The Trump administration acted Friday to bar taxpayer-funded family planning clinics from referring women for abortions, energizing its conservative political base ahead of crucial midterm elections while setting the stage for new legal battles.
The Health and Human Services Department sent its proposal to rewrite the rules to the White House, setting in motion a regulatory process that could take months. Scant on details, an administration overview of the plan said it would echo a Reagan-era rule by banning abortion referrals by federally funded clinics and forbidding them from locating in facilities that also provide abortions.
Planned Parenthood, a principal provider of family planning, abortion services, and basic preventive care for women, said the plan appears designed to target the organization. "The end result would make it impossible for women to come to Planned Parenthood, who are counting on us every day," said executive vice president Dawn Laguens.
But presidential counselor Kellyanne Conway told Fox News that the administration is simply recognizing "that abortion is not family planning. This is family planning money."
The policy was derided as a "gag rule" by abortion rights supporters, a point challenged by the administration, which said counseling about abortion would be OK, but not referrals. It's likely to trigger lawsuits from opponents, and certain to galvanize activists on both sides of the abortion debate going into November's congressional elections.
Social and religious conservatives have remained steadfastly loyal to President Donald Trump despite issues like his reimbursements to attorney Michael Cohen, who paid hush money to a porn star alleging an affair, and Trump's past boasts of sexually aggressive behavior. Trump has not wavered from advancing the agenda of the religious right.
Tuesday night, Trump is scheduled to speak at the Susan B. Anthony List's "campaign for life" gala. The group works to elect candidates who want to reduce and ultimately end abortion. It says it spent more than $18 million in the 2016 election cycle to defeat Hillary Clinton and promote a "pro-life Senate."
The original Reagan-era family planning rule barred clinics from discussing abortion with women. It never went into effect as written, although the Supreme Court ruled it was an appropriate use of executive power. The policy was rescinded under President Bill Clinton, and a new rule took effect requiring "nondirective" counseling to include a full range of options for women.
The Trump administration said its proposal will roll back the Clinton requirement that abortion be discussed as an option along with prenatal care and adoption.
Known as Title X, the family-planning program serves about 4 million women a year through clinics, costing taxpayers about $260 million.
Although abortion is politically divisive, the U.S. abortion rate has dropped significantly, from about 29 per 1,000 women of reproductive age in 1980 to about 15 in 2014. Better contraception, fewer unintended pregnancies and state restrictions may have played a role, according to a recent scientific report.
Abortion remains legal, but federal family planning funds cannot be used to pay for the procedure. Planned Parenthood clinics now qualify for Title X family planning grants, but they keep that money separate from funds that pay for abortions.
Abortion opponents say a taxpayer-funded program should have no connection to abortion. Doctors' groups and abortion rights supporters say a ban on counseling women trespasses on the doctor-patient relationship.
The American College of Obstetricians and Gynecologists said the administration action amounts to an "egregious intrusion" in the doctor-patient relationship and could force doctors to omit "essential, medically accurate information" from counseling sessions with patients.
Health care and rights
Planned Parenthood's Laguens hinted at legal action, saying, "we will not stand by while our basic health care and rights are stripped away."
Jessica Marcella of the National Family Planning & Reproductive Health Association, which represents clinics, said requiring physical separation from abortion facilities is impractical, and would disrupt services for women.
"I cannot imagine a scenario in which public health groups would allow this effort to go unchallenged," Marcella said.
But abortion opponents said Trump is merely reaffirming the core mission of the family planning program.
"The new regulations will draw a bright line between abortion centers and family planning programs, just as ... federal law requires and the Supreme Court has upheld," said Tony Perkins, president of the Family Research Council, a key voice for religious conservatives.
Kristan Hawkins of Students for Life of America said, "Abortion is not health care or birth control and many women want natural health care choices, rather than hormone-induced changes."
Abortion opponents allege the federal family planning program in effect cross-subsidizes abortions provided by Planned Parenthood, whose clinics are also major recipients of grants for family planning and basic preventive care. Hawkins' group is circulating a petition to urge lawmakers to support the Trump administration's proposal.
Abortion opponents say the administration plan is not a "gag rule." It "will not prohibit counseling for clients about abortion ... but neither will it include the current mandate that [clinics] must counsel and refer for abortion," said the administration's own summary.