Without notice to the public, the Department of Health and Human Services’ (HHS) Office of Population Affairs (OPA) removed a collection of ten pages related to the Affordable Care Act (ACA) from its “Title X Family Planning” website. These changes, which occurred between April and May of 2017, are documented in the Web Integrity Project’s latest report.
Administering the Title X grant program is the core mission of OPA, which also serves as the key office providing advice to the HHS Secretary and the Assistant Secretary for Health on reproductive health topics, including family planning. The Title X grant program provides family planning and preventive health care services to over four million predominantly low-income, underinsured, or uninsured people annually, and the ACA further expanded access to low-cost contraceptive services.
Prior to the removals, the main page of the collection of ACA-related pages was accessible from the sidebar of the Title X website, via a link with the text “Affordable Care Act.” The website’s removed ACA pages, which are preserved by the Internet Archive’s Wayback Machine, included information about contraceptive coverage, the Health Insurance Marketplace, the types of ACA-related grants awarded through Title X, and resources to help Title X providers implement the ACA. Now, these resources and information are unavailable to providers at over 4,000 Title X-funded sites and patients seeking family planning services.
Some content related to the topics of three of the removed pages can still be found elsewhere on OPA’s Title X website. For example, some of the information from the “Contraceptive Coverage” page, which discussed coverage of women’s preventive services under the ACA, was relocated to the “Women’s Preventive Services” page. Like the “Contraceptive Coverage” page, the “Women’s Preventive Services” page includes information about how contraception and other preventive care must be covered by insurance plans without deductibles or co-pays. However, contraception-related content on the “Women’s Preventive Services” page is presented under the broad header of “preventive services”, which includes services beyond family planning, such as prenatal care and screenings for breast and cervical cancers. Additionally, the “Women’s Preventive Services” page does not include information from the “Contraceptive Coverage” page about the “proven health benefits” of contraception and the specific forms of contraception to which the ACA ensures access. In effect, the “Women’s Preventive Service” page buries information about contraception and de-emphasizes contraception in prevention and family planning.
Content from seven of the removed pages is no longer available on the OPA website. For example, a page about the ACA Collaborative, which was established in August 2014 by OPA to study “the impact of health system changes resulting from the Affordable Care Act on Title X centers,” was completely removed from the Title X website.
The ACA Collaborative was created when three primary grantees — the Guttmacher Institute, the Altarum Institute, and the National Family Planning and Reproductive Health Association (NFPRHA) — were awarded a combined $4 million in Title X funding between 2014 and 2016 to conduct research projects. While data and findings from the projects were never ultimately shared before the page was removed, the page outlined the goals of each project and made the case for applied research that would enable efficient delivery of services at Title X centers. The page served as a record that this research had been funded. Its removal makes it difficult for the public, health care providers, or other interested parties to learn about these research efforts and access any findings that may have stemmed from them.
In response to WIP’s request for comment about the webpage removals, an OPA spokesperson said that “most of the content was not removed, but rather reorganized.” The spokesperson also noted that “whenever possible, OPA website redirects are placed to guide visitors to related content” to avoid URLs for removed pages leading to error messages. However, as noted above, content from only three of the ten removed pages can be found elsewhere on the website. After WIP requested comment, the office established redirects for 4 of the 10 removed pages — including pages about ACA-related grants, Health IT, and the “Contraceptive Coverage” page — but until then, the URLs for all of the ten removed pages led to error messages.
This is not the first time that WIP has documented removals of information related to the ACA’s impacts on women’s preventive services. In March 2018, WIP released a report detailing removals from the Office on Women’s Health (OWH) website, including removals of information about mandated access to free or low-cost breast cancer screenings under the ACA. Like other pages removed from other HHS websites, these pages were taken down without any advance notice or explanation for why they were being removed, which may be a violation of the Paperwork Reduction Act.
The removals from both the OPA and OWH websites are just two examples from a long list of attacks by the Trump administration on women’s reproductive healthcare. HHS is currently considering a domestic gag rule that, among other things, would prevent Title X centers from providing abortion counseling and referrals, significantly undermining their ability to provide care that many women seek and need. The rule also proposes dropping language specifying that Title X centers must offer comprehensive family planning methods and services that are “medically approved.” This means clinics could receive Title X funding if they provide only fertility-awareness and sexual risk avoidance methods of contraception, despite the fact that they are less effective than other contraceptive methods.
In November 2018, HHS also finalized two rules that would expand exemptions to the ACA’s contraceptive coverage mandate to include employers that object on religious or moral grounds. The rules, which have the potential to make it harder for many women to access affordable contraception, were scheduled to take effect in January 2019, but were blocked by a federal court.
In proposing these rules, the Trump administration has made clear its intention to dismantle Title X and roll back ACA measures that provide broad access to contraception. Yet, currently the domestic gag rule is not finalized and rules regarding contraceptive coverage remain unchanged. Without these proposed rules in place, the ACA removals from the OPA website undermine current laws and policies, and more broadly, undermine women’s health.