For the second time in two years, Baltimore City is taking the Trump administration to court over its reproductive health care agenda—this time for a proposed rule that city officials say would “severely restrict access” to family planning for low-income Baltimoreans.
The rule change, released in February and backed by religious conservatives, would withhold funding from federally supported family planning clinics, known as Title X clinics, that refer clients to abortion providers. It would also prohibit clinics located on the same sites as abortion providers from receiving Title X funds, essentially requiring them to financially and physically separate or risk losing financing.
(The Hyde Amendment bars the use of federal funds directly for most abortions, though family planning clinics do receive federal dollars under Title X.)
The rule change is set to take effect on May 3 unless it’s blocked by courts. City Solicitor Andre Davis told Baltimore Fishbowl the city expects to file a motion for preliminary injunction today.
But in a federal lawsuit filed yesterday against Health and Human Services Secretary Alex Azar, the city argues the policy change imposes “costly and unnecessary infrastructure requirements on Title X clinics,” and would require medical staff “to violate their professional ethics” by making them direct pregnant patients away from abortion providers and into prenatal care. Alternatively, if those clinics choose to forego federal dollars, the city says the policy unfairly threatens to shut them down.
The lawsuit summarizes it as a “gag rule” that bars medical professionals from referring patients to abortion providers or giving them the facts about abortion.
In terms of numbers, the lawsuit says Baltimore City would lose out on $1.43 million in Title X funding, and more than 16,000 patients annually receiving family planning, cancer screening and other preventive health services at 23 city sites would have their care threatened. Those costs would be compounded by increased health care costs for those patients for unintended pregnancies, sexually transmitted infections, undetected cancers, delayed prenatal care and more.
Ex-Officio Mayor Bernard C. “Jack” Young and newly sworn-in City Health Commissioner Dr. Letitia Dzirasa endorsed the lawsuit, with Dzirasa saying in a statement that new rules would have a “devastating impact” on residents receiving reproductive health care, cancer screenings and education from Title X recipients. “We cannot stand idly by as funding is being pulled,” she said. “We will continue to pursue justice in this case on behalf of the residents of Baltimore City.”
Davis, who filed the challenge, said the rule change violates multiple federal statutes, including the very Title X provision that allows for these funds, provisions of the Affordable Care Act and others. He also said it infringes on residents’ freedoms to free speech, sex equality and access to abortion.
“With our co-counsel at every turn, the Law Department intends to continue to push back when the Trump Administration takes unlawful and misguided steps to diminish health care resources that are so critical to our City and its residents,” Davis, a former federal appellate judge, told Baltimore Fishbowl via email.
Assisting the city with its complaint are attorneys from international law firm Arnold & Porter, working pro bono, Stepahnie Toti of the Lawyering Project and fellows and students from the Yale Law School Reproductive Justice Clinic.
If the change does become federal policy next month, the financial burden will fall to states. Maryland’s General Assembly already passed legislation this session requiring the state’s Department of Health to reject federal Title X funds if the changes take effect, and start providing at least $1 million per year in state funds for family planning starting in fiscal 2021. According to a fiscal and policy note on the bill, Maryland would lose $3.2 million in federal funds in fiscal 2020 under HHS’ proposed rule change.
This is the second major lawsuit Baltimore City has filed against the Trump administration over family planning policy. One year ago, the city and the Democracy Forward Foundation won a federal case against HHS for the agency’s termination of the federal Teen Pregnancy Prevention Program in 2017.
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