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Biden administration reverses Trump rule barring federally funded family planning clinics from abortion referrals

Demonstrators outside the Texas Capitol in Austin on Sept. 11.
Demonstrators outside the Texas Capitol in Austin on Sept. 11. (Jordan Vonderhaar/Getty Images)
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The Biden administration has revoked a Trump-era rule that had become a flash point in the abortion wars, saying Monday it would no longer bar clinics that receive federal family planning aid from advising people about ending their pregnancies.

The new rule for the half-century-old family planning program known as Title X will allow health centers to receive the federal funds even if they refer patients for abortions. It takes effect Nov. 8.

The rule reverses a move initiated in 2018 by President Donald Trump to appeal to the social conservatives crucial to his political base, siding with them in a long-running battle with the Planned Parenthood Federation of America and other family planning groups.

“Today more than ever, we are making clear that access to quality family planning care includes accurate information and referrals — based on a patient’s needs and direction,” Health and Human Services Secretary Xavier Becerra said in a statement accompanying the revision.

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Federal health officials issued the rewrite as the nation’s abortion laws have been thrust into the forefront of legal and political debate. Roe v. Wade, the 1973 Supreme Court decision that cemented abortion rights in the United States, is under fresh attack as the high court’s composition has grown increasingly conservative.

A month ago, a divided Supreme Court said that a new Texas abortion law, which bans the procedure as early as six weeks into a pregnancy, could go into effect while the statute’s legality is fought out in the courts. And the high court is reviewing a Mississippi law, blocked by lower courts, that would prohibit almost all abortions after 15 weeks of gestation.

Critics of the Trump administration’s rewrite of Title X policy derided it as an “abortion gag rule” that constrained what doctors and other health practitioners could discuss with patients. Rather than heeding the restrictions, affiliates of Planned Parenthood, which serve about 4 in 10 of the program’s patients, as well as other health centers forfeited the Title X funds that had been a main support of their work.

An estimated 981 clinics — about 1 in 4 that received Title X money — dropped out in 2019, and a half-dozen states no longer had any health centers in the program, according to the Guttmacher Institute, a reproductive rights research and policy organization.

The number of patients served by Title X grants fell by 2.4 million from 2018 to 2020, according to the program’s most recent annual reports. It estimates that nearly two-thirds of that drop was because of the Trump administration’s restrictions.

More than 20 states, which also receive some of the $286 million in family planning grants, filed federal lawsuits to try to prevent the restrictions from taking effect. Lower courts in Maryland and on the West Coast issued injunctions that blocked them temporarily. But in the summer of 2019, a California appeals court decided the Trump rule could begin while the litigation played out. And after giving protesting Title X participants two extra months to report their plans to comply with the rule, Trump health officials put it into effect. In February 2020, the U.S. Court of Appeals for the 9th Circuit ruled in a divided decision in favor of the restrictions.

The reaction to the new rule was split along ideological lines, with abortion rights groups lauding the changes and antiabortion groups disparaging them. Alexis McGill Johnson, Planned Parenthood’s president, called the jettisoning of the Trump rule “a huge victory for patients and a huge victory for sexual and reproductive health care.” She said in an interview that based on conversations with affiliates that withdrew during Trump’s tenure, they have “a strong desire . . . to be back in the program” and plan to reapply as soon as they can.

Connor Semelsberger, a director of federal affairs at the antiabortion Family Research Council, castigated the Biden administration. He said in a statement that “it comes as no surprise” that it “moved at lightning speed to . . . send millions of taxpayer dollars to America’s largest abortion business, Planned Parenthood.”

Title X has been an ideological lightning rod since shortly after it was created in 1970 under President Richard M. Nixon as part of federal public health law. It is intended mainly to help the poor or uninsured.

The program always has forbidden the use of the federal money to pay directly for abortions. But the Trump rule went further, prohibiting health centers that receive Title X money from referring pregnant individuals elsewhere for an abortion. The rule did not go quite as far as an earlier version, in place during the Reagan era, that had banned all abortion counseling.

The Trump rule allowed clinics to provide “nondirective pregnancy counseling, including nondirective counseling on abortion,” but said they did not have to do so.

In addition, the Trump rule said clinics that used other sources of money to perform abortions were required to create a “clear physical and financial separation” for those services. Critics contended this part of the rule was a weapon against Planned Parenthood clinics, seeking to provoke them to withdraw from Title X by making it harder — in some cases, impossible — for them to function. That portion of the rule has now been removed.

Monday’s regulatory action follows a presidential memorandum Biden issued in January, one week after taking office, that set in motion the rule change. The memo said his administration would pursue policies enabling women to “have access to the healthcare they need.” Biden’s memo singled out Title X, saying that his predecessor’s rule “puts women’s health at risk by making it harder for women to receive complete medical information.”

Biden also said at the time that his administration’s policies would “support women’s and girls’ sexual and reproductive health and rights in the United States as well as globally.” As part of the memo, the president lifted what is known as the “Mexico City Policy,” which has seesawed back and forth for nearly three decades, depending on whether Republicans or Democrats have been in the White House.

As a condition of receiving U.S. global family planning aid, the Mexico City rule, when in effect, has required nonprofit organizations to certify they would not use money from any source to perform or promote abortions. Before Biden undid it, the Trump administration broadened that rule to apply to other types of U.S. international aid, as well.

In April, the Department of Health and Human Services proposed the Title X rule that is now becoming final.

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