TRENTON – Attorney General Gurbir S. Grewal announced today that New Jersey is a participant in the multi-state lawsuit seeking to block a new federal regulation that would limit access to health care and family planning services for millions of low-income individuals and families by imposing a multitude of new restrictions on the Title X program.
Title X provides more than $286 million in federal funding annually to support an array of vital health care services in New Jersey and across the nation, including reproductive health services and counseling to four million women. In New Jersey, Title X-funded health care providers are an essential part of the health care landscape, having served nearly 100,000 patients and prevented more than 19,000 unplanned pregnancies in 2017.
“The Trump Administration’s attempt to limit access to critical health care and family planning resources is reckless and unacceptable,” said Governor Phil Murphy. “Low-income New Jerseyans rely on Title X for critical primary and preventive health care needs and providing access to these services is essential in building a stronger and fairer New Jersey. I fully support Attorney General Grewal and his efforts to challenge this rule in court.”
“New Jersey is proud to stand with its Title X healthcare providers, the patients they serve, and a broad coalition of other states in challenging a rule that puts the health of women and low-income individuals at risk to advance an ideological agenda,” said Attorney General Grewal. “We will fight to protect our residents’ access to high-quality reproductive health care and family planning services.”
“The Trump Administration’s new Title X rules are short-sighted, unethical, and rooted in political ideology rather than in evidence-based standards of care,” said New Jersey Health Commissioner Dr. Shereef Elnahal.
“Doctors, nurses, and other providers should be able to speak honestly and openly with their patients about all healthcare options, and these new rules violate that sacred provider-patient relationship in women’s health,” Dr. Elnahal said. “I’m proud that the Attorney General and New Jersey are standing up for patients’ and providers’ fundamental rights.”
Filed in U.S. District Court in Oregon, the states’ complaint contends that the new regulation from the U.S. Department of Health and Human Services (HHS) imposes “burdensome and unnecessary restrictions” that would reduce access to care, interfere with the patient-provider relationship and undermine the intent of Congress in enacting Title X nearly 50 years ago. Among other harms, the complaint alleges, the new rule unlawfully “gags” certain Title-X-funded health care providers by prohibiting them from providing pregnant patients with “nondirective counseling” on all legal options relating to their pregnancies.
Nondirective counseling includes the provision of “neutral, factual, accurate and complete information about prenatal care and delivery, infant care, foster care, adoption and abortion.”
The net result of the rule, the states contend, is that many providers will be “unwilling to participate in a program that compromises their medical and ethical standards.” That in turn will erode the quality of care available under Title X, and “dramatically” reduce the number of high-quality providers working at facilities funded by the program.
The multi-state lawsuit is led by Oregon, and in addition to New Jersey is joined by 18 other states and the District of Columbia. Among the other participating states are: New York, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Michigan, Massachusetts, Minnesota, Nevada, New Mexico, North Carolina, Pennsylvania, Vermont, Rhode Island, Virginia and Wisconsin.
The complaint argues that the HHS Final Rule forces Title X recipients to make an untenable choice: ignore the rule and lose their Title X funding, or accept intrusive federal mandates that restrict access to care and impose unconstitutional limits on the conversation between healthcare providers and their patients. In either case, the complaint asserts, a critical federal program designed to serve as a health care safety net for millions of people across the country – including many families and women living at or below the poverty threshold – will be seriously compromised.
Specifically, crucial Title-X-funded family planning services will suffer, significant public health threats may emerge, and unintended pregnancies are likely to increase, among other harms.
Among the health care services provided by Title-X-funded clinics are well-woman exams, lifesaving cervical and breast cancer screenings, birth control, contraception education, and testing and treatment for sexually-transmitted infections including HIV.
In addition to allegations related to rule essentially gagging health care providers, the lawsuit charges that it unlawfully imposes “arbitrary and irrational” barriers to comprehensive health care by prohibiting abortion referrals – regardless of the professional opinions of health care providers or the needs or desires of the patient – and requiring strict financial and physical separation between any Title X program and any facility that provides abortion. (Under the rule the provider must have, at a minimum, separate examination and waiting rooms, office entrances and exits, phone numbers, e-mail addresses, educational services, websites, personnel, electronic or paper-based health care records, and workstations).
In a New-Jersey-specific component of the complaint, it is noted that the non-profit New Jersey Family Planning League (NJFPL) is currently the sole statewide grantee for federal Title X family planning services. For more than 44 years, the complaint explains, the NJFPL has been managing a system of sub-recipient agencies that provide quality family planning services to the residents of New Jersey. According to the complaint, the NJFPL’s Title X grant for the 2017-18 fiscal year – approximately $8.8 million – helped support “one of the largest single existing systems for the provision of preventive health care “ in New Jersey, and served a patient base comprised mostly of patients living well below the federal poverty level.
NJFPL currently provides Title X funding to 10 sub-recipient agencies in New Jersey.
Those sub-recipient agencies provide family planning and reproductive health services at 47 service sites throughout the 21 counties – including nine counties that are served by only one Title X-funded clinic each. The service sites include Planned Parenthood affiliates, a county health department, a hospital-based agency and other community-based, non-profit providers. The complaint contends that patients who are unable to continue receiving family planning services at a Title-X-funded clinic may not be able to access services elsewhere “due to distance, cost, language barriers, confidentiality concerns” and other factors.
“Fewer providers means increased wait time, leading to delayed care and increased opportunity for unintended pregnancy, HIV and STDs to go undetected and/or untreated,” the complaint notes. The complaint further notes that other health concerns which can put a pregnancy at risk – including cancer, diabetes and other conditions – may go undetected and unaddressed if the HHS rule is implemented.
Deputy Attorneys General Kimberly Cahall and Elspeth Faiman Hans, and Assistant Attorney General Glenn J. Moramarco are representing the State of New Jersey in this matter.