California and Nevada Co-Lead Multistate Amicus Brief Supporting Challenge to the Harmful Trump-Pence Title X Rule

Before the rule took effect, the Title X family planning program served four million patients nationwide

California had the largest program, serving more than one million Title X patients statewide    

SACRAMENTO – California Attorney General Xavier Becerra and Nevada Attorney General Aaron Ford today filed a multistate amicus brief in the U.S. Court of Appeals for the Fourth Circuit, supporting the City of Baltimore in its lawsuit against the Trump-Pence Administration’s Title X rule. The new rule restricts access to critical preventive reproductive healthcare by prohibiting doctors from providing referrals for abortion or offering complete information to patients about their family planning options. In the brief, the state coalition explains that the new rule endangers the health, well-being, and economic security of their residents, leaving patients in entire regions and states nationwide without providers. The coalition urges the court to uphold a lower court ruling halting implementation of the Title X rule.

“With this rule, the Trump-Pence Administration has upended the Title X program, which provides critical reproductive and preventative health services to low-income women and families across the nation,” said California Attorney General Xavier Becerra. “At a time when many Americans are facing uncertainty in both their health and finances due to the coronavirus, programs that provide low-cost healthcare, like Title X, are more critical than ever. Our coalition stands with the millions of women and families across the nation who rely on Title X for healthcare services in urging the court to halt this harmful rule.”

“Politics has no place in the doctor’s office, and I’m proud to lead an effort to fight misguided attempts to prevent families from receiving accurate information and options about their healthcare,” said Nevada Attorney General Aaron D. Ford. “Millions of low-income and under-served families rely on Title X for access to a broad range of health services, and my office will use every means to ensure their rights are protected.” ​

The Title X family planning program is instrumental in states’ efforts to deliver preventative and reproductive healthcare to low-income women and families. Over the last 50 years, Title X has created a strong network of medical providers committed to delivering high-quality, evidence-based preventive health services. Prior to 2019, the Title X program funded a wide array of critical public health services, including family planning counseling, access to FDA-approved contraceptive methods, pelvic exams, and crucial screenings for high blood pressure, anemia, diabetes, sexually transmitted diseases and infections, and cervical and breast cancer. The Trump-Pence Administration’s new Title X Rule, however, has harmed the Title X program nationwide.

Since the new Title X rule went into effect, the states’ Title X programs have been upended, with many qualified providers leaving the program. In 13 states, more than 50 percent of Title X grantees have withdrawn from the program, and several states no longer have any Title X providers. Further, new providers have not filled the gap caused by the withdrawals. As a result, states have faced increased burdens to meet residents’ needs for essential healthcare. California alone has experienced a significant loss of Title X providers—going from 366 health centers in 38 counties to 229 health centers in only 18 counties. This leaves several rural counties with no Title X providers. As a result of these withdrawals, 38 percent fewer patients were served in 2019 compared to before the Trump-Pence Rule went into effect. And this year, California’s Title X network is projected to serve fewer patients still, a reduction of almost 72 percent since before the rule took effect.

The coalition also notes that in light of the recent pandemic, clinic withdrawals from the Title X program place an additional strain on health systems nationwide. Due to COVID-19, many people have lost insurance coverage or are experiencing financial instability due to unemployment and could benefit from Title X’s low-cost services. 

Today’s brief is the latest step in Attorney General Becerra’s efforts to protect the Title X program. On July 30, 2018, he led a coalition of 13 attorneys general in filing a comment letter opposing the Trump-Pence Administration’s proposed rule. On March 4, 2019, he filed a lawsuit challenging the final rule in the Northern District Court of California, claiming the proposed restrictions to Title X disregard the rule of law and harm California’s healthcare providers and over one million women in our state who relied on Title X for healthcare services. That lawsuit is ongoing in the Ninth Circuit.  

Joining Attorneys General Becerra and Ford in filing the brief are the attorneys general of Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.

A copy of the amicus brief is available here.