CHICAGO — The American Medical Association (AMA) today petitioned the U.S. Supreme Court to review a Court of Appeals decision upholding a 2019 Trump administration rule that imposed drastic changes on the Title X family planning program, inappropriately interfering with open communications between patients and health care professionals. The AMA’s petition was joined by Planned Parenthood Federation of America (PPFA), the National Family Planning & Reproductive Health Association (NFPRHA), the American Civil Liberties Union (ACLU), Essential Access Health (EAH), the Oregon Medical Association and others.

The petition asserts that the high court’s review is warranted following conflicting decisions by the Fourth Circuit and Ninth Circuit, leaving unresolved questions of law about an essential federal health care program. The Fourth Circuit found the Title X rule invalid, while the Ninth Circuit upheld the rule.

The petitioners argue that until the Ninth Circuit’s erroneous decision is corrected, the administration’s gag rule is harming patient care and causing physicians and other health care professionals to violate ethical obligations by preventing Title X clinics from providing full information to patients about all of their reproductive care options. This marks the first time in recent history the AMA has petitioned the U.S. Supreme Court, further underscoring the government’s significant overstep in issuing the rule.

“The AMA strongly believes that our nation’s highest court must step in to remove government overreach and interference in the patient-physician relationship. Restricting the information that physicians can provide to their Title X patients blocks honest, informed conversations about all health care options—an unconscionable violation that is essentially a gag rule,” said AMA President Susan R. Bailey, M.D. “As physicians and leaders in medicine, we are fighting against the government’s intrusion in the exam room while protecting open communication between patients and physicians, which is the foundation of high-quality medical care.”

Since its inception a half century ago, Title X has served as a vital public health program, ensuring vulnerable populations—especially low-income women—have access to basic, preventive reproductive health care. In addition to restricting physicians and other health care professionals from providing complete information and appropriate referrals for care to their Title X patients, the administration’s rule withholds federal funding from providers that do offer the full range of family planning services, much to the detriment of the millions of Americans who depend on Title X for reproductive care.

The petition states that “the consequences of the rule are clear and stark—and already occurring.” Roughly one in every four Title X providers has withdrawn from the program in response to the rule’s implementation last year, ultimately jeopardizing care for 1.6 million patients nationwide. A recent U.S. Health and Human Services (HHS) estimate supports these figures, acknowledging that Title X services sites decreased by 945 sites and the number of annual patients served in 2019 fell by 21%—despite the Title X rule being in effect for only a few months. In California, for example, it is projected that in 2020, there will be an almost 75% reduction in the number of patients served by Title X in the state. As of August 2020, six states are without any Title X site at all.

“The Title X gag rule is designed to take away access to reproductive health care, like birth control and life-saving cancer screenings, by forcing safety net providers like Planned Parenthood out of the program,” said Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America. “Before this rule was put in place, Planned Parenthood health centers proudly served about 40% of the 4 million patients who got care through the Title X program each year. Since our health centers and others have been forced out, people who have always faced systemic barriers to health care—including those in rural areas, as well as Black, Latino, and Indigenous communities—have suffered the most. Health care should never come down to how much you earn or where you live. We are proud to join with our partners in taking this fight to the highest court.”

“The Trump administration's Title X rule was a lawless attack on this vital public health program, and must be rejected,” said Ruth Harlow, Senior Staff Attorney at the ACLU. “We call on the Supreme Court to uphold its role as an essential check on unlawful agency actions, hear this vitally important case, and restore the full range of clinical family planning care that millions nationwide have historically relied upon.”

“At stake for our nation is the reproductive health of millions, the majority of whom already face inequities in their lives. Every person deserves high-quality family planning care, and we are committed to restoring Title X’s integrity. We will fight the Trump administration’s unlawful and dangerous Title X rule to the very end,” said Clare Coleman, President & CEO of NFPRHA.

“The Trump administration’s Title X regulations are another flagrant example of the federal government prioritizing politics over public health. The unlawful regulations deny women complete and unbiased information about their pregnancy options and dictate a lower standard of care for low-income and uninsured patients,” said Julie Rabinovitz, President and CEO of Essential Access Health. “We are committed to halting implementation of the regulations nationwide and ensuring that Title X patients across the country can receive the care they want, when they need it.”

Over the course of its 50-year history, Title X has been an enormous success for patients, their communities, and our country — serving more than 4 million patients a year with critical, often life-saving reproductive care. Without Title X, the rates of unintended pregnancy and abortions would have been 31% higher, according to estimates. Most of the patients served by Title X are economically disadvantaged and live in areas where there are few health care options.

In emphasizing Title X’s immense impact, the petition notes that “for six in 10 women who obtain contraceptive care at a Title X-funded site, that provider was their only source of medical care over the past year.” The petition stresses that patients, physicians, and the health of the nation will be irreparably harmed without the Supreme Court’s review of the case.


Editor’s Note: In March 2019, the AMA filed a lawsuit in the United States District Court, District of Oregon to block the rule from going into effect. The lawsuit was joined by the Oregon Medical Association and Planned Parenthood Federation of America. Additional AMA insight on the cases’ core issues can be found here.

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The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care.  The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.