Planned Parenthood pulls out of family planning program over Trump abortion rule

Planned Parenthood made good Monday on months of threats to pull out of the Title X federal family planning program rather than comply with a new Trump administration rule barring federally funded clinics from referring patients to abortion providers.

The organization and other major participants in the Title X program had to show by midnight Monday their plans to comply with the new rule or forfeit millions of dollars in federal grants. By withdrawing more than 400 of its participating clinics from the program, Planned Parenthood's exit will leave low-income women in many parts of the country without federally-funded access to birth control and other reproductive health services.

"We will not be bullied into withholding abortion information from our patients," said acting President Alexis McGill Johnson on a call with reporters. "When you have an unethical rule that is asking us to limit what our providers can tell our patients, then it becomes really important for us to not agree to be in the program."

Planned Parenthood serves about 1.6 million of the roughly 4 million low-income women who depend on Title X clinics for free and subsidized care.

Vermont's health department also gave notice Monday that it is quitting Title X. The agency relied entirely on Planned Parenthood clinics to provide services under the program. And Maine Family Planning, the sole Title X provider in the state, informed HHS that it is withdrawing over the rule.

“It’s important that we maintain women’s rights and access to health care," said Vermont GOP Gov. Phil Scott.

Planned Parenthood's decision marks a partial victory for Republican activists and lawmakers who have been trying to defund the organization for decades. But while the group gets about $60 million a year under Title X, it receives far more from Medicaid. It also gets funding from other federal and state programs to combat HIV and provide sexual education to teenagers.

Johnson declined to answer questions about the precise financial impact of pulling out of Title X, but said the outcome will be "devastating" for low-income women unless the organization can raise enough private funds to make up the loss.

"We are committed to keeping our doors open as long as possible," she said. "But using fundraising, essentially charity, to fill in for what should be a federal responsibility is really a challenge. It's like holding an umbrella during a tsunami."

The organization has said for months it wouldn't operate under the Trump rule, which also requires clinics to refer pregnant patients for pre-natal care, regardless of the woman's wishes. And while it's been illegal for decades to use any federal funding for abortions, the new rule also bars clinics that get Title X money from providing abortions using other funding sources.

Mia Heck, director of external affairs at the Department of Health and Human Services, blasted Planned Parenthood and other groups protesting the policy for "blaming the government for their own actions."

"They are abandoning their obligations to serve their patients under the program," Heck said.

HHS served notice last week that providers that didn't show a "good faith effort" to comply with the policy would be booted from the program. Planned Parenthood made a late effort last week to freeze the policy change, but the 9th U.S. Circuit Court of Appeals in California on Friday refused to issue an emergency injunction.

Other providers may yet pull out over the Trump rule. Washington state, Oregon, Illinois, New York, Hawaii and Maryland have previously said they won't participate under the restrictions. These states have pledged to make up the lost federal dollars with state funding, either on a permanent or stopgap basis. But in most states, Planned Parenthood clinics will be on their own.

"It will simply be impossible for other providers to fill the gap," McGill Johnson said. "This gag rule will mean women will have to drive hundreds of miles just to access a provider."

Planned Parenthood is suing the Trump administration over the rule with the American Medical Association, arguing that the policy change muzzles providers in violation of the Affordable Care Act and the Constitution. Nearly two-dozen states have also brought challenges, as well as a number of participating health care providers.

Lower courts blocked major provisions of the new rule in April, but a three-judge panel of the 9th Circuit lifted those injunctions on June 20, finding that the administration will likely prevail in the legal battle because the Supreme Court upheld similar Reagan-era rules almost 30 years ago. An 11-judge panel upheld that decision in July. The 9th Circuit is set to hear the case again in late September, and Maine Family Planning recently appealed its case to the 1st U.S. Circuit Court of Appeals in Boston.

But with the rules set to take hold this week, a wave of organizations from Colorado to New York to Maine have already begun exiting the Title X program, forfeiting their federal funding and losing access to discounted drugs.

HHS has said it may move to replace providers who quit Title X, but many parts of the country have few other groups able to step in. Critics of the new rule say the replacements for Planned Parenthood clinics may be anti-abortion, faith-based providers who are newly eligible for federal funding.