Physician-Patient Relationship

What you need to know about the Title X Rule


On March 5, 2019, the AMA filed a lawsuit to block the Trump Administration’s rule that would decimate the Title X program and limit the medical advice physicians can give their Title X patients.

The lawsuit came in the wake of new regulations released on Feb. 22, 2019 by The U.S. Department of Health and Human Services (HHS) affecting low income family planning and preventative health services program known as Title X.

The newly issued federal regulations, if allowed to stand, would limit women’s access to care and force doctors to withhold information about all of their health care options.

The Title X rule impacts physicians and patients in three key ways:

  • It imposes a “gag rule” on physicians that restricts them from providing complete information to patients about all of their health care options and providing appropriate referrals for care. The administration wants to allow Title X clinics not to provide full information to patients about all of their health care options and block physicians from providing appropriate referrals for care. The AMA does not believe that the government should tell physicians what they can and can’t say to patients.

    The new rule would violate patients’ rights under the Code of Medical Ethics, would force doctors to violate their obligation to give honest and informed advice, would withhold federal family planning funding from entities that provide critical medical services to vulnerable populations, and would harm millions of patients who rely on Title X for their reproductive health.
  • It re-directs funds away from evidence-based contraception methods and to non-medical family planning services such as abstinence and “fertility awareness.” Better education and expanded access to contraception have driven down rates of unintended pregnancy to historic lows. Why would we take a step backwards?                                                                                                                                      
  • It withholds funds from qualified Title X providers that offer the full range of family planning services to vulnerable populations. Of note: existing regulations already prohibit the use of Title X funds for abortion services.

The Title X program ensures that every person—regardless of where they live, how much money they make, their background, or whether or not they have health insurance—has access to basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment.

Roughly 4,000 clinics received Title X funds that accounted for 19 percent of their revenue ($244.6 million) in 2017, according to the HHS 2017 national summary on Title X. Those clinics served 4 million family planning clients that generated 6.6 million encounters.

The AMA strongly opposes any government interference in the exam room, especially legislation or regulations that attempt to dictate the content of physicians’ conversations with their patients. Protecting the patient-physician relationship, including defending the freedom of communication between patients and their physicians, is a core priority for the AMA. The ability of physicians to have open, frank and confidential communications with their patients has always been a fundamental tenet of high quality medical care, as communicated in the AMA Code of Medical Ethics.