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A leading provider of women’s health care in Maine announced Friday it would seek a preliminary injunction to prevent implementation of impending federal prohibitions on what doctors can tell patients about reproductive care.
A final rule governing the changes to the Title X program and backed by President Donald Trump was relea se d Friday and will go into effect 60 days after it’s filed in the Federal Register, though it’s expected to be appealed in court. It effectively institutes what opponents have called a “gag rule,” similar to what his administration mandates for overseas health providers that receive federal funds.
The changes block doctors and nurses at health care facilities that receive Title X funds from discussing abortion as a viable option with pregnant patients, or making referrals to abortion providers. Additionally, any organization that receives Title X funding, including Planned Parenthood, would have to stop performing abortions in order to continue receiving that money.
Maine Family Planning is the state’s only direct recipient of Title X money. Each year, roughly $2 million in federal funds are given to the organization for health care services. It disburses portions to each of its 18 owner-operated health care centers. Lesser amounts are earmarked for partner groups, such as Planned Parenthood.
The organization announced early Friday evening that it would go to court to try to block implementation of the rule.
“We will have to weigh that against our mission and obligation to make sure those services are available,” said Kate Brogan, vice president for public affairs for Maine Family Planning.
Proposed by Trump last May, the new restrictions will “deeply impact” the ability of nurse practitioners at Title X facilities to provide comprehensive services, and “contradict medical ethics,” Julie Jenkins, a nurse practitioner at Belfast Family Planning, said.
Gov. Janet Mills allied herself with Maine Family Planning on Friday, saying she will work with Attorney General Aaron Frey, Health and Human Services Commissioner Jeanne Lambrew and the Legislature to “determine what we can do at the state level to protect the health care of Maine women.”
“Every woman should be able to access reproductive health care when and where she needs it,” Mills said.
The two female members of Maine’s congressional delegation also expressed opposition to the new rule. U.S. Rep. Chellie Pingree, a Democrat who represents the 1st District, said the decision is “rooted in ideology, not evidence-based care” and that she would fight implementation.
U.S. Sen. Susan Collins, a Republican, cited a letter she co-wrote with Republican Alaska Sen. Lisa Murkowski to oppose the changes when they were first floated last year.
“I oppose this misguided rule change that could significantly diminish access for women to crucial contraceptive services, which have been critical in reducing the number of abortions in our country over the past three decades,” she said in a prepared statement.
A spokeswoman for Collins said the senator would evaluate “potential legislative remedies in the coming weeks.”
The decades-old $286 million Title X program, enacted by Republican President Richard Nixon, has been a game-changer for millions of low-income citizens who might otherwise struggle to find affordable reproductive health care. This includes access to birth control, testing for sexually transmitted diseases, prenatal care and certain cancer screenings.
In Maine last fiscal year, that federal program helped serve 23,811 patients at more than 40 health care centers. Nearly 80 percent of those patients qualified for free or reduced fee services — numbers that suggest the program “is doing just what it’s supposed to do,” Deirdre Fulton-McDonough, a spokeswoman for Maine Family Planning, said.
Under the current policy, Title X physicians present multiple family planning options to pregnant patients, even those who know they want an abortion, Jenkins said. More often than not, talk with a patient considering abortion extends well beyond simply giving a referral. A patient might not know even what an abortion is, what different types are available to them and which stage in their pregnancy they need to get one by, Jenkins said.
Nurse practitioners like Jenkins would be barred from directly counseling a patient on where to seek an abortion, even if the patient asks for that counseling. Answering general questions about abortion is allowed under the new rule, Brogan said.
Title X recipients have always been prohibited from using that money to provide abortion services, but they can share physicians, buildings and other company infrastructure with privately funded abortion providers as long as there’s clear financial separation between the two, Brogan said. This is the case at all Maine Family Planning locations statewide, each of which share buildings with privately funded abortion providers.
The new policy mandates that these services be unequivocally separate — a requirement that would be “exponentially more” expensive if Maine Family Planning continues to offer the same level of service, Fulton-McDonough said.
“It will affect every single one of our sites if we have to separate our services,” Brogan said.
For Teresa McCann-Tumidajski, executive director of Maine Right to Life, an anti-abortion group, this change “makes common sense.” She said the hard-line distinction between abortion service providers and Title X facilities is necessary to avoid inadvertently funding abortion providers simply by sharing facilities and company infrastructure.
Regardless, when the new changes are implemented, Brogan said, it will alter the way many Mainers receive health care, and Maine Family Planning will likely be forced to confront how it chooses to offer services in the future.
That may include refusing Title X funding altogether and looking for other funding alternatives, she said, “if it becomes too onerous to operate under that system and we don’t feel like we would be giving our patients good care.”