The Trump-Pence Gag Rule: Bad Medicine for Maine and the Nation

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George A. Hill, President & CEO, Maine Family Planning

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Thankfully, a federal judge last week blocked a Trump Administration rule that would severely restrict how Maine Family Planning (MFP) and other recipients of Title X funding provide and talk about abortion care. But make no mistake, the fight to provide patients with a full range of reproductive care is far from over. 

I have been preparing for some version of a Domestic Gag Rule since the moment Donald Trump took office. After all, the right-wing anti-abortion lobby has prioritized this misguided attack on low-income patients for decades. I battled a similar Gag Rule back in the 1980s, under former President Ronald Reagan and based on Trump’s campaign promises – not to mention his installation of anti-choice leaders to key positions within the U.S. Department of Health and Human Services – I knew this assault on the nation’s tremendously successful Title X family planning program was looming and could prevent our expert health care providers from discussing with patients the full range of reproductive care they may require. 

Still, when the Trump-Pence administration unveiled its proposed rule change to Title X in June 2018, I felt shock. Part of me couldn’t believe that conservatives would use their obsession with abortion to justify sabotaging a robust, effective, bipartisan program that ensures access to sexual and reproductive health care (such as birth control and cancer screenings) for more than 4 million low-income patients annually.

My colleagues and I at Maine Family Planning, the state’s oldest and largest reproductive health care organization and its sole Title X national family planning program grantee, shifted immediately into rapid response mode, determined to do everything in our power to stop the Gag Rule and continue providing high-quality, affordable care to more than 23,800 patients every year.

As the statewide Title X grantee, we organized a diverse Defend Title X coalition, representing patients, providers, and advocacy groups. We submitted lengthy comments in opposition to the rule change and urged our supporters to do the same. At the same time, we began conversations about potential litigation, cognizant of how the proposed Gag Rule posed unique harms to Mainers and that going to court might be the only way to stop it.

Maine Family Planning operates 18 clinics statewide, many in rural or remote areas. We also help fund reproductive health services provided by Planned Parenthood of Northern New England in the southern part of our state, and a host of community health centers providing family planning services elsewhere.

Maine Family Planning also separately offers abortion care at our 18 clinics as part of the full spectrum of reproductive health care. In accordance with federal law, and as confirmed by annual audits, abortion services are provided without using any federal resources, including Title X funds.

We consider the provision of such comprehensive care central to our identity. But because of this, we have a target on our back.

If the Domestic Gag Rule ever goes into effect, our expert clinicians will be barred from making referrals for abortion care, even when the patient requests a referral. Under the Gag Rule, MFP would be forced to stop offering abortion care at 17 of our 18 health centers, and to implement costly (and unnecessary) physical separation provisions at our flagship clinic in Augusta, Maine. The Gag Rule would decimate abortion access in our large and rural state, while undermining the sacred relationship between patients and providers. Needless to say, it would do nothing to enhance public health outcomes; on the contrary, we would undoubtedly see a jump in the unplanned pregnancies, STD rates, and other troubling health indicators.

Once we saw the final version of the Domestic Gag Rule, we saw that we were faced with an impossible choice: Continue to accept Title X funding and violate our mission and medical ethics, or leave the program and sacrifice more than $2 million in annual federal funds, which would force drastic cuts to services that would undermine the family planning network we’ve been honored to oversee for close to 50 years.

And that’s why, on March 6, MFP filed a case in US District Court, represented by the Center for Reproductive Rights and Covington & Burling LLP, seeking to prevent the rule from taking effect. Our first step was to request a preliminary injunction that would block the rule from being implemented while our legal challenge made its way through the courts.

Our hearing before federal Judge Lance Walker was Wednesday, April 24 in Bangor, Maine. MFP attorneys argued that the Gag Rule would wreak havoc on Maine’s health care network and noted that the government had spectacularly failed to address how the Rule would harm Mainers. The judge promised a decision within a few days – with parts of the Rule slated to go into effect on May 3.

Then, on Thursday, April 25, a federal judge in Washington state issued a nationwide injunction on the Gag Rule in response to a case brought by the ACLU and National Family Planning and Reproductive Health Association (NFPRHA), of which MFP is a member. The injunction means MFP and Title X providers like us may continue to provide and speak openly to our patients about abortion care, consistent with long-standing program rules. (This ruling followed the decision of a federal judge in Oregon to grant a preliminary injunction against Trump’s Title X rules restricting abortion access.)

Because the nationwide injunction protects Mainers from imminent implementation of the Rule, we filed notice to withdraw our motion for an injunction the following day.

However, this is not the end of the road for our case. We maintain the strong views set forth in our motion, including that the Gag Rule is an unlawful violation of Title X and the U.S. Constitution, and we will continue to pursue vindication of those claims and to permanently invalidate the Gag Rule in our case going forward.

Meanwhile, MFP continues to help patients every day in places like Fort Kent, a small town on the Canadian border, Calais, a coastal community, and Norway, a small village in the Western mountains. It is a challenge to operate amidst so many unknowns, but in some ways our current situation is preferable to the “waiting game” that occupied the first two years of the Trump presidency. At least now, we have the opportunity to fight.

And fight we will, until the last day, on behalf of patients and providers in Maine and across the country.

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