After a string of setbacks, opponents of abortion chalked up a significant victory in 2019 with the enactment of a federal regulation to prevent a major type of federal funding from reaching entities that provide abortion services.

At issue was Title X funding, a Department of Health and Human Services grant program that targets lower-income Americans who are facing unintended pregnancies or seeking family planning services.

The Trump administration enacted a rule that effectively said that any facility receiving federal Title X funding cannot also be an abortion provider. Previously, abortion providers such as Planned Parenthood could receive Title X funds as long as the funds were only used for non-abortion services.

"When this rule was instituted, Planned Parenthood was faced with having to choose between continuing to receive the Title X funding for family planning care or continuing to provide abortion services at some of their clinics," said Gretchen E. Ely, a professor at the State University of New York-Buffalo's School of Social Work.

In August 2019, one month before the rule was scheduled to take effect, Planned Parenthood decided to stop taking Title X rather than discontinuing abortion services. A federal appeals court upheld the rule's legality in February 2020.

Samuel Lau, director of federal advocacy communications for the Planned Parenthood Federation of America, said the rule "has left many states without any direct grantees or with serious gaps in care in the program" after Planned Parenthood stopped taking funds.

On another front, the Trump administration made progress targeting the other major source of government funding for Planned Parenthood: Medicaid, the federal-state program that provides health coverage for low-income Americans.

The administration has encouraged states to seek permission to bar Planned Parenthood from participating in their state Medicaid programs. In January 2020, the administration approved Texas' request to implement a Medicaid family planning program that bars patients from accessing care at Planned Parenthood or other entities that also provide abortion.

The Texas case represented "the first time the federal government has allowed a state to explicitly waive Medicaid's free choice of provider for family planning provision," Lau said.

In practical terms, this did not change anything on the ground in Texas, because six years earlier, the state had launched a fully state-funded program that effectively barred access to Planned Parenthood through the program. But the approval of Texas' plan "could open the floodgates for other anti-abortion politicians to follow suit," Lau said, noting that similar waivers are pending from Idaho, South Carolina, and Tennessee. 

It's important to note these changes have been in the regulatory realm rather than passed by Congress. Abortion rights advocates say that a victory by presumptive Democratic presidential nominee Joe Biden this fall could reverse these policies.

For now, however, we rate this a Promise Kept.

Over the past year, President Donald Trump and his Republican allies have failed in several efforts to defund Planned Parenthood.

As we've noted, federal dollars do not actually fund abortions. A longstanding provision known as the Hyde Amendment excludes Planned Parenthood and other medical providers from using federal dollars to pay for most abortion services, except in instances of rape, incest or when a woman's life is in danger.

Abortion opponents argue that even these types of federal payments mean that the government is indirectly supporting abortion, so they have pursued various legal and regulatory approaches to shut down the federal funding streams that currently support organizations like Planned Parenthood.

Indeed, estimates show that the organization receives about 40 percent of its funding from the government. Planned Parenthood receives more than $500 million in combined state and federal government funds.

Planned Parenthood gets most of its funding through Medicaid reimbursements and from Title X, a Health and Human Services grant program that funds comprehensive family planning services.

Those who support defunding Planned Parenthood cheered when Congress and Trump in 2017 effectively overturned an Obama administration rule that had been written to prevent state and local governments from pulling federal funding from Planned Parenthood and other clinics.

But Kinsey Hasstedt, a senior policy manager with the Guttmacher Institute, a reproductive-issues research organization, said this move was more symbolic than something with a solid legal effect. The question will play out in the courts.

"In repealing that regulation, Congress and President Trump surely sought to send a message inviting state efforts to exclude Planned Parenthood and other like providers from Title X," she said. "That doesn't mean states actually have the legal right to do so."

Meanwhile, other developments in the past year have been less favorable to those advocating for defunding.

In the Republican effort to "repeal and replace" the Affordable Care Act, provisions to effectively defund Planned Parenthood were typically included, notably in the "skinny repeal" bill that came close to passing the Senate. But in the end, none of the bills passed.

In the omnibus spending bill that Congress passed and Trump signed in March 2018, defunding supporters were unable to attach a provision to curb federal funding for Planned Parenthood and groups like it.

Then, in August, the Senate voted down an amendment to a spending bill sponsored by Sen. Rand Paul, R-Ky., that would have shut down federal funding for Planned Parenthood. The amendment failed, 45-48, with all Democrats voting against, joined by Republicans Susan Collins of Maine and Lisa Murkowski of Alaska.

Finally, in December, the Supreme Court decided not to hear a pair of cases related to state efforts designed to keep groups like Planned Parenthood from receiving federal funding. In the cases at issue, states argued against the rights of individuals to legally challenge state moves to curb federal funding, including Medicaid dollars, to Planned Parenthood.

In the absence of a high court ruling, lower court rulings stand, and they mostly sided with the rights of individuals to challenge state actions. So the Supreme Court's non-decision was seen as a victory for the Planned Parenthood side.

Unlike the other developments listed here, the court's decision was outside the purview of the Trump administration, but it could have had a substantial impact, said Sara Rosenbaum, a health law and policy professor at George Washington University's Milken Institute School of Public Health.

"If the court had agreed to hear their appeals and had ruled in their favor, my conservative estimate is that half the states would have eliminated Planned Parenthood as a qualified provider" for federal funds, she said.

Now that Democrats have taken control of the U.S. House of Representatives, defunding Planned Parenthood through Congress is even more unlikely.

For now, the administration hopes to defund Planned Parenthood through a regulatory process.

One move involves proposed regulations for Title X funding that would, among other things, block funds for Planned Parenthood and other providers that offer abortion services.

"Because Planned Parenthood serves so many Title X family planning patients -- about 41 percent of the 4 million who receive Title X services -- if Title X becomes restricted only to providers who do not offer abortions, it would cut about $50 million in funding from Planned Parenthood, and that would be real progress towards de-funding them," said Gretchen E. Ely, an associate professor in the University at Buffalo's School of Social Work.

Another effort involves proposed administration regulations to two separate monthly bills to be sent to people who bought Affordable Care Act marketplace plans that include abortion coverage  -- one bill for the bulk of their health coverage, and a second bill exclusively for abortion services.

That adds extra hassle for people who use ACA plans to get services at Planned Parenthood, offering an indirect avenue to de-fund the group and reduce coverage of abortion generally, Ely said.

If either regulation is finalized, opponents are expected to challenge them in court.

"From our perspective, it seems that the administration has done everything it could" to defund Planned Parenthood, said David N. O'Steen, executive director of National Right to Life, an anti-abortion group.

The bottom line is that the Trump administration's chances of carrying through on this promise are smaller now that Democrats control the U.S. House of Representatives. If the regulatory proposals are finalized, we'll reconsider, but for now, we rate this promise Stalled.

As a presidential candidate, Donald Trump promised to defund Planned Parenthood. That has yet to happen.

Trump joined other Republicans in opposition to federal funding for the health services provider on the grounds that Planned Parenthood helps some patients obtain abortions.

"I would defund it because of the abortion factor, which they say is 3 percent," Trump said on Feb. 25, 2016. "I don't know what percentage it is. They say it's 3 percent. But I would defund it, because I'm pro-life. But millions of women are helped by Planned Parenthood."

Federal funding does not actually fund abortions. The Hyde Amendment excludes Planned Parenthood and others from using federal dollars to pay for most abortion services, except in instances of rape, incest or when a woman's life is in danger. Abortion opponents argue the government is tacitly supporting abortion by funding non-abortion services.

So how far has Trump come in keeping his promise?

First, it's important to note that Planned Parenthood is not a line item on the budget, so it can't simply be crossed out. Planned Parenthood gets most of its funding through Medicaid reimbursements for preventive care and some from Title X, a Health and Human Services grant program that funds comprehensive family planning services.

Trump's proposed 2018 budget, which he sent Congress in May, called for denying funding, whether through Medicaid or Title X, to any group that performs abortions, including Planned Parenthood, even if that money isn't going toward abortions. The House and Senate versions of the budget don't include that language.

But the best shot Trump had at getting rid of the Medicaid reimbursements was through failed health care reform.

The GOP health care bill would have effectively blocked Planned Parenthood from securing reimbursements from Medicaid for a year. Sens. Lisa Murkowski, R-Ak., and Susan Collins, R-Maine, who alongside Sen. John McCain, R-Ariz., killed the bill in the Senate, had cited Planned Parenthood funding as one of the conditions of their support for the bill.

The Health and Human Services Department has put all grants provided through Title X up for renewal in June 2018. Terms for grants, which have not yet been announced, are expected to set more stringent anti-abortion conditions for the funding. Heading the department is Teresa Manning, is a prominent anti-abortion activist.

The Trump administration is working to cut back access to abortion, but his vow to cut funding for Planned Parenthood has been met with roadblocks so far. For now, we rate this promise Stalled.

During his presidential campaign, Donald Trump joined other Republicans in vowing to end federal funding for Planned Parenthood, solely because the health services provider helps some patients obtain abortions.

At a GOP debate in Houston, Trump responded to criticism from Sen. Marco Rubio of Florida that Trump had defended Planned Parenthood.

"As far as Planned Parenthood is concerned, I'm pro-life. I'm totally against abortion, having to do with Planned Parenthood," Trump said on Feb. 25, 2016. "But millions and millions of women — cervical cancer, breast cancer — are helped by Planned Parenthood. So you can say whatever you want, but they have millions of women going through Planned Parenthood that are helped greatly. And I wouldn't fund it.

"I would defund it because of the abortion factor, which they say is 3 percent. I don't know what percentage it is. They say it's 3 percent. But I would defund it, because I'm pro-life. But millions of women are helped by Planned Parenthood."

WHY HE'S PROMISING IT

Politicians and groups opposed to abortion rights attacked Planned Parenthood after a series of heavily edited videos appeared in the summer of 2015.

Those videos, from the group Center for Medical Progress, purported to show officials from Planned Parenthood discussing how the organization illegally sells tissue from aborted fetuses for profit.

Planned Parenthood is allowed to donate tissue to research firms for a procurement fee. More than a dozen states launched investigations into Planned Parenthood practices and found no evidence of illegal tissue harvesting and sales.

Later on,  two abortion opponents from the center were indicted on record-tampering and organ-trafficking charges. The pair reportedly used fake California driver's licenses to discuss buying organs from Planned Parenthood. The charges were eventually dropped.

Even so, Republicans cited Planned Parenthood by name as an organization the party opposed when it adopted its new party platform in July 2016.

"We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare," the platform read.

WHAT NEEDS TO HAPPEN

By law, the federal government is not allowed to use taxpayer funds for abortions, except in cases of rape, incest or to save the life of the mother. But opponents argue money is fungible, so any funds going to Planned Parenthood support the group's abortion services.

The GOP has tried for years to strip funding from the organization, but were stymied. President Barack Obama in 2016 vetoed one such bill.

Now with majorities in both the House and Senate, and a Republican president, conservatives can push through provisions that Democrats had previously been able to oppose.

Congress has been advancing filibuster-proof legislation that would begin the dismantling parts of the Affordable Care Act. A measure to stop grants and Medicaid reimbursements to Planned Parenthood could be attached to that resolution.

Because of the nature of the measure, Democrats would not be able to prevent the resolution from passing on their own.

HOW MUCH IT WILL COST

It's difficult to say exactly how much money Planned Parenthood gets from the federal government.

The organization does not get paid directly by Washington, but rather is reimbursed for services provided to Medicaid patients and through Title X grants for family planning services. Services covered under these sources include HIV and STD tests, pregnancy tests, cancer screenings, birth control and more.

Planned Parenthood's 2014-15 annual report says affiliates received $553.7 million in government grants and reimbursements that fiscal year. That's 43 percent of the group's total budget. The rest of its $1.3 billion nationwide budget comes from donations and non-government sources.

But Medicaid is a joint state and federal program, so it's hard to tell just how much money came from which source. It's also tough to tell how state governments would respond to having federal funds cut off for reimbursements and grants.

The group notes that roughly 60 percent of its 2.5 million or so annual clients are Medicaid patients. They would potentially be hard-pressed to find a replacement provider for Planned Parenthood's services.

WHAT'S STANDING IN HIS WAY

While Trump has signed a letter promising to cut off funding to Planned Parenthood while it still provides abortions, he has indicated he welcomes other services the group provides.

Some Trump voters also have expressed dismay at the prospect of eroding Planned Parenthood's ability to provide services, and the group itself has been girding for a bitter campaign to maintain services.

Furthermore, Republican senators Lisa Murkowski of Alaska and Susan Collins of Maine have indicated they may oppose a final measure that singles out Planned Parenthood.

POSSIBLE TIMELINE

In 2017, the Senate has already voted for the budget resolution, 51-48, with Republican Sen. Rand Paul of Kentucky voting nay because the measure did not balance the budget and added to the deficit.

The House agreed to it by a vote of 227-198, with nine Republicans voting against it.

No Democrats voted for the measure.

Congress now will examine parts of the resolution in a process called reconciliation. While some Republicans — including Trump — have indicated they want a replacement to the Affordable Care Act before it's repealed, Planned Parenthood could still conceivably lose its federal funding if Congress includes the provision in its final resolution.

We rate this promise In The Works.