WASHINGTON -- President Donald Trump's administration on Friday issued a rule barring groups that provide abortion referrals from participating in the $286 million federal family-planning program.
The new federal rule, which has been expected for months, would strip millions of dollars away from Planned Parenthood and direct it toward faith-based medical providers. Opponents have vowed to challenge it in court.
Federally funded family-planning clinics would have to maintain a "clear physical and financial separation" between services funded by the government and any organization that provides abortions or referrals for abortions. Recipients of grants through the federal program, called Title X, were already prohibited from performing abortions with those funds.
The rule announced Friday is not a wholesale defunding of Planned Parenthood, a long-held goal of conservatives. All organizations receiving money through Title X could still perform abortions. However, clinics supported by Title X would have to perform abortions in a facility separate from their other operations, keep separate accounting to ensure that the facility receives no federal funding, and adhere to the new requirement that they not refer patients to the separate facility.
Health and Human Services Department officials have said the change is necessary to ensure transparency and the legal and ethical use of taxpayer funds. Critics have decried the change as a "gag rule" that would undermine the doctor-patient relationship.
Under the new rule, if a pregnant patient has decided to have an abortion and makes an explicit request for a referral, a doctor would be allowed to provide a list of comprehensive care providers. However, he could not indicate which of them offer abortion services.
The mandate does not prevent clinics from talking about abortion with patients, just from referring patients for the procedure or telling them where the procedure can be obtained. But it removes a requirement from President Bill Clinton's administration that the programs counsel women on all reproductive options, including abortion and adoption. That change would make anti-abortion providers eligible for funding.
The change also allows funding to organizations that oppose contraception. Some of the faith-based groups advocate "fertility awareness" or the rhythm method and abstinence as methods of preventing pregnancy. In November, the Health and Human Services Department issued a funding opportunity announcement for Title X that elevates natural family planning and abstinence counseling as program priorities.
Many women's organizations said the new requirements will interfere with health providers' responsibilities to fully counsel patients about reproductive health.
The "domestic gag rule harms women in more ways than one," Stephanie Schriock, president of the pro-abortion rights political action committee Emily's List, said in a statement. "It effectively dismantles Title X, forces doctors to lie and forbids them from referring their patients for abortion, and prevents women from being able to access Planned Parenthood's services."
Anti-abortion organizations heralded the regulation as a long-sought victory.
"The finalized 'protect life rule' draws a bright line between abortion and family planning programs," Tony Perkins, president of the Family Research Council, said in a statement, adding that the rule will loosen Planned Parenthood's "hold on tens of millions of tax dollars."
Conservative lawmakers also called the move long overdue, and some were especially pleased by the prospect that health providers opposed to abortions could now be eligible for federal family-planning funds.
"Importantly, faith-based health organizations will no longer be forced to compromise their pro-life principles to receive government funding," said Rep. Steve Scalise, the House Republican whip.
Planned Parenthood and other groups representing the clinics say the new requirements for physical separation of facilities would be costly and all but impossible to fulfill.
White House counselor Kellyanne Conway scoffed at Planned Parenthood's argument that the rule was an attempt to drive it out of business.
"They've been saying for years they don't co-mingle their funds, so this should be easy for them," she told reporters at the White House. "Physically separate and financially separate."
PLANNED PARENTHOOD
Title X serves 4 million mostly low-income women at more than 4,000 clinics nationwide. About 40 percent of those clinics are operated by Planned Parenthood, which receives close to $60 million through the family-planning funding program each year.
Title X provides funding for programs that provide services like birth control, screening for breast cancer and cervical cancer, and screening and treatment for sexually transmitted diseases.
In Arkansas, Planned Parenthood has been denied Medicaid Title X funds since 2015, when Gov. Asa Hutchinson signed an order cutting off the nonprofit's nonabortion services, which include cancer screening, breast exams and contraception.
Planned Parenthood sued, and a Little Rock federal judge granted an injunction. The 8th U.S. Circuit Court of Appeals overturned the lower court, keeping the prohibition on Medicaid funding in place.
Planned Parenthood has continued to pursue the litigation, and the case is scheduled for a bench trial in February 2020.
Emily Miller, the spokesman for Planned Parenthood Great Plains, said in an emailed statement Friday that the nonprofit is committed to pursuing the case "no matter what." Planned Parenthood Great Plains encompasses Arkansas, Oklahoma, Kansas and Missouri.
Arkansas lawmakers continue to try to restrict abortion, and Hutchinson last week signed a so-called trigger law that would make abortions illegal in the state if the U.S. Supreme Court overturns the 1973 Roe v. Wade decision that legalized abortion.
Arkansas became the fifth state to pre-emptively ban abortions. The others are Louisiana, Mississippi, North Dakota and South Dakota.
In an emailed statement, Gloria Pedro, Arkansas manager of Public Policy and Organizing for Planned Parenthood Great Plains, condemned the Trump administration's new rule on Title X.
"No one should be denied access to the health care they need and deserve," Pedro said in the statement. "The gag rule is an attack on women's rights. It will undoubtedly and disproportionately affect women of color and people with low incomes -- many of whom rely on Title X as their only source of sexual and reproductive health care. We are unwavering in our commitment to ensuring all Arkansans can access high-quality preventive health care."
Planned Parenthood is the nation's largest provider of reproductive care services, including abortions.
"In many parts of the country Planned Parenthood is the only provider who participates in the program," said Leana Wen, president of the Planned Parenthood Federation of America.
She added: "Patients expect their doctors to speak honestly with them, to answer their questions, to help them in their time of need. Imagine if the Trump administration prevented doctors from talking to our patients with diabetes about insulin. It would never happen. Reproductive health care should be no different."
Wen added that Planned Parenthood "will fight through every avenue so this illegal, unethical rule never goes into effect," saying the new policy would prevent doctors from referring women for abortions "even if your life depended on it."
Washington state Gov. Jay Inslee and 14 of his fellow governors have denounced the proposed rule and threatened legal action in order to block it from going into effect in their states.
"The administration's action will do irreparable harm to the public's health and damage the network of highly qualified family planning providers across the country," Clare Coleman, president of the National Family Planning & Reproductive Health Association, said in a statement.
The rule takes effect 60 days after it is published in the Federal Register. However, clinics will have 120 days to comply with the requirement that family planning and abortion services are kept financially separated and a year to comply with the physical separation requirement.
The administration has also implemented a similar rule -- the so-called Mexico City gag rule -- for grantees of U.S. foreign aid that prevents organizations that get those funds from referring, providing or discussing abortion with patients.
Information for this article was contributed by Ariana Eunjung Cha of The Washington Post; by Ginny Monk and Linda Satter of the Arkansas Democrat-Gazette; by Pam Belluck of The New York Times; and by Ricardo Alonso-Zaldivar, David Crary and Jill Colvin of The Associated Press.
A Section on 02/23/2019
CORRECTION: Planned Parenthood Great Plains encompasses Arkansas, Kansas, Oklahoma and Missouri. An earlier version of this story did not include Oklahoma.