Planned Parenthood Rolls the Dice on Title X

Planned Parenthood’s decision to withdraw from the Title X program is driven by 2020 politics, but may be a serious miscalculation borne from their abortion rhetoric.

A women stands with her child in a stroller during a pro-life rally outside the Planned Parenthood Reproductive Health Center on June 4, 2019 in St Louis, Missouri.
A women stands with her child in a stroller during a pro-life rally outside the Planned Parenthood Reproductive Health Center on June 4, 2019 in St Louis, Missouri. (photo: Photo by Michael B. Thomas/Getty Images)

The 2020 election is officially a referendum on Planned Parenthood now that the organization is pulling out of the Title X family planning program rather than comply with new federal rules that require Title X providers be physically and financially separate from abortion providers.

It is the first major strategic decision the organization has made since the activist-dominated board jettisoned CEO Dr. Leana Wen. The stakes are high for Planned Parenthood, which could suffer a huge blow to their political relevancy and business model if they have made the wrong bet on Title X in 2020.

Wen’s July 16 termination by PPFA and its political action committee showed that the agenda priorities of abortion activists trumped the priorities of those like Wen who saw Planned Parenthood as primarily a health provider. With Wen and her team purged from leadership, Planned Parenthood is now, as another ex-CEO warned, a NARAL with clinics.

Wen’s vision was arguably more dangerous for the pro-life movement, because she played the long game. Wen believed her organization’s abortion agenda would be secure only by transforming Planned Parenthood into a provider of comprehensive medical care, with abortion presented as part of a range of services.

Planned Parenthood’s activists, however, jettisoned Wen because they see the Trump administration as an existential crisis, even though the organization’s financial health is better than ever. But purges put organizations at a disadvantage at critical moments, and here, Planned Parenthood’s leadership may have made a critical error.


Planned Parenthood’s Gamble

Planned Parenthood’s political gamble on 2020 is similar to the gamble made at the start of the U.S. Civil War, when the Confederate leadership, convinced that they were indispensable to Europe as a source of cotton, actually embargoed themselves in an effort to force European nations to side with them over the U.S.

Instead, something very different happened: the British Empire switched to Egyptian cotton rather than declare war on the U.S. The French refused to intervene without allies. By the time the truth about the Confederacy’s “indispensability” was laid bare, it was too late.

Something very similar may now happen to Planned Parenthood, which announced that clinics are going to turn away Title X patients as a result of the Trump administration’s actions. Planned Parenthood has no need to actually do this: the organization runs a surplus in the hundreds of millions of dollars and could easily make up the $60 million. But Planned Parenthood believes that turning away Title X patients will galvanize people at the ballot box to throw out President Trump and kick Republicans out of power in the U.S. Senate.


Breaking the Abortion Model

But people are adaptable and can seek out alternatives when necessary. Wen apparently realized that in the post-Affordable Care Act world, Planned Parenthood clinics with their limited services cannot compete with Federally Qualified Health Centers unless they provide comprehensive care. It is no secret: even pro-life groups have pointed out that reality.

Planned Parenthood’s activist leaders are acting like their customers have no other options. The reality is, they just might. Once patients start visiting FQHCs instead of Planned Parenthood, they will build relationships with those providers, and the pipeline to Planned Parenthood’s 333,000 annual abortions will start to break down.

But turning away Title X recipients will also have financial ramifications beyond abortion. If people start to go elsewhere for that $60 million of Title X services they got from Planned Parenthood, a good portion of the half-billion dollars in public funds for other medical services (mostly through Medicaid) goes with them as well.


Political Ramifications

But Planned Parenthood’s biggest source of revenue is actually more than $600 million in private donations that it makes through fundraising as a successful advocate for abortion. Since Planned Parenthood has now made Title X an election issue, if it wins 2020, it will have enhanced its political power and justified the calculus to purge Wen and her supporters. But if Planned Parenthood loses this critical battle, their political effectiveness starts to become called into question. Private donors may begin to see that Planned Parenthood has become an ineffective NARAL-type lobbying group burdened by an obsolete health-delivery system, and not worth the hefty investment. They may place their money elsewhere, while the activists will be left with an organization with a health care model they broke and cannot fix overnight.

Empires maintain themselves by projecting power and convincing others of their indispensability — but the calculus changes when that aura is shattered.

Convinced by their own rhetoric of indispensability, Planned Parenthood may discover the battle over Title X is their high-water mark.

Read more: Planned Parenthood’s Termination of Leana Wen Reveals Deep Internal Divisions