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With Title X Funding at Stake, States Join the Legal Battle

Several states have vowed to sue the Trump administration over its new rules that will withhold federal funding from health clinics that provide abortion services or referrals.

Washington State Attorney General Bob Ferguson speaks at a news conference announcing a lawsuit against the Trump administration's "domestic gag rule."
(AP/Elaine Thompson)
March 6 1:00 p.m. Update:

On Tuesday, the American Medical Association filed a lawsuit against the Trump administration's changes to the federal Title X program. The day before, California Attorney General Xavier Becerra announced his own lawsuit to block them. Separately, 20 other state attorneys general plan to sue.

Original Story:

Washington will be among the first states to sue the Trump administration over its new Title X rules, released Friday, that will withhold federal funding from health clinics that provide abortion services or referrals.

Washington State Attorney General Bob Ferguson said on Monday that he plans to file a lawsuit with the National Family Planning and Reproductive Health Association -- which represents Title X grantees, once the rule is formally published, which happened on Tuesday afternoon. California and New York's attorneys general have also reportedly vowed to sue.

"We will not allow the federal government to dictate what a provider can or cannot say to a patient,” Ferguson said at a press conference on Monday.

The Title X program is the only federal funding stream dedicated to reproductive health and family planning. It was signed into law by President Richard Nixon and championed by then-Congressman George H.W. Bush. The Trump administration's rules reverse a history of bipartisanship. 

The 1976 Hyde Amendment prevents federal dollars from directly funding abortions. Title X money, which largely benefits low-income patients, is spent on other aspects of women's health, such as birth control, pregnancy testing, STI treatment and cancer screenings. Title X grantees range from state and local health departments to Planned Parenthood affiliates.

To continue abortion services or referrals under the new rules, clinics will need to conduct those services in a facility that is physically separate from the clinic that receives Title X funding. 

"Any grantees that perform, support or refer for abortion have a choice -- disentangle themselves from abortion or fund their activities with privately raised funds," a Trump official told CNN in May.

Opponents refer to it as a “domestic gag rule” because it mirrors the "global gag rule," which prohibits American aid money from going to overseas organizations that provide abortion services or referrals.

In announcing his upcoming lawsuit, Ferguson said the rule violates aspects of the Affordable Care Act and Roe v. Wade, the 1973 Supreme Court case that legalized abortion. He called it an “assault on women” during Monday's press conference.

A variety of health groups swiftly condemned the rule. Women’s health and progressive health organizations including Planned Parenthood and Physicians for Reproductive Health predictably called the rule "unethical." The American Medical Association also rebuked the rule, saying in a statement that “the patient-physician relationship relies on trust, open conversation and informed decisionmaking, and the government should not be telling physicians what they can and cannot say to their patients.”

Abortion opponents, however, praised the change.

"We thank President Trump for taking decisive action to disentangle taxpayers from the abortion industry," said Marjorie Dannenfelser, president of the Susan B. Anthony List, in a statement.


What's Next for Title X?

The new rules are set to go into effect 60 days after publication, unless a judge in the pending litigation decides otherwise. The next round of Title X funding is set to be administered April 1. There’s been no word from the Trump administration on whether this round of grantees will be subject to the new rules.

“Folks who have [funding] applications in now are not out of the woods," says Kinsey Hasstedt, senior policy manager for the Guttmacher Institute, an abortion rights organization that studies abortion access. "Those entities could be beholden to most of the provisions of the rule as they make their way through the courts.” 

In Washington, one-third of the state's family planning dollars come from Title X money, according to Ferguson. He said many of the state's Title X providers would have no choice but to withdraw from the program.

Planned Parenthood officials have also been vocal about withdrawing from the program if the rules take effect. It’s unclear how many other state and local entities would forgo Title X money, but Hasstedt says there will be some sort of loss felt for people seeking family planning care.

“The idea that federally qualified health centers or community health centers can step in to fill in the gap is a favorite political talking point [of conservatives], but the reality," says Hasstedt, "is that those places are too strained."

Mattie covers all things health for Governing.

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