The first day after the last day of Title X funding, two teenagers walked through the door of a Minnesota Planned Parenthood clinic.
They needed birth control, they needed to get tested for sexually transmitted infections, and they needed free health care, just like before.
But this was the first day after the last day. Reproductive health care just got more expensive for the people who can least afford it.
This time, the young couple learned, their visit would end with a bill. Not a huge sum, but a lot for two kids who might have been trying to keep an STD test from showing up on their parents’ insurance.
They turned and walked out of the clinic. No birth control. No health screening.
Clinic staff shared stories like this one all last week with Dr. Sarah Traxler, chief medical officer for Planned Parenthood North Central States.
Planned Parenthood just walked away from a federal grant program that covered the cost of birth control and reproductive health care for tens of thousands of Minnesotans in need. Because staying in the program would have meant knuckling under to a new Trump administration rule that bans Title X recipients from telling patients where to go to get an abortion.
Withdrawing from the program meant losing $2.7 million in health care grants for 26,000 low-income patients at Planned Parenthood clinics across Minnesota.
For Planned Parenthood officials, who administered 90% of the Title X grants in Minnesota, the choice felt like no choice at all.
“As a physician, I really had a strong reaction to being basically bullied into compromising my medical ethics in order to get grant funding,” Traxler said. “We couldn’t allow the government into the exam room.”
A birth control prescription that a low-income patient received at no cost a month ago might cost them $25 or $50 a month now. Patients who paid nothing for their last $200 injection of a long-term contraceptive like Depo-Provera might now face a bill for $125.
Not a huge sum. But a lot if you’re barely earning enough to cover rent and groceries.
Traxler thinks about a woman she just treated after an irregular Pap smear — all the tests and screenings the Title X funds covered. Would the next patient be able to afford those tests, or would she turn and walk out the door?
Federal law already bars the use of taxpayer funds for abortions, but only two of Minnesota’s 18 Planned Parenthood clinics offer abortion services. The other 16, scattered across the state, serve more than 50,000 patients a year — and more than half of them were covered by Title X.
For now, Planned Parenthood will keep all its Minnesota clinics open and bill low-income clients on a sliding scale. Minnesota has its own family planning grant programs to cushion the blow, and clinics have navigators who can connect people in need to other programs and resources.
But patients like Kia Whittier know their next visit to Planned Parenthood will be very different from their first.
Whittier was 19 years old the first time she walked into a clinic to ask about birth control.
“I was so nervous,” she said. She got her prescription, she got a lesson in sex education that she’d never received in high school; and when they handed her the bill, “at the bottom, the total said zero. It was covered. I didn’t have to worry at all. That made me really happy.”
Without realizing it, Whittier had become a Title X beneficiary. Now 24, she is an enthusiastic Planned Parenthood booster and volunteer.
But when she thinks about her next visit, she gets nervous again.
“It’s really scary,” she said. “I need to get more birth control and now I don’t know how I’m going to pay for it.”
She’ll talk with her partner, and she’ll talk with clinic staff. Then she’ll make some hard choices.
“I definitely will go in and still talk with someone, because I feel most comfortable at Planned Parenthood clinics, rather than my primary care provider, when it comes to talking about birth control,” she said.
“But if I can’t afford it, then I just won’t have birth control for a while.”
President Donald Trump took office on a promise to defund Planned Parenthood. The Title X restrictions — which would have required Planned Parenthood to financially and verbally wall off the clinics that provide abortions from the majority that do not — was designed to do just that.
Abortion opponents cheered Planned Parenthood’s withdrawal and jeered when officials pointed out that losing Title X funding was going to make it harder and more expensive for millions of Americans to get access to health care and birth control. If Planned Parenthood wanted to keep the funds, opponents pointed out, all they had to do was get out of the abortion business.
But there are people who can’t afford birth control next month.
If there’s one thing that ought to terrify both opponents of abortion and supporters of Planned Parenthood — it’s that.