Multiple courts issue injunctions on Title X 'gag rule' that would disproportionately impact Eastern Washington

A federal district court judge in Washington has temporarily blocked implementation of a proposed new rule restricting Title X funding if doctors discuss abortion with their patients.

Opponents to the rule change, which was proposed and finalized by the Trump administration, have said it is effectively a "domestic gag rule" that will harm patients, as it will limit doctors' abilities to refer patients for abortions and no longer require that doctors give their patients information about all their medical options. Globally, the gag rule has prevented billions of dollars in U.S. aid from going to nongovernmental organizations that use outside money to provide abortions or referrals for abortions.

Earlier this year, Washington state sued to block the rule's implementation, along with Planned Parenthood of Greater Washington and North Idaho (PPGWNI).

"Politics don’t belong in the exam room," state Attorney General Bob Ferguson said in an announcement Thursday, April 25. "We are asking the court to stop the Trump administration’s unlawful rule from going into effect while our legal challenge continues."

After oral arguments Thursday, both the state and Planned Parenthood applauded Judge Stanley Bastian's move to immediately issue a nationwide injunction.

“This is a victory for patients in Washington and throughout our country,” Karl Eastlund, CEO of Planned Parenthood Of Greater Washington and North Idaho, said in a news release. "Because of this, our patients can still access the life-saving health care, like cancer screenings and STI treatments, they need through Title X, our nation’s only program for affordable birth control and reproductive health care."

Gov. Jay Inslee also lauded the ruling.

"This is a major victory for millions of Americans whose health care is at stake under President Trump’s dangerous and legally indefensible gag rule," Gov. Inslee said in an announcement. "Washington has always been a state that stands with women and their right to safe and legal reproductive healthcare, and today we are proud to be keeping women’s health care secure in all 50 states."

With the new rule also requiring physical separation (on top of currently required financial separation) between facilities that receive Title X money and those that perform abortion, thousands of patients in Washington could have been impacted. Nearly 90 percent of Washington state's more than 91,000 Title X clients are served by providers or clinics that also provide abortion with non-Title X money.

Planned Parenthood noted in its announcement that the rule would've disproportionately affected Eastern Washington patients.

"Eastern Washington is home to more rural communities, where there is already a shortage of health care providers. The gag rule would contribute to this shortage," the PPGWNI affiliate noted Thursday. "In all of Eastern Washington, which has 20 counties, 11 counties would not have any Title X providers at all. In total, if the final rule went into effect, the number of Washington counties without a Title X-funded health center would jump from five to 21."

Meanwhile, the pro-life organization Americans United for Life argued that the reasoning for the injunction was overly broad.

"The order did not grapple with any of the government’s responses, rejecting them in a single sentence as 'dismissive, speculative, and not based on any evidence presented.' There was no reasoned analysis for why the district court did not apply the U.S. Supreme Court’s binding decision in Rust v. Sullivan, which upheld similar Title X regulations, other than the fact that the regulations were from 30 years ago and subsequent administrations have issued different regulations in the interim," said Rachel Morrison, Americans United for Life's litigation counsel, in a statement. "Even though Title X statutorily excludes abortion from its family planning projects and funding, the district court apparently believes that Title X providers have a right to continue to receive taxpayer dollars to support their advocacy and promotion of abortion."

Thursday's hearing in Washington followed a separate case heard earlier this week in U.S. District Court in Oregon that also sought to block the rule. In that case, the American Medical Association joined Planned Parenthood in arguing that the rule would cause harm to patients and politicize medical practices, which ethically require patients receive complete, medically accurate information.

After oral arguments in that case on Tuesday, U.S. District Court Judge Michael McShane said he'd grant a preliminary injunction blocking the rule.

"Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care," said Barbara L. McAneny M.D., president of the American Medical Association, in a news release. "The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer."

This story was updated Friday, April 26, to add comments from Americans United for Life.