WASHINGTON, D.C. – Attorney General Karl A. Racine and his counterparts from 20 other states today sued the Trump administration to stop a federal gag rule that endangers family planning and other healthcare services for more than 58,000 low-income District residents. The suit seeks to stop a federal Department of Health and Human Services (HHS) rule restricting Title X grants, which help patients access contraception, cancer screenings, exams, and other related health services. The gag rule would illegally restrict health care professionals who work for Title X-funded organizations from providing information or referrals for abortion services to their patients.

The Title X Family Planning Program became law under President Richard Nixon in 1970 as part of the Public Health Service Act. It is the only federal grant program dedicated to family planning and related health services. It primarily benefits lower-income, uninsured, and underinsured individuals or families. Grants are provided to governmental and non-profit healthcare providers.

Unity Health Care, Inc., a non-profit organization, is currently the sole Title X grantee in the District, receiving more than $900,000 from the program in Fiscal Year 2018. Unity serves patients, regardless of their ability to pay, at 26 sites across the District. These sites include traditional clinics as well as school-based sites, shelters for individuals experiencing homelessness, and a homeless outreach van. Unity also provides Title X sub-grants to other community health providers, currently including five sub-grantees located throughout the District. More than 58,000 District residents – the majority of whom live at or below the poverty line – receive services through the District’s Title X providers. Neither Unity nor its sub-grantees provide abortions.  

The lawsuit challenges the rule’s legality and notes how it will harm the District as well as fellow states. The complaint argues that the rule violates the Constitution and other federal laws and would cause significant harm to the states. The suit argues the HHS rule should be blocked for:

• Violating the Constitution: The HHS gag rule would restrict the speech of health-care providers who accept Title X funds because it would prevent them from referring patients to abortion providers. In some cases, it would also force them to refer patients to prenatal care providers even if those patients request a referral to an abortion provider.
   
• Violating other federal laws: The suit also argues that the gag rule violates the federal Administrative Procedure Act, which governs how federal agencies propose and implement rules, in several ways. For instance, the APA prohibits federal rules that conflict with existing state and federal laws. The lawsuit contends that the rule’s prohibition on referrals for abortion services and compulsory referrals for prenatal services conflict with existing federal law requiring Title X recipients to practice “non-directive counseling.” That requirement means providers must counsel patients in a way that does not favor or disfavor a particular family planning outcome. Likewise, state and federal laws (including the Affordable Care Act) prohibit rules that create unreasonable barriers or limit healthcare options for patients.  
   
• Imposing significant costs on the District and states: The lawsuit argues the rule will force healthcare providers across the country to choose between their ethical standards and Title X funding, meaning many providers will refuse or not apply for these essential family-planning grants. This means states would be forced to choose between replacing the lost Title X funds and funding other important services. If those funds are not replaced, then states would bear the financial burden of problems that result from the loss of family planning care. They include an increase in unintended pregnancies, an increase in cancers not detected in early stages, and a higher rate of sexually transmitted infections.

The suit was filed today in the United States District Court for the District of Oregon. AG Racine was joined by counterparts from 20 other states in the lawsuit, which was led by Oregon Governor Kate Brown, Oregon Attorney General Ellen Rosenblum, and New York Attorney General Letitia James. A total of 21 states joined the lawsuit, including Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.

A copy of the complaint in Oregon v. Azar is available at: https://oag.dc.gov/sites/default/files/2019-03/Oregon-v-Azar-Complaint.pdf