Judge Blocks Abortion ‘Gag Rule’ for Title X Providers

A federal district court judge in Oregon blocked a Trump administration rule that would have barred health care professionals accepting federal funding from counseling women on abortion.

iStock/Worawee Meepian

“At the heart of these rules is an arrogant assumption that the government is better suited to direct women’s health care than their providers,” said Judge Michael McShane of the U.S. District Court in the District of Oregon, before announcing his plans to issue a preliminary injunction to block the rule from taking effect.

Federal laws have long prohibited the use of taxpayer funds to pay for most abortions, but the Trump administration’s new policy, which had been set to take effect May 3, would go much further. It would have barred health care professionals who counsel patients on or refer them for abortion from receiving Title X funding, a program for low-income women under the Public Health Service Act. It also included a costly new requirement that clinics be physically and financially separate from facilities that provide abortions and added new requirements around involving families in the family planning decisions of minors.

Title X is the only federal reproductive-health services program for low-income and underinsured women. Each year it provides more than 4 million women with family planning and contraceptive care, preventive health screenings for breast and cervical cancers, and treatment for sexually transmitted infections.

Since the rule was issued in February (Psychiatric News, March 29, 2019), half a dozen lawsuits have been filed around the country, including one by the AMA and Planned Parenthood that called the policy a government-imposed “gag rule” and said it would be illegal and unethical and threaten the health care of millions of women. Planned Parenthood, which serves 41% of patients served by the Title X program, said it will leave the program if Trump’s rule takes effect. California also filed suit, as did 20 Democrat-led states and the District of Columbia.

APA joined with 17 other physician leaders and medical specialty organizations representing 4.3 million health care professionals to denounce the rule, saying it disregards the expertise of the medical and scientific communities and evidence-based standards.

“To allow this gag rule to take effect would interfere with our fundamental right as physicians to discuss the full range of options for care with our patients based on their individual medical situation and personal wishes,” said Maureen Sayres Van Niel, M.D., president of APA’s Caucus of Women Psychiatrists and a reproductive psychiatrist in Cambridge, Mass. “This is a blatant attempt to politicize a fundamental right of women patients, and, like many other national medical associations, we condemn these efforts.”

In 1996 Congress mandated that patients receiving information about their pregnancies through Title X receive “nondirective” counseling. And in 2010 Congress mandated that the Department of Health and Human Services cannot impose rules that create unreasonable barriers to care, interfere with doctors giving their patients a full range of options, restrict the ability of health care providers to disclose all relevant information to patients, or violate the ethical standards of health care professionals.

“The gag rule blatantly violates Congress’ mandate by forcing doctors to withhold information from their patients and imposing unreasonable barriers to care,” Planned Parenthood wrote in a statement.

Leana Wen, M.D., president of Planned Parenthood Federation of America, said this latest ruling represents a victory for patients and doctors.

“Because of this, our patients across the country can still access life-saving health care,” she said. “However, while this is a victory for patients and doctors, this relief is preliminary, and we will continue to fight the Trump-Pence administration in court and in Congress to ensure our patients’ health and rights are protected.”

AMA President Barbara L. McAneny, M.D., expressed similar sentiments. “Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care,” she said. “The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer. The new rule would have placed obstacles to health care for low-income patients. We are pleased the judge shared the AMA’s concern about the physician-patient relationship.” ■