Federal appeals court upholds Trump administration's abortion-referral restriction

A federal appeals court on Monday ruled in favor of a polarizing Trump administration policy banning federally funded family planning centers from referring women for abortions. Although lower courts have consistently opposed the Department of Health and Human Services' desire to block referrals, the California-based U.S. Court of Appeals for the 9th Circuit passed the latest decision 7-to-4. While the move delighted social conservatives who are the core of President Trump's political base, it came as a huge blow to civil libertarians and reproductive rights groups that had been fighting the so-called "gag rule."

According to CNN, with over 20 states filing lawsuits to try to block the rule, it was challenged in federal courts in California, Oregon, and Washington state last year, all of which ruled in favor of the plaintiffs. However, on Monday, the appeals court ruled that the HHS is well within its rights to modify the program. In the 82-page opinion dismissing the concerns of three lower courts on the West Coast, the appeals court ruled that "the Final Rule is not arbitrary and capricious because HHS properly examined the relevant considerations and gave reasonable explanations." 

Health-care groups were already barred from using Title X funds to pay for abortions under current law, reports The Washington Post. The rule issued by HHS in February last year, went a step further, barring health centers that provide abortions or abortion referrals from participating in the half-century-old $286 million federal family planning program. The highly-criticized rule also requires federally funded family planning clinics to maintain a "clear physical and financial separation" between services funded by the program and any organization that provides abortions or abortion referrals.

Despite severe push back from reproductive rights groups, the appeals court has repeatedly given the rule the green light, upholding it in June, July, and August. Following the ruling in August, Planned Parenthood—which covered 40% of the Title X program's participants—chose to withdraw from the program, leaving over one million low-income women without their regular source of care. The findings of studies conducted to determine the impacts of the rule and Planned Parenthood's subsequent exit have been stark.

According to a report by the reproductive rights group Power to Decide, "the domestic gag rule’s impact on birth control access is nothing short of catastrophic for people living on limited incomes. It means that people who have long relied on the program may have higher out of pocket costs for health care and contraception because clinics will no longer have funds to support them. As a result of this rule, the number of women who live in counties without a single clinic offering the full range of birth control methods could triple. People already counting every penny may need to travel longer distances to clinics offering services, take more time off work, or pay for additional child care costs." As of November 4, 2019, about 900 clinics had already been forced out of the program.

Although Circuit Judge Sandra Ikuta claimed in the court's opinion that the Trump administration’s rule is slightly less restrictive than a 1988 version upheld by the Supreme Court, Circuit Judge Richard Paez and three fellow judges strongly condemned the rule in a 28-page dissent. "In vacating the district courts’ preliminary injunctions, the majority sanctions the agency’s gross overreach and puts its own policy preferences before the law. Women and their families will suffer for it," Paez warned. Reproductive rights supporters blasted Monday's ruling, deeming it an obstacle to patients seeking care.

Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, claimed the rule is "causing immense harm across the country" and creating "egregious barriers for people with low incomes to get birth control and preventive care like STI testing, education, and cancer screenings." Dr. Patrice Harris, president of the American Medical Association, expressed the group's disappointment in a statement. "This government overreach and interference demands that physicians violate their ethical obligations -- prohibiting open, frank conversations with patients about all their health care options -- if they want to continue treating patients under the Title X program," she said.

"It is unconscionable that the government is telling physicians that they can treat this underserved population only if they promise not to discuss or make referrals for all treatment options," Harris added. Meanwhile, Justice Department spokesperson Mollie Timmons said in a statement that "we are pleased" by the court's decision. "Congress has long prohibited the use of Title X funds in programs where abortion is a method of family planning and HHS’s recent rule makes that longstanding prohibition a reality. We look forward to continuing to defend this vital rule against all challenges."