WASHINGTON — A Trump administration proposal to bar federally funded family planning facilities from providing or referring patients for abortions is aimed at forcing organizations like Planned Parenthood to make a simple choice: cease offering abortion services or lose some of their government money.
But the proposed rules, which the Department of Health and Human Services submitted Thursday night, have raised complicated questions about the fate of Planned Parenthood and other reproductive health organizations that provide both family planning and abortion services — and the potential health effects on women who depend on such providers for basic care.
At issue are the regulations surrounding Title X, the 1970 law that created the federal family planning program. The statute already bans direct funding of abortion, but many organizations that provide abortions, including Planned Parenthood, use Title X money to subsidize other women’s health services, such as dispensing birth control and providing cancer screenings. The proposal — a top priority of social conservatives who are staunch supporters of President Trump — seeks to end that commingling, or at least make it more difficult for reproductive health providers to do both.
To qualify for Title X money under the new policy, an organization would have to have “a bright line of physical as well as financial separation” between family planning programs and facilities where abortion is “performed, supported, or referred for as a method of family planning,” according to a summary of the proposal obtained by The New York Times.
Sarah Huckabee Sanders, the White House press secretary, said in a statement that the proposal fulfilled Mr. Trump’s “promise to continue to improve women’s health and ensure that federal funds are not used to fund the abortion industry in violation of the law.”
The changes could have real-life effects on the four million women who receive birth control and basic preventive services from federally subsidized providers.
How Planned Parenthood says the proposal would affect women.
Planned Parenthood and its supporters say the move would essentially bar the organization from receiving Title X funding, costing millions of women throughout the United States access to basic care, including contraceptives and screenings for cancer and sexually transmitted diseases. The organization says it has no intention of ceasing to provide abortions or referrals as part of its reproductive health services.
“This is a far-reaching attack and attempt to take away women’s basic rights and reproductive rights, period,” said Dawn Laguens, the group’s executive vice president and chief executive.
Social conservative activists who pushed hard for the change appeared to agree, saying the organization would lose access to $60 million in federal funding under the new rules.
“Planned Parenthood and other abortion centers will now have to choose between dropping their abortion services from any location that gets Title X dollars and moving those abortion operations off-site,” said Tony Perkins, the president of the Family Research Council. “Either way, this will loosen the group’s hold on tens of millions of tax dollars.”
Because Planned Parenthood has an outsize role in providing federally subsidized family planning services — it serves 41 percent of women who receive them — cutting the organization off from Title X money could have major consequences. An analysis in the journal Health Affairs found that in two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from federally subsidized facilities. In one-fifth of the counties in which they are located, Planned Parenthood centers are the only federally funded option for obtaining family planning services.
The analysis of data compiled by the Guttmacher Institute found that, without Planned Parenthood facilities, “in the short term, it is doubtful that other providers could step up in a timely way to absorb the millions of women suddenly left without their preferred source of care.”
Still, stripping Title X money from the organization would not decimate it. Three-quarters of the federal money its clinics receive comes through Medicaid, the federal health program for the poor. The largest effect would most likely be felt by women who do not have health insurance, particularly in states that did not expand Medicaid under the 2010 Affordable Care Act.
Abortion opponents said they dropped the ‘domestic gag rule.’ It’s not that simple.
The policy is modeled on a Reagan-era rule that required the same physical separation between abortion and family planning services that the Trump administration is seeking to mandate. But there is a difference: While the 1988 regulations specifically barred Title X facilities from even mentioning abortion as an option for pregnant women — a prohibition that came to be known as the “domestic gag rule” — the version proposed this week does not ban such counseling.
Abortion opponents said the Trump administration plan would not silence any family planning organization, and thus could not be regarded as a domestic gag rule.
The proposal is “a recognition that when providers provide women with the real facts about abortion, there’s nothing to fear from that information,” said Steven H. Aden, the general counsel of Americans United for Life, “and that ordinarily women will choose not to engage in abortion. The old rule was both obsolete and unnecessary.”
But Democrats and abortion rights advocates said the practical result of the proposal would be to silence medical caregivers the same way that an explicit gag rule would because they would no longer be allowed to refer women to providers that perform abortions.
“It is a distinction without a diitfference,” said Kashif Syed, a senior analyst at the Planned Parenthood Federation of America. “Blocking doctors from telling patients where they can get specific health services in this country is the very definition of a gag rule.”
The policy, according to the summary, would also scrap a requirement imposed by the Clinton administration, which rescinded the Reagan rules in 1994, that Title X providers give patients information about abortion.
One near certainty: legal challenges.
When President Ronald Reagan issued similar guidelines in 1988, they were swiftly blocked in court, prompting a battle that went all the way to the Supreme Court. In its 1991 ruling in Rust v. Sullivan, the Supreme Court upheld the Title X restrictions in a 5-4 decision. The court rejected the plaintiffs’ contention that the policy violated the free-speech rights of clinic employees and the constitutional rights of patients to choose whether to end a pregnancy.
On Friday, officials at Planned Parenthood said they would have to wait to see the text of the proposed Trump administration rules before determining whether to bring a similar legal challenge. But they did not rule out the possibility.
“We will do everything we can to fight for our patients,” said Carrie Flaxman, Planned Parenthood’s deputy director of public policy litigation.
Gov. Jay Inslee of Washington State, a Democrat, said the state’s attorney general was looking into “our legal options.”
“If this administration insists on weaponizing the Title X program, I will work with our legislative leaders to make sure that no matter what happens in D.C., every woman in Washington State has access to all the family planning and health care services she needs,” he said in a statement.
Proponents of the policy said they were confident that their side would prevail in any legal confrontation.
“The constitutionality of this approach has been tried and tested and affirmed by the United States Supreme Court,” said Mr. Aden, who added that he anticipated “a big court fight.”
Margot Sanger-Katz contributed reporting.