In July and August 2019, NCLR and thirteen other national LGBTQ organizations filed friend-of-the-court briefs in the U.S. Court of Appeals for the Fourth and Ninth Circuits in multiple challenges to the Trump administration’s domestic “gag rule.” The cases concern a set of regulations from the Department of Health and Human Services (HHS) that change the rules in the federal family planning program known as Title X. The program funds clinics and health departments around the country so they can provide family planning services to people with lower incomes. The law creating the program specified that the funds could not be used to pay for abortion care, but sites that provide both family planning and abortion have always been able to receive Title X funds, as long as they only use them for contraception and not abortion.
The new regulations require clinics that provide the full range of reproductive health care – family planning and abortion – to create complete physical and financial separation between abortion and family planning services. That means separate buildings, more staff, redundant computer and billing and filing systems, etc. None of this is necessary to keep Title X funds from paying for abortion care; Title X sites know how to track their funds and comply with the law and have been doing it for years. The new Trump regulations would also force medical providers in the Title X program to direct women toward continuing a pregnancy to term, regardless of the patient’s wishes, in violation of a legal requirement that all counseling be non-directive.
We filed our amicus brief in these cases to help the courts understand the true extent of the harm that would ensue if the new rules are allowed to stand, including harm to LGBTQ people. There is much at stake for LGBTQ people when government misuses its power and hijacks public health to further a political agenda at the expense of vulnerable communities. The Gag Rule and the Separation Requirement, working together, would drive the providers of care to the majority of Title X patients out of the program. This would affect many people within the LGBTQ community, including lesbian and bisexual women, as well as transgender, nonbinary, and gender nonconforming individuals who can become pregnant and need affordable access to birth control, treatment for STIs to preserve future fertility, and other reproductive health options. In recent years, many reproductive health care providers have filled a critical gap in the provision of health care to the LGBTQ community. These clinics are particularly well-suited to provide LGBTQ care because of their expertise in providing services that are still stigmatized, such as abortion, contraception, and screening and treatment for STIs. We filed our brief to tell the courts that if the new Title X rules are allowed to remain in place, it will devastate the Title X program, as many providers will exit. The result will be not only a sharp reduction in family planning services, but also a loss of important health care services that have been developed by these sites to serve the LGBTQ community.