Minnesota clinics fight Trump rule restricting funds for abortion referrals

Five days a week, Caitlin Young sees a steady flow of women, and occasionally men, stream into a bright, white clinic in Richfield sandwiched between a strip mall beauty salon and a smokehouse.

"Birth control, annual exams, STI [sexually transmitted infections] testing and treatment is what I do, all day every day," the nurse-midwife said as she walked through exam rooms and lab stations at the south suburban Planned Parent­hood site.

The clientele reflects Richfield's diverse population. A significant share of patients — about 22% — are low-income and qualify for federally subsidized care. "We accept everybody who walks through the door, no matter your walk of life," Young said.

But the clinic, along with 30 others in Minnesota, now finds itself on the front lines of a protracted legal fight over a Trump administration effort to deny federal Title X reproductive health care funds for low-income patients at clinics that provide abortion referrals.

New rules issued by the U.S. Department of Health and Human Services in February significantly tighten eligibility requirements, barring staff at clinics that receive the taxpayer-funded grants from providing referrals to abortion providers. The new regulations, now under legal challenge, also require "clear financial and physical separation" between clinics that receive Title X funds and clinics that perform abortions.

Federal law already prohibits federal taxpayer money from being used for most abortions. But Health and Human Services Secretary Alex Azar has described the changes as "foundational reforms" that will "bring integrity to the program" by ensuring "taxpayer money is not being used to, directly or indirectly, fund abortion."

Title X, established under President Richard Nixon in 1970, provides grants to subsidize birth control access, sexually transmitted infection testing, cancer screenings and other reproductive health care services for an estimated 4 million low-income patients across the country.

The new restrictions have been met with praise from groups that oppose abortion, including those active in Minnesota.

"We agree with the new rule that Title X funds shouldn't go to places that perform or promote abortion," said Paul Stark, communications director for Minnesota Citizens Concerned for Life. "It's not about family planning funding, which is not cut by the rule, but only about preventing that funding from directly or indirectly supporting abortion."

Critics contend the change is a "gag rule" meant to undercut Planned Parenthood, which serves about 40% of all Title X patients, and other clinics that provide abortion referrals in addition to other services. Providers, reproductive health advocates and attorneys general from 22 states, including Minnesota, filed lawsuits challenging the rule. A federal judge sided with critics on Thursday, temporarily blocking the rule from taking effect May 3 as planned while the lawsuit continues.

"Frankly, it is both cruel and unethical that they are forcing providers and health care agencies and the safety net to fight for their existence to serve vulnerable populations," said Jessica Marcella, vice president of advocacy and communications for the National Family Planning & Reproductive Health Association, one of the groups challenging the change. "It is forcing providers to withhold information and limit care to their patients if they decide to participate, or threaten … that they will remove these essential resources."

Opponents of the new rules say the outcome of the cases could affect access to basic health care for millions of low-income patients, including 53,000 in Minnesota. Alissa Light, board president of the state-based Reproductive Health Alliance, said the proposed changes to Title X would lead to an "astronomical reduction to basic health care," especially in rural areas. Thirty-one providers in Minnesota, including 17 Planned Parenthood clinics, could lose funding under the rule. Three-quarters of the centers are located in greater Minnesota.

One such center in the northern Minnesota town of Virginia serves patients from across a wide swath of the Iron Range. Clinic manager Nyssa Krause said many come to the clinic for annual exams and wellness checks. Like the Richfield site, roughly 16% of the patients are funded by Title X.

"There are other centers, but not [ones] that provide the specific family planning and reproductive care that we do with that kind of confidentiality and the options for financial assistance," Krause said.

Another center run by Krause in Duluth sees a large number of college students, many of whom are navigating health care decisions on their own for the first time. Losing Title X funding could lead to scaled-back care and higher out-of-pocket costs for those patients, she said.

Groups in Minnesota that oppose abortion dispute the notion that access to family planning services will decrease under the new rules. They hope the restrictions, combined with other recent rule changes, will allow the money now going to Planned Parenthood to be diverted to organizations that do not provide abortion referrals, including faith-based facilities and crisis pregnancy centers.

"We foresee minimal if any impact on women in Minnesota because of the fact that there are so many more qualified health care facilities that can provide those services for women that do not provide abortion or refer to abortion," said John Helmberger of the Minnesota Family Council. "The services that women need … are going to be available across the state."

But opponents of the rule see more dire consequences. U.S. Sen. Tina Smith, a former Planned Parenthood executive, joined Sarah Stoesz, president and CEO of Planned Parenthood North Central States, for a tour of the Richfield clinic on Friday.

Smith asked Young what she thought would happen if the Title X restrictions took effect. The nurse cited a study that documented a spike in unplanned pregnancies after a similar change was enacted in Texas.

"We would see an evidence-based increase in unplanned pregnancy," Young said. "That would go up."