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NJ Joins Multistate Lawsuit to Block Changes to Federal Title X Rule

Nearly 100,000 low-income women in Garden State rely on family healthcare providers, many of which can’t survive without Title X funding

Gurbir Grewal
State Attorney General Gurbir Grewal

New Jersey has joined a multistate lawsuit to block pending changes to the federal program that supports dozens of family healthcare providers in the Garden State, serving nearly 100,000 low-income women. The suit claims the reforms are “burdensome and unnecessary,” not based on evidence, and would degrade healthcare services.

In February, the Trump administration released a final draft of rules for Title X, a national funding program that provides $286 million annually — including $8.8 million for facilities in New Jersey — to pay for cancer screenings, birth control, and other care for women and families. While federal law already prohibits this money being used for abortions, the regulations are designed to strengthen that ban.

Building more barriers

Specifically, the reforms call for additional physical and operational barriers to separate abortion services from other healthcare, which women’s health advocates fear would create significant challenges for clinics, especially smaller facilities with limited funding. The new regulations also include what opponents call a “gag rule” to prohibit providers from recommending or referring patients for abortion services, something critics said interferes with a doctor’s pledge to provide unbiased medical advice.

“The Trump administration’s new Title X rules are short-sighted, unethical, and rooted in political ideology rather than in evidence-based standards of care,” said New Jersey Health Commissioner Dr. Shereef Elnahal. In the Garden State, these providers form the single largest system for preventive healthcare, the suit notes.

To push back, New Jersey joined litigation filed Tuesday in a U.S. District Court in Oregon by 20 states, including New York, Pennsylvania, Maryland, Delaware, and Connecticut. The papers allege that the final rule would “fundamentally alter” the Title X program, which was established nearly 50 years ago to ensure low-income women had access to family-planning services. Nearly half of the patients served through the grants lack health insurance, according to research.

“The Final Rule restricts access to high-quality healthcare in numerous ways,” the suit states. The changes would also place unfair burdens on the states, which would likely be forced to pick up additional costs, it also notes.

The requirements for greater segregation of abortion services involve “strict, unnecessary, and arbitrary financial and physical separation” the papers claim and would “force clinics to close or reduce their services to the detriment of their patients, because many clinics could or would not restructure as required but could no longer remain open or maintain service levels without Title X funds.”

An illegal ‘gag rule’

The suit also states that the ‘gag rule’ is illegal in how it restricts doctors’ ability to practice. And it warns this change could drive high-quality providers out of the program if they choose not to “compromise their medical and ethical standards” by agreeing to the restrictions, “eroding the high standard of care that has long applied to pregnancy counseling under Title X.”

In the Garden State, Title X funding is distributed by the nonprofit New Jersey Family Planning League, which regrants the dollars to 47 providers, including Planned Parenthood affiliates, county health departments, hospital-based programs, Federally Qualified Health Centers, and other family-planning organizations. While these exist in all 21 counties, nine counties have only one Title X-funded clinic, according to the suit.

“New Jersey is proud to stand with its Title X healthcare providers, the patients they serve, and a broad coalition of other states in challenging a rule that puts the health of women and low-income individuals at risk to advance an ideological agenda,” said Attorney General Gurbir S. Grewal, who has bucked the Trump administration on several proposed reforms to women’s healthcare services. “We will fight to protect our residents’ access to high-quality reproductive health care and family planning services.”

Restoring state funding for family planning

The federal funds are not the only public support these programs receive. Soon after he took office in January 2018, Democratic Gov. Phil Murphy signed a law restoring state support of nearly $7.5 million annually for these services, a budget line that had been eliminated under former Gov. Chris Christie, a Republican.

“The Trump administration’s attempt to limit access to critical healthcare and family planning resources is reckless and unacceptable,” Murphy said Tuesday.

According to the lawsuit, the funding helped prevent more than 19,000 unplanned pregnancies in 2017, as well as 9,000-plus births and some 6,500 abortions. It also avoided roughly $148 million in maternity and birth-related healthcare costs.

In addition, the Family Planning League now monitors the use of funds to ensure that programs are complying with the federal law restricting the use of Title X for abortion services, the suit notes. The league also undergoes audits and reviews.

Clinics may shut down

If Title X funding is not available, some clinics may need to close, advocates warn. And those closures could force patients to find care elsewhere, which would be a challenge, especially in rural areas. Fewer providers means longer wait times, delayed care, and lower-quality results, the suit notes.

“Depending on the community, other family-planning providers may not be accessible due to distance, cost, language barriers, confidentiality concerns, or quality and comprehensiveness of services available. Although publicly funded FQHCs exist in all New Jersey counties, they are not equipped to absorb the impact of the loss of family-planning service providers in their communities,” the lawsuit warns.

Based on these concerns, the states in the lawsuit are asking the court to declare the final rule unconstitutional and block its implementation, which was scheduled to take effect in two months. They are also seeking court costs and attorneys fees.

"The Trump-Pence administration's gag rule is medically unethical and deeply harmful to patients, and we won't stand for it," said Casey Olesko with Planned Parenthood Action Fund of NJ; Planned Parenthood affiliates serve more than 70 percent of the state’s Title X patients, she said.

"We applaud Attorney General Grewal and the Murphy administration for standing up for the thousands of New Jersey residents who rely on the Title X program for affordable, accessible reproductive healthcare,” Olesko said.

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