Updated at 5:37 p.m. ET
Planned Parenthood is leaving the federal Title X family planning program rather than comply with new Trump administration rules regarding abortion counseling.
The new rules, issued by the U.S. Department of Health and Human Services earlier this year, prohibit Title X grantees from providing or referring patients for abortion, except in cases of rape, incest or medical emergency.
"The Trump administration has forced Planned Parenthood grantees out of Title X," said Alexis McGill Johnson, Planned Parenthood's acting president, in a conference call Monday. "The impact of the Trump administration's gag rule will reverberate across the country."
Officials say that means patients are likely to see longer wait times or increased costs for reproductive health services.
Planned Parenthood and other medical groups say the rule is unethical and interferes with the doctor-patient relationship. Abortion-rights opponents, meanwhile, have long argued for a complete separation between federal dollars and any organization involved in providing or facilitating abortions.
The announcement follows a letter submitted by Planned Parenthood last week to the U.S. Court of Appeals for the 9th Circuit. An attorney for Planned Parenthood said the organization had hoped to remain in the program but stop using Title X funds while the matter is being litigated. But, the letter says, recent guidance from HHS informed grantees that they would have to leave the program if they could not show "good-faith efforts" to comply. The letter expresses "deep regret" but says Planned Parenthood clinics "now have no option but to withdraw from the Title X program."
In a statement to NPR Monday, HHS officials said, "Every grantee had the choice to accept the grant and comply with the program's regulations or not accept the grant if they did not want to comply. Some grantees are now blaming the government for their own actions – having chosen to accept the grant while failing to comply with the regulations that accompany it – and they are abandoning their obligations to serve their patients under the program."
Planned Parenthood's withdrawal from the $286 million federal program represents a significant shift in the way the family planning program operates. The organization has been involved in the program since its inception, and officials say it serves about 40% of the nation's 4 million Title X recipients, who receive services such as contraception and STD screenings.
Planned Parenthood officials declined to say how much money flows to the organization's clinics nationwide through Title X.
Doreen Denny, senior director of government relations for Concerned Women for America, which opposes abortion rights, called the news "a day of reckoning and decision" for Planned Parenthood.
"I think that Planned Parenthood certainly knew that they had a choice to make when they first applied for grants this round. They knew that these rules could take effect," Denny said. "So this isn't a surprise to them."
Abortion-rights opponents have called on political leaders to defund Planned Parenthood and have praised President Trump for his administration's efforts to deliver on his campaign promise to do just that.
The impact of the rule change is not limited to Planned Parenthood. Maine's sole Title X grantee, Maine Family Planning, is also withdrawing. In a letter to HHS, CEO George Hill said his group is leaving the program "more in sorrow than in anger."
Emily Nestler is an attorney with the Center for Reproductive Rights, which is representing Maine Family Planning in its own legal challenge to the Trump administration rules. She said the move could force as many as 15 clinics to close in the largely rural state.
"Today is the tipping point, I think, and you're going to really see the unwinding of a program that has provided extraordinary care and been a huge success for decades," Nestler said in an interview with NPR.
Anti-abortion advocates say they hope the changes to the Title X program will open up funding for other groups, including religiously based organizations and crisis pregnancy centers that counsel women against abortions. Some of those groups do not provide a full range of contraceptive services.
MARY LOUISE KELLY, HOST:
Planned Parenthood is leaving the federal Title X family planning program. After months of saying it will not comply with new Trump administration rules for Title X, Planned Parenthood says the Trump administration has forced them out of the program, which provides reproductive health care for millions of low-income people. The new rules govern how providers can talk to patients about abortion.
NPR's Sarah McCammon covers reproductive rights. She's with us now.
SARAH MCCAMMON, BYLINE: Hi there.
KELLY: So the backdrop here is the U.S. Court of Appeals decided on Friday that it would not block this Trump administration rule. And today, we heard from Planned Parenthood and other groups, and they're out.
MCCAMMON: Right. A lot of clinics around the country that have been in this program for a long time say they're out of Title X as of today, and that is because of a deadline set by the Department of Health and Human Services to show that these groups who receive these funds are complying with the Trump administration rules. And you're right. A federal court said it would not block them. The regulations say that except in rare cases like rape, incest or a medical emergency, Title X recipients cannot refer their patients for abortion or provide them.
And we heard from Planned Parenthood acting president Alexis McGill Johnson today. She says they won't comply with that rule. She says it's unethical and gets in the way of the doctor-patient relationship.
(SOUNDBITE OF ARCHIVED RECORDING)
ALEXIS MCGILL JOHNSON: At Planned Parenthood, we refuse to cower to the Trump administration. We will not be bullied into withholding abortion information from our patients. Our patients deserve to make their own health care decisions, not to be forced to have Donald Trump or Mike Pence make those decisions for them.
MCCAMMON: And anyone who's followed this knows Planned Parenthood has been saying this for a while, but this is kind of the rubber meeting the road. McGill Johnson says Planned Parenthood affiliates around the country that receive these funds are sending letters to the federal government today announcing their withdrawal from Title X. Also today, at least one other group, Maine Family Planning, said it's doing the same.
KELLY: All right, so setting aside letters and all the legalese and policy issues, what does this mean if I am a woman and I rely on Planned Parenthood for services from birth control to pregnancy tests and so on?
MCCAMMON: Right. Well, Planned Parenthood has declined to put an exact dollar figure on what Title X means for their organization, so it's hard to know exactly how large of a share of their budget it is. But it is a big program, and Planned Parenthood serves 4 in 10 people who receive it. So for Planned Parenthood clinics, what they're saying is it could mean longer wait times for appointments. Some people may wait longer for care or go without it, may have to drive longer distances for treatment or pay more than they've paid in the past.
In rural areas, the impact is likely going to be bigger. In Maine, for example, a state with a lot of rural areas, of course, Maine Family Planning is the only Title X grantee, and they, again, are withdrawing. I spoke with an attorney who's representing them in a lawsuit against this rule, and she said as many as 15 clinics could be forced to close in Maine if other funding sources can't be found. These groups are looking for other types of funding, but they say they cannot patch through forever.
KELLY: President Trump and his supporters - are they counting this move today as a victory?
MCCAMMON: Definitely. President Trump and other Republicans have promised to defund Planned Parenthood, as they put it. They've campaigned on that. I talked to Doreen Denny of Concerned Women for America, a group that opposes abortion rights. She says no public dollars should go to Planned Parenthood if they are involved in abortion in any way.
DOREEN DENNY: Planned Parenthood certainly knew that they had a choice to make. When they were - first applied for grants this round, they knew that these rules could take effect. So this isn't a surprise to them.
MCCAMMON: And Denny and others would like to see other groups, including crisis pregnancy centers that counsel patients against abortion, get these funds, and they hope this is sort of a step toward that. Reproductive health advocates warn that this is really puncturing, though, the safety net that a lot of patients know.
KELLY: Just briefly, Sarah, are we expecting more legal challenges to this Trump administration rule?
MCCAMMON: Well, there are several underway, and those will continue. We'll also be watching in the coming months to see what kinds of other organizations apply for and get Title X funds under these new rules.
KELLY: All right, that is NPR's Sarah McCammon reporting on these latest developments with Planned Parenthood and Title X.
Thank you, Sarah.
MCCAMMON: Thank you.
(SOUNDBITE OF BAECHULGI'S "CALM") Transcript provided by NPR, Copyright NPR.