Appeals court lets Title X 'gag rule' go into effect, allows Trump family planning restrictions

Medical justice
Unless overturned by another court, the Trump administration’s Title X final rule will take effect. (Getty/yavdat)

A federal appeals court ruled that the Trump administration’s final Title X rule, opposed by many physician groups, can take effect while several lawsuits filed to stop its implementation play out.

The 9th U.S. Circuit Court of Appeals on Thursday granted a Department of Health and Human Services (HHS) motion for a stay pending appeal of three preliminary injunctions issued in lower federal courts in Oregon, Washington state and California.

The American Medical Association (AMA), the country’s largest physician organization, had filed suit along with Planned Parenthood in Oregon to stop the final rule from going into effect in early May and will continue to fight the case in court.

The final rule was largely seen as a direct attack on Planned Parenthood, and that group said it would continue to fight the restrictions.

“Planned Parenthood will not stand for this attack on millions of people across the country. We will be immediately seeking emergency relief from the Court of Appeals," said Leana Wen, M.D., president of the Planned Parenthood Federation of America, in a statement. "Planned Parenthood will not let the government censor our doctors and nurses.”

Planned Parenthood said the court ruling allows the Title X changes to take effect in every state but Maryland, where a statewide injunction against the rule remains in place. That injunction stems from a lawsuit filed by the city of Baltimore, which the Trump administration has asked the 4th Circuit Court of Appeals to also lift.

HHS Secretary Alex Azar said in a statement Thursday that he was pleased with the ruling that removes the nationwide block on the department’s new family planning rule.

“We are pleased that the Ninth Circuit has recognized that there is no need to hold up the new family planning rules that enforce laws on the books and revert substantially to rules that the Supreme Court upheld decades ago,” he said.

“We are also pleased that the Ninth Circuit agreed that the three preliminary injunctions against the new rules, including two nationwide injunctions, were inappropriate. This decision is a major step toward the Trump Administration being able to ensure that all Title X projects comply with the Title X statute and do not support abortion as a method of family planning,” he said.

HHS published the final rule despite the opposition of numerous physician groups, including the AMA, which said changes made by the Trump administration to the Title X program places a “gag rule” on what physicians can say to patients, including referring them to providers who can perform an abortion.

RELATED: Trump administration releases Title X rule restricting abortion clinic funding

The final rule released in February revises regulations around the Title X family planning program to block funding to groups that provide abortion referrals. Planned Parenthood said the rule makes it illegal for healthcare providers in the Title X program to refer patients for abortion and also blocks access to care at Planned Parenthood by imposing what it said are cost-prohibitive and unnecessary “physical separation” requirements.

The group said it has limited emergency funds that will allow affiliates to continue care for patients in the short term while seeking emergency relief from the 9th Circuit decision.

A panel of three judges, all appointed by previous Republican presidents, disagreed with the lower court judgments to issue preliminary injunctions to block the rule. "Absent a stay, HHS will be forced to allow taxpayer dollars to be spent in a manner that it has concluded violates the law, as well as the government’s important policy interest in ensuring that taxpayer dollars do not go to fund or subsidize abortions," the judges wrote in an unanimous opinion.

RELATED: U.S. judge blocks 'gag rule' on abortion, calls policy 'madness'

Opponents vowed to continue to fight the final rule, saying it will put patients and health centers that rely on Title X funds in jeopardy.

The National Family Planning & Reproductive Health Association, which was a party to the lawsuit filed in Washington state, said it was “determined and prepared to take every measure possible to protect high-quality family planning care for all who need it.”

“Despite the devastating effects on Title X care, the government has pushed us one step closer to implementation of its harmful regulation to overhaul the nation’s family planning program. The government is relentless in its drive to impose this ideological rule; and we remain equally intent on exercising all of our legal options to prevent the Trump administration from succeeding,” said the group’s president and CEO Clare Coleman in a statement. Coleman was one of several witnesses who had testified at a House committee hearing on Wednesday on the Title X changes.

“The Title X family planning rule is unlawful, disrespectful of patients’ health needs, disregards the government’s own standards of care, and must be rejected to protect the four million patients who rely on Title X,” she said.

Planned Parenthood is the largest reproductive health and abortion provider in the U.S. The final rule requires providers that receive Title X funding to maintain "physical and financial separation" from an abortion provider.

“The Trump-Pence administration’s gag rule is unethical, illegal and harmful to public health,” said Wen.

RELATED: Federal judge rules in favor of AMA lawsuit, says he will block Trump restriction on abortion clinic funding

She said the decision by the 9th Circuit judges “is devastating for the millions of people who rely on Title X health centers for cancer screenings, HIV tests, affordable birth control and other critical primary and preventive care.”

Planned Parenthood had been encouraged by action from the House of Representatives on Wednesday, which passed a spending package that would block the rule from being implemented, and the group urged the Senate to act on the bill.

In a post on twitter, California Attorney General Xavier Becerra, who had filed suit in his state to stop the Title X final rule, said he was reviewing the Ninth Circuit panel’s ruling. “Staying the preliminary injunction we secured in district court risks access to critical reproductive healthcare for millions of Americans,” he said.

“This ruling allows the Trump-Pence administration to prohibit doctors and other medical providers from giving factual, unbiased information to patients. We continue our fight in court so that families in California and beyond can get the certainty they need and deserve around medical care in 2019,” he said.

Opponents of the rule say it would shift millions of dollars from groups such as Planned Parenthood to faith-based family planning organizations. The new rule will allow—for the first time in the Title X program’s near 50-year history—funding to got to faith-based clinics that oppose abortion and contraception and promote methods such as abstinence and the rhythm method.

Washington is one state that has opposed the final rule. Washington Gov. Jay Inslee, a Democratic presidential candidate, posted his reaction on his Twitter account.