Washington State

Office of the Attorney General

Attorney General

Bob Ferguson

Mar 5 2019

Ferguson will ask judge to block the rule, which guts funding for reproductive healthcare, family planning services

YAKIMA — Attorney General Bob Ferguson today filed a lawsuit in the U.S. District Court for the Eastern District of Washington challenging the Trump Administration’s “gag rule” that impacts federal funding for reproductive healthcare and family planning services. Ferguson announced the lawsuit on Feb. 25.

On Monday, the U.S. Department of Health & Human Services formally published the gag rule, which will go into effect on May 3. Later this month, Ferguson will file a motion for preliminary injunction, which asks the court to block rule before it goes into effect.

Ferguson filed the lawsuit in the Eastern District because of the disproportionate impacts to rural Washingtonian women. If the rule goes into effect, it will leave 21 Washington counties without a Title X provider at all, 11 of those in Eastern Washington. This includes Spokane and Yakima counties. As a result, some Washingtonians will need to travel hundreds of miles to receive family planning care, while others will lose access altogether.

The rule will force out of the program health care professionals who provide nearly 90 percent of Title X family planning services to Washington patients, keeping thousands of vulnerable Washingtonians from reasonably accessing contraception, cancer and STI screening and other family planning care.

In Washington, 91,284 patients received care through Title X in 2017. More than half of these patients were at or below the federal poverty line. The Washington Department of Health estimates that services provided to these patients prevented over 18,000 unintended pregnancies and over 6,000 abortions, resulting in savings for the state of more than $113 million.

“President Trump is illegally inserting ideological politics between a woman and her doctor by ‘gagging’ providers,” Ferguson said. “This is a transparent attack on Planned Parenthood that disproportionately harms low-income women in rural Washington. My office will stand up for Washington women to challenge this unlawful presidential action.”

The rule is scheduled to go into effect 60 days after it is published, on May 3. The rule gives health care providers between 60 days and one year to comply with various provisions of the rule.

Title X

Title X is a federal grant program that helps ensure access to affordable, preventative reproductive health care. Congress enacted Title X in 1970 in an effort to reduce the rate of unintended pregnancies and break the cycle of poverty ensnaring women who were unable to pay for contraception.

Title X programs serve an estimated 4 million women annually across the United States. More than two-thirds of these women have incomes at or below the federal poverty level.

In addition to family planning care, Title X providers such as Planned Parenthood also screen for high blood pressure, breast cancer, diabetes, STIs and depression. For four out of 10 women who receive contraceptive care from Title X-funded providers, this is their only source of healthcare.

Title X provides funds for 85 clinic sites in Washington operated by 16 organizations. One-third of the funding for family planning programs in Washington come from the federal government and Title X.

Ferguson’s lawsuit

The rule makes two major unlawful changes to the Title X family planning program. First, it imposes a “gag” on Title X providers that prohibits them from referring their patients to abortion providers. It also requires Title X providers to refer each pregnant patient into a prenatal care program, regardless of the patient’s wishes or the provider’s medical judgment.

The “gag rule” violates the Affordable Care Act, which protects providers and patients from government interference in the health care relationship. The Affordable Care Act states that the federal government cannot impose a rule limiting “the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions.” Many patients visit Title X providers for pregnancy testing and counseling. They will no longer receive neutral, factual information about all of their options.

The “gag” provisions also violate statutory requirements, approved annually by Congress since 1996, that all pregnancy counseling in a Title X-funded clinic must be non-directive. Under the rule, providers may refuse to give information regarding abortion to patients, regardless of the patient’s wishes or medical needs.

Second, it requires clinics that also provide any abortion care or referrals to create a physical wall between their family planning functions and their abortion services, requiring separate entrances and exits, treatment facilities, and personnel as well as duplicate health care records. Clinics have one year to comply with costly, time-consuming and counterproductive physical separation requirements, which will be impossible for many clinics.

This physical separation provision also violates the Affordable Care Act, which prohibits the federal government from imposing a rule that creates “any unreasonable barriers to the ability of individuals to obtain appropriate medical care.”

The rule goes against Title X’s purpose of equalizing access to modern, effective contraception because it will defund full-service reproductive health clinics like Planned Parenthood that provide the vast majority of family planning care in states like Washington.

Assistant Attorneys General Jeff Sprung, Kristin Beneski and Paul Crisalli are handling the case for Washington.

Attorney General Ferguson has previously taken on the Trump Administration in an effort to protect women’s reproductive rights. Ferguson joined three other attorneys general in July to urge the Trump Administration to withdraw the proposed rule. Last year, Ferguson filed a lawsuit to block the Administration’s rules undermining women’s access to contraception. Two federal judges temporarily halted the rules’ implementation in separate cases across the nation.

Ferguson has filed 34 lawsuits against the Trump Administration and has not lost a case. Ferguson now has 17 legal victories against the federal government since President Trump assumed office. Nine of those cases are finished and cannot be appealed. The Trump Administration has appealed or may appeal the other eight, which include lawsuits involving Dreamers and 3D-printed guns.


The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Visit www.atg.wa.gov to learn more.


Brionna Aho, Communications Director, (360) 753-2727; Brionna.aho@atg.wa.gov