and accessibility to information regarding contraceptive offerings under student health insurance plans.

At Georgetown in particular, Stuer said he thinks the university frequently downplays its lack of contraceptive offerings, leaving many students in shock when they arrive on campus and are denied these services.

“I think Georgetown pretty clearly tries to hide what the landscape is on campus when it comes to sexual and reproductive health, and I think a lot of people hearing that would definitely second-guess their decision to come to school here,” Stuer said. “Students feel like they’ve been lied to by omission.”

Willcox, on the other hand, said it should be common knowledge to students opting to attend a religious university that these services will likely not be offered. In her opinion, the responsibility should rest with students to research this information before enrolling.

“I think that if you’re going to Georgetown, you know it’s a Catholic school, so maybe they should know going in that because of its Catholic affiliation, that’s something that they don’t really have a lot of control over,” Willcox said. “There are a lot of things about our school that because we’re a Catholic institution, that’s kind of just the way they are.”

Morse suggested that American should make physical pamphlets with insurance information available in the student health center, as well as require students enrolled in the student plan to complete a mandatory information course on how it works and what it offers.

“I’m a public-health major and I don’t even know how to look at my claims about my health insurance and what they mean,” Morse said. “I just think as a young person my health care literacy needs to be better.”

Even at George Washington University where contraception is also offered, Coughtrey said, the school should be as upfront as possible regarding services and costs that fall under the student health insurance plan to ease student understanding and use.

“It’s always a good idea to be as transparent and understanding as possible because medical things and insurance get really confusing, especially as a young college student if you’ve always been under your parents’ plan or if you really haven’t had to do a lot of your own insurance filing,” Coughtrey said.

Cryptocurrencies are the “mother or father of all scams,” economist tells Congress

By Ivy Kaplan

Over the past two years, the popularity of bitcoin and other cryptocurrencies have grown within the U.S., allowing some users to get rich quick, while others have been swindled out of thousands, even millions of dollars. To shed light on the opportunities and risks that this new digital asset class poses, two experts sat down with members of Congress on Thursday.

A cryptocurrency is a digital currency designed to work as a medium of exchange. Cryptocurrencies use decentralized control, meaning anyone can use them without relying on traditional banks, and operate completely on the internet through a blockchain, essentially a digital public ledger that keeps track of all existing transactions according to NASDAQ.

As bitcoin’s popularity and investment value surged in 2017, many amateur investors took a chance on the new cryptocurrency to increase their annual income.

However, stories ranging from young business owners investing in the currencies to turn a profit, to grandmothers placing their trust in Bitcoin investments for long-term financial security and losing it all have become common since the cryptocurrency industry, valued at $830 billion at its peak, plunged by 75 percent last January.

These anecdotes were more worrisome for some senators on the U.S. Senate Committee on Banking, Housing and Urban Affairs than others.

“It’s one thing for tech billionaires or the Winklevoss twins to be investing in a complex and poorly regulated market,” Sen. Sherrod Brown (D-OH), ranking member of the committee, said. “I’m concerned about families who risk their savings.”

In 2017, this profile of an overly-eager yet unknowledgeable investor was familiar to Dr. Nouriel Roubini, a professor of economics at New York University and one of the few global economists who predicted the 2008 financial crisis, as Sen. Chris Van Hollen (D-MD) pointed out.

Roubini used these examples to criticize the use of cryptocurrency and to warn U.S. senators of the dangers that the currencies present. According to Roubini, these include massive susceptibility to price manipulation, widespread pump-and-dump schemes, spoofing and insider trading; all characteristics of a digital landscape filled with “massive criminality.”

“Crypto is the mother or father of all scams and bubbles,” Roubini said. “Utility tokens and widespread tokenization would mean a return to the stone age of barter. Even the Flintstones knew better than crypto as they used clamshells as their own one currency.”

As he further pointed out, many of these investments never panned out because more than 80 percent of initial coin offerings turned out to be scams.

“Scammers, swindlers, criminals, charlatans, insider whales and carnival barkers (all conflicted insiders) tapped into clueless retail investors’ FOMO … and took them for a ride selling them and dumping on them crappy assets at the peak,” Roubini said.

Peter Van Valkenburgh, director of research at the Coin Center- a nonprofit focused on the policy issues facing cryptocurrencies, on the other hand, praised Bitcoin and other cryptocurrencies for their future potential.

“Is it perfect? No. Neither was email when it was invented in 1972,” Van Valkenburgh said. “The mere fact that it works without trusted intermediaries is amazing- it’s a computer science breakthrough and it will be as significant for freedom, prosperity and human flourishing as the birth of the internet.”

For Van Valkenburgh, the profile of the average cryptocurrency investor was not the main problem facing cryptocurrency usage in the U.S. Instead, he said, attempts by states at regulating “natively global payment networks” are irrational, and deserve future discussion.

“Federal preemption and an alternative federal license for these companies, perhaps one that also polices from market manipulation and supervises for that, would be, I think, a wise choice that would make America a leader and protect our consumers,” Van Valkenburgh said.

As cryptocurrencies become more widely-utilized, law enforcement agencies and tax authorities are now in the position of determining where they fit into regulating this new financial landscape.

Sen. Elizabeth Warren (D-MA) raised concerns that these unregulated cryptocurrency markets would perpetuate longstanding trends of benefitting the rich, while leaving low-income consumers to suffer.

“These new technologies create these new opportunities, but if we’re not careful, they can follow the same old patterns of making the rich richer and leaving everybody else behind,” Warren said. “The challenge here for us is to try to figure out how to nurture the productive uses of virtual currencies while protecting consumers from scammers and other sorts of threats.”

Van Valkenburgh exhibited few concerns about criminal activity that has taken place so far, claiming that “if criminals aren’t using your technology, your technology is not worth anything.” Instead, he cited proficient law enforcement as an easy solution to the problem.

“We have phenomenal law enforcement in this country that I’ve had the pleasure of meeting who have become extremely adept at analyzing that big data and finding and de-anonymizing or identifying a bitcoin address as being belonging to somebody involved in moving the proceeds of crime,” Van Valkenburgh said.

Roubini disagreed, claiming that these currencies have already been used by terrorists, human traffickers and tax evaders.

“It’s correct that in principle, law enforcement authorities can go after this stuff, but of course, a system that is supposed to be anonymous … implies significant risks to enforcement,” Roubini said.

As Thursday’s hearing was only informational, the committee did not take any concrete steps toward enacting cryptocurrency regulation.

Immigration, Tuition Costs among high priorities for UDC International Student

By Ivy Kaplan

Making political moves through the media

By Ivy Kaplan

For Aaron Traub, a 20-year-old public relations major at American University, the media have played a significant role in propelling political issues into the public eye over the last two years, for better and for worse.

Traub said one of his biggest concerns facing the country is the inexperience of Trump administration staff members and how often this inexperience is brought up in the media.

“The way that [Trump’s staff are] exposed in the media makes them seem unqualified and that’s sort of where my perception is coming from,” Traub said.

After talking with his older family members, Traub said the discontent they expressed about Trump’s staff rubbed off on him, leading him to believe that these figures are incompetent and that they should not have been appointed for their roles.

“People like Jeff Sessions, Michael Cohen, all of these people who are related to the Trump scandal … it’s mentioned so often in the news that they’re very unqualified for their roles and that’s what people have been saying,” Traub said. “People who are much older like my parents, grandparents, etc. all say that.”

On the other hand, Traub has witnessed the media’s power to unify the country as well, giving people a platform to speak out about and bring attention to another crucial topic: sexual assault and the #MeToo movement.

Traub was shocked to hear about the wrongdoings of Matt Lauer and Kevin Spacey through social media. This inspired him to become more of a feminist advocate at a time when the future of women’s rights in the U.S. are uncertain.

“I was just kind of amazed that because when this movement was happening, people were able to speak up about it and sort of show the true colors of those figures that a lot of people in our society look up to and admire,” Traub said. “And it’s like are these really people we should be admiring?”

After interning over the summer with Congressman Ted Deutch, a democrat from Florida, Traub said he learned just how much his vote matters in the upcoming midterms. With his Florida absentee ballot requested and on the way to D.C., Traub is looking forward to making his voice heard as a democrat in a primarily Republican state.

Immigration, gun reform high priorities for Spanish native

By Ivy Kaplan

Although she can’t legally vote in the upcoming U.S. midterm elections as a foreign national, that won’t stop American University senior Xana Pena Rivas for speaking out on political issues she’s passionate about.

Pena Rivas, who lives right outside of Parkland and has seen firsthand the tragic impact of a mass shooting on a community, said she believes gun violence is one of the most important issues plaguing the country today.

“I feel like it’s one of the issues that I keep hearing about constantly in the news cycle,” Pena Rivas said. “It’s like there’s a shooting constantly, and coming from a country where that doesn’t happen, I personally always am shocked when it happens here.”

According to Pena Rivas, gun control is not even on the public’s radar in Spain, making the contrast between the two countries and the need for reform in the U.S. even more apparent.

“There are no gun laws in Spain since it’s not a big issue,” Pena Rivas said. “Police officers don’t even always walk with guns.”

Although Pena Rivas moved to the U.S. at age 14, to this day she is still trying to navigate the U.S. immigration system and become an American citizen, a process that she claimed is “not easy” due to the many legal steps and requirements for naturalization.

Given her firsthand experience and frustration in dealing with U.S. Citizenship and Immigration Services, immigration immediately stood out to her as a topic to keep in mind during the midterms.

“Immigration is definitely a huge factor currently, and as somebody who goes through the immigration process there needs to be a change,” Pena Rivas said. “It’s too hard to come to the U.S.”

Citing specific challenges such as seeking legal assistance, Pena Rivas believes the immigration process needs to be significantly simplified by potential political candidates.

“Being from Europe it’s a lot easier, but … finding a lawyer that knows how the system works is almost impossible, which is like their job,” Pena Rivas said. “If they can’t even understand the system then how are normal people supposed to understand the system?”