Oregon took the lead on Tuesday in a multi-state front against the Trump administration’s “gag rule” on abortion providers.
Attorney General Ellen Rosenblum filed a lawsuit in Eugene along with 20 other attorneys general from 19 states and the District of Columbia against a change to the Title X program on family planning. Issued Friday by the U.S. Department of Human Services, the rule blocks nearly $300 million in federal dollars from going to clinics that provide abortions. The change amounts to a direct financial hit on Planned Parenthood and other organizations that offer abortions.
Under the rule, Title X providers would be required to separate abortions from other services, both financially and physically. Providers would have to have a separate entrance for abortion services, with separate exam rooms, extra personnel to staff the space, a second phone number and website and separate electronic medical records to receive Title X funds. The rule also would prevent family planning providers from even discussing abortion as an option or referring patients to an abortion provider -- even when the patient asks for that information.
“The Final Rule would impose burdensome and unnecessary restrictions that would reduce access to care, interfere with the patient-provider relationship and undermine Congress’s intent in enacting Title X of the Public Health Service Act nearly five decades ago,” the suit says.
Oregon officials say the rule is unlawful and unethical.
"This Title X 'gag rule' is an astonishing step backward from providing quality health care and information to millions of our most vulnerable Americans," Ellen Rosenblum, Oregon's attorney general, said in a conference call on Tuesday. "We simply won't stand by and allow the federal government control what medical providers can and cannot say to their patients."
Planned Parenthood, the American Medical Association and the Oregon Medical Association also filed a suit against the rule on Tuesday, following a similar complaint filed Monday by California's attorney general.
"Title X is the nation’s only program focused on affordable birth control and reproductive health care," Dr. Leana Wen, president of Planned Parenthood Federation of America, said in the media call. "The Trump-Pence administration is attempting to dismantle this critical program, threatening essential health care like cancer screenings for more than 4 million people."
Supporters of the new rule, which include religious organizations, say that Title X money was appropriated for preventative services -- not for abortions.
But the multistate lawsuit says the rule violates the Affordable Care Act. The act bans regulations that place “any unreasonable barriers to the ability of individuals to obtain appropriate medical care.”
In Oregon, clinics that received Title X funding served over 37,000 Oregonians in 2017, including many in rural communities, according to Rosenblum's office. The Title X program is administered in Oregon by the Oregon Health Authority and provides funding to 37 agencies with more than 100 clinics located in almost every county in the state, the suit states. Two-thirds of their patients are of low income.
Services offered included exams; Pap test screenings for cervical cancer; screenings and treatment for sexually transmitted infections; federally approved methods of contraception; and contraceptive management, client counseling and education.
Lisa Gardner, president and CEO of Planned Parenthood of Southwestern Oregon, said if the rule were to go into effect that Planned Parenthood would elect to not receive Title X funds rather than adjust to the requirements. She said it would cost the organization more to create separate locations than they receive in Title X reimbursements, which amounted to about $225,000 in 2017.
Planned Parenthood does not charge co-pays to women who qualify for Title X reimbursements. Some of those women might qualify for Medicaid in Oregon, but many do not, she said, leaving them in the lurch if Planned Parenthood pulled out of the program.
The organization has 13 percent of the Title X centers in Oregon but serves about 40 percent of the patients, Gardner said.
If the rule goes into effect, Oregon would see a spike in unwanted pregnancies and a spike in abortions, she said, with self-induced abortions and higher mortality rates. Rosenblum predicted it would create "abortion provider deserts" in rural areas.
Opponents to the rule nationwide banded together last year to oppose it.
In May, Rosenblum joined 19 other attorneys general in filing a friend-of-the-court brief challenging the proposed rule, saying it “will open the door to applications from less qualified providers, including those with no experience in providing family planning clinical care and those focused more on their own advocacy than patients’ expressed needs."
Gov. Kate Brown and two other governors threatened to pull out of the Title X program in protest.
There's wide opposition to the rule among state lawmakers. Oregon is considered the most progressive nationwide state on abortion, allowing the use of state funds for abortions of Medicaid clients and undocumented immigrants.
"We are the only state in the country with no restrictions on abortion which is why this rule is doubly insulting to the thousands of Oregonians who depend on Title X clinics for their health care needs,” Rosenblum said.
Besides Oregon, the lawsuit includes Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin.
The lawsuits seek a court injunction to stop the rule from taking effect in 60 days as scheduled.
You can reach Lynne Terry [email protected].