24 States Contest Texas Judge’s Ruling Against Title X Family Planning Program

A coalition of 24 states united to appeal a Texas judge’s ruling that could essentially withhold medication abortion pills nationwide and jeopardize reproductive care access under the Title X family planning program.

Texas federal judge, Matthew J. Kacsmaryk, issued a final judgment in December, deeming the Department of Health and Human Services (HHS) Title X family planning program rule as exceeding the HHS secretary's authority and violating constitutional rights. While the impact of this ruling is uncertain, it appears that, for now, government officials running the Title X program cannot require providers to protect the confidentiality of minor clients throughout the country.

The presiding judge, Kacsmaryk, also oversaw the case ordering the Food and Drug Administration (FDA) to halt the 23-year-old approval of mifepristone for medication abortion use. However, the Supreme Court temporarily blocked it on April 21 after the Biden administration requested a federal appeals court to intervene.

In their amicus brief supporting the Biden administration and Title X, the coalition of states urged the US Court of Appeals for the Fifth Circuit to protect privacy in family planning decisions, emphasizing that imposing restrictions on the Title X program would hinder access to reproductive care for vulnerable youths.

Title X program provides funding to states, enabling them to offer affordable reproductive healthcare services, as mentioned in the amicus brief.

These clinics not only provide reproductive healthcare services but also offer preventive screenings to patients, such as cervical and breast cancer screenings. In 2021, 324,536 women received cervical cancer screenings at Title X clinics, and 364,731 received breast cancer screenings.

The coalition also mentioned that the judge's ruling eliminating confidentiality protections for adolescents in Texas could discourage teenage patients from seeking contraceptives and family planning services without parental consent, jeopardizing the Title X program's mission to provide confidential medical care to millions of Americans.  

In the lawsuit, the state attorneys general warned that this could lead to sexually active adolescents forgoing medical care due to a lack of guaranteed confidentiality, with severe and devastating consequences for teenage patients, who comprise over one-third of Title X patients.

The states argued that Title X-funded confidential family planning services are crucial in achieving Congress's goal of reducing healthcare barriers, specifically among adolescents who experience high rates of teenage pregnancy, sexually transmitted infections, and other health issues.

Confidentiality laws enable patients to discuss sensitive topics that impact their health and well-being; removing such laws can significantly affect the patient-provider relationship, the state attorneys general posited.

“Limiting access to health care services relied upon by some of our most vulnerable populations will only increase health disparities and risks to patients,” Kwame Raoul¸ Illinois Attorney General, a representing member of the coalition, said. “Title X has provided care to millions of Americans, and I will continue to fight to ensure patients have access to the health care they need.”

In filing the brief, Attorney General Kaul is joined by the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and the District of Columbia.

In a separate amicus brief, the coalition also encouraged the protection of medication abortions, highlighting the overwhelming medical consensus that supports the FDA's approval of mifepristone for medication abortion, which has been in place for over two decades.

Upholding the court order limiting access to safe medication for first-trimester abortions could result in higher medical costs and increased health risks, potentially forcing individuals into more invasive and risky procedures, the coalition wrote.
Studies have indicated that statewide abortion bans can lead to clinicians and pharmacists limiting access to drugs that treat chronic conditions that mostly impact women. These medications are also used for medication abortion.

“Restricting access to reproductive care endangers people’s health and safety,” Rob Bonta, California Attorney General said. “Mifepristone is an exceedingly safe and effective medication that saves lives and empowers vulnerable communities. The FDA’s decades-old approval of its use was based on scientific research and data — unlike the recent attacks on it, which are fueled by empty rhetoric and partisan claims.”

“I urge the court to heed our call and reverse the Texas court’s dangerous and irresponsible decision,” Bonta continued. “As some try to roll back reproductive freedoms across the nation, California and its partners will continue to fight for more rights, more liberties, and more access to healthcare for all.”

Rollbacks in mifepristone prescribing may also deepen healthcare disparities, especially for underserved groups such as people of color, low-income individuals, people with disabilities, and LGBTQ individuals.

While the US Supreme Court has temporarily prevented any limitation of access to mifepristone, oral arguments for the underlying case are set to be heard by the Fifth Circuit on May 17, 2023.