A coalition of 20 US states and California's Attorney General have announced lawsuits seeking to block a new rule barring groups providing abortions or abortion referrals from receiving federal funding.
Changes to the Title X family planning programme announced by the Trump administration last month are expected to shift tens of millions of dollars from Planned Parenthood towards faith-based clinics.
The lawsuits seek a court injunction to stop the rule from taking effect in 60 days.
The filings are the first of what is expected to be a flurry of challenges to the new rule that would affect more than 4 million low-income women who receive services including cancer screenings and pregnancy tests through the Department of Health and Human Services programme.
The California suit was filed in US District Court in San Francisco on Monday. The multi state lawsuit, brought mostly by Democratic-controlled states, is expected to be filed on Tuesday in US District Court in Oregon.
“Everyone deserves the ability make their own decisions about their health care,” Oregon governor Kate Brown, a Democrat, said in a statement.
“It is appalling that the federal government wants to rob individuals of the right to complete medical information and full access to the critical health care services they rely on.”
The rule imposes what administration officials have referred to as a “bright line” of physical and financial separation between the provision of family planning and abortion services.
It would effectively require Planned Parenthood to drastically alter its operations, or forgo an estimated $60m in annual funding.
It also bars federally funded family planning clinics from referring women for abortions. Opponents call this stipulation a “gag” rule, arguing it will compromise medical ethics and potentially endanger women's lives.
Xavier Becerra, California's Attorney General, called the rule an “extraordinary overreach.”
“HHS has exceeded the scope its statutory authority and acted in a manner that is arbitrary, capricious, and not in accordance with law,” he wrote.
In a statement, Mr Becerra, a Democrat, said the rule would deny “patients access to critical health care services and prevents doctors from providing comprehensive and accurate information about medical care”.
It would also put California's Title X providers, which serve about 1 million women, “in an untenable situation”.
He wrote: “If existing health care providers are forced to decide whether to provide full and accurate information to patients, or forego federal Title X funding, numerous providers will have no choice but to sacrifice needed funds, to the detriment of the patients they serve.”
The 21 states are just some of the parties – including the American Civil Liberties Union and the Centre for Reproductive Rights – that have vowed to sue over the rule, which was published on Monday in the Federal Register.
Supporters of the rule, which include numerous religious and anti-abortion organisations, have pointed to how the Supreme Court upheld similar regulations in 1991's Rust v Sullivan decision in a 5-to-4 ruling.
But those regulations, introduced under Ronald Reagan and tied up in legal challenges, were in effect for only several weeks before the arrival of the Clinton administration, which promptly eliminated them.
Maureen Ferguson, senior policy adviser with the Catholic Association, has argued the rule “simply clarifies that abortion is not an appropriate method of family planning..."
"The difference between the two is profound," she added
"Title X money is appropriated by Congress for preventative family planning services, and was never meant to subsidise abortion clinics.”
Both state lawsuits argue, however, that the rule violates a provision of the Affordable Care Act, which wasn't in place 28 years ago, and which forbids regulations that create “unreasonable barriers to the ability of individuals to obtain appropriate medical care”.
The multi-state lawsuit also describes the requirement of physical and financial separation as onerous.
In a statement, Oregon officials explain that “it would require health clinics to open another location, or create a separate entrance for patients, have separate examination rooms, hire separate personnel to work at separate workstations, maintain a separate phone number and website, and have separate electronic medical systems in order to continue to accept Title X funds.”
That lawsuit also takes issue with the rule's mandate that every pregnant patient get a referral for prenatal care “regardless of the needs or the wishes of the patient”.
In addition to Oregon, the states participating in the multi-state lawsuit are Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin. The District of Columbia is also a party to the suit.
The nation's Democratic attorneys general have repeatedly challenged initiatives of the Trump administration, weighing in on issues including the president's immigration policy and efforts to fund a wall along the US-Mexico border through an emergency declaration.
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