The nation's largest doctors' group on Thursday asked the Supreme Court to strike down a Trump administration rule that's had a far-reaching impact on family planning by prohibiting taxpayer-funded clinics from referring women for abortions.
The American Medical Association acted after two U.S. appeals courts issued conflicting rulings on the legality of the Trump administration restrictions, which apply to clinics that mainly serve low-income women.
"We do think this conflict needs to be resolved and we need to figure out how to deliver services under a program that has had bipartisan support for decades," said AMA President Dr. Susan Bailey.
The AMA's move will raise the profile of a reproductive rights issue overshadowed by bigger election-year battles. The recent death of liberal Justice Ruth Bader Ginsburg has prompted speculation that a more conservative court could overturn the Roe v. Wade decision that legalized abortion, as well as the Obama health law that expanded coverage and made birth control free for most women.
But the changes to Title X, as the federal family planning program is known, are already in effect — and getting much less attention.
Last year the Trump administration finalized a rule that prohibits clinics from referring pregnant women for abortions and imposes other restrictions, including a requirement for strict financial and physical separation of family planning facilities from ones that provide abortions.
As a result, more than 900 out of nearly 4,000 clinics receiving federal funds left the program, including Planned Parenthood and its affiliates. Advocates say the exodus has disrupted care for women who receive birth control and routine medical attention from the clinics. The program usually serves some 4 million clients, and the AMA says that was down about 20% last year.
The Trump administration's regulation "warps and decimates" Title X, the AMA said in its petition asking the Supreme Court to take the case.
An appeals court based in San Francisco upheld the Trump administration's regulations, but a second court based in Richmond, Virginia, ruled in a Maryland case that the restrictions were invalid. The AMA says that means the administration's abortion referral rule is in effect everywhere but Maryland.
Casting the case as an issue of free speech and medical ethics, the AMA said the administration's rule attempts to control communication between clinicians and patients by prohibiting abortion referrals, while at the same time compelling clinics to refer pregnant women for prenatal care, even if a woman has decided that she wants to have an abortion.
"The patient-physician relationship is the cornerstone of good medical care, and patients must be able to believe and completely trust that their physicians are giving them all of their options, and that communication is not being blocked in any way," said Bailey. "It is frankly against our code of medical ethics."
In response, HHS rejected the accusation that the regulation amounts to a "gag rule" and noted that the federal appeals court in politically liberal San Francisco upheld it. Nonetheless, it was a conservative mix of appellate judges who decided the case.
HHS also says it is trying to increase the number of patients served and improve quality.
Longstanding laws prohibit the use of federal funds to pay for abortions, but the family planning rule is part of a broader Republican effort to shut down various streams of taxpayer money still available to Planned Parenthood, the nation's largest provider of abortions. That's been a critical priority for religious and social conservatives in President Donald Trump's political base.
Abortion remains a legal medical procedure, but the number and rate of abortions is at its lowest point in nearly 50 years. Improved access to birth control is seen as one of the reasons.
Democratic presidential candidate Joe Biden promises to rescind the Trump administration's family planning rule and also supports allowing federal programs to pay for abortions. But the AMA says regardless of who wins the election, it believes the Supreme Court should address the issue and overturn the Trump administration rule.
"Title X has contributed to a 30-year low in unintended pregnancies," said Bailey. "We can't afford to walk away from that progress."
Joining the AMA's petition are the ACLU, Planned Parenthood, the National Family Planning & Reproductive Health Association, and Essential Access Health, which administers the Title X family planning program in California.