With the Trump administration's final revision to the Title X Family Planning Program now on the books, so too are lawsuits to challenge it.
California filed the first suit Monday, the same day the new rule was published in the Federal Register , in district court in the hopes of blocking changes that are scheduled to go into effect May 3.
"The Trump-Pence Administration has doubled down on its attacks on women's health," California Attorney General Xavier Becerra said in a statement . "This illegal Title X rule denies patients access to critical healthcare services and prevents doctors from providing comprehensive and accurate information about medical care."
Included in the revised regulations from the US Department of Health and Human Services is a prohibition on what health care providers who receive Title X funds can discuss with patients. Under current law, these funds may not be used to pay for abortions. But under the revisions, health care providers who receive Title X funds cannot talk about abortion with patients or offer referrals for the procedure.
"As a doctor, I cannot imagine withholding information from my patients. It's unethical, and it flies in the face of the oath I took to care for my patients," Dr. Erin Berry said at a news conference last week.
"It threatens the doctor-patient relationship and prevents patients from having full and honest information about all of their health care options," added Berry, who serves as the Washington state medical director and director of clinical research for Planned Parenthood of the Great Northwest and the Hawaiian Islands. "Politicians have no business telling me what I can talk to my patients about. This rule is shameful, and it's dangerous."
Title X-funded clinics that don't honor what opponents have dubbed a "gag rule" will be forced to forgo federal funding. As a result, many fear, these clinics that serve approximately 4 million people a year may be forced to close their doors. Low-income people, rural residents, communities of color and the uninsured, opponents argue, are the ones who will suffer most.
Last week, a group of 19 medical organizations representing 4.3 million health care providers -- including the American Academy of Pediatrics, the American Psychiatric Association and the American College of Obstetricians and Gynecologists -- signed a letter protesting the revisions .
"As the only federal program exclusively dedicated to providing low-income patients, including adolescents, with access to family planning and preventative health services and information, Title X plays a vital role in the fabric of America's family planning safety net," the letter said. "The final regulation is the latest of numerous recent decisions -- from rolling back insurance coverage for contraceptives to attempting to eliminate funding for evidence-based teen pregnancy prevention programs -- that unravel the threads of this safety net."
Established in 1970, during the Nixon administration, when it enjoyed bipartisan support, Title X provides more than $250 million in funding to clinics that offer affordable birth control, cancer screening, STD testing and treatment, and other reproductive health care and family planning services.
What constitutes "family planning," however, has become a political point of contention.
Anti-abortion groups have cheered the administration's push to revise Title X.
"Abortion is neither healthcare nor family planning which is why the Title X program has no business funding it," Jeanne Mancini, president of March for Life, said in a statement.
The new regulation "protects low-income women" who will now receive services only from "federally qualified health centers" that offer "better regulatory oversight, a wider range of services, and more life-affirming options," Mancini added.
Other lawsuits came in Tuesday, with more being promised.
Twenty-one state attorneys general have signed on to a lawsuit led by Oregon and filed in US District Court in Eugene. Planned Parenthood Federation of America has joined the American Medical Association for a separate case.
Washington Attorney General Bob Ferguson vowed last week to file suit. The American Civil Liberties Union plans to battle in the courts on behalf of Cedar River Clinics in Washington state, as well as the National Family Planning and Reproductive Health Association, which represents a coalition of 900 providers. And the Center for Reproductive Rights will get into the legal fight on behalf of Maine Family Planning, which operates 18 clinics throughout the state.
Some have framed the revised Title X rules as an effort to defund Planned Parenthood. And while Planned Parenthood certainly stands to lose millions, independent clinics and health centers that don't have national name recognition -- like those in Maine -- see this as a fight for their survival, too.