Two lawsuits announced Monday seek to block Trump administration changes to the Title X family planning program. They’re the first of what is expected to be a flurry of challenges to the new rule, which would affect more than 4 million low-income women who receive services including cancer screenings and pregnancy tests through the Department of Health and Human Services program.

A coalition of 20 states and California Attorney General Xavier Becerra (D) separately announced lawsuits that seek a court injunction to stop the rule from taking effect in 60 days. The California suit was filed in U.S. District Court in San Francisco on Monday; the multistate lawsuit, brought mostly by Democratic-controlled states, is expected to be filed Tuesday in U.S. District Court in Eugene, Ore.

The rule imposes what administration officials have referred to as a “bright line” of physical and financial separation between the provision of family planning and abortion services, effectively requiring Planned Parenthood to drastically alter its operations, or else cease to receive an estimated $60 million in annual funding.

Opponents have called it a “gag” rule that compromises medical ethics and endangers the lives of patients because it explicitly bars doctors, nurses or other care personnel from referring a woman for an abortion.

“Everyone deserves the ability make their own decisions about their health care,” Kate Brown, governor of Oregon, which is leading the 21-state effort, said in a statement.

“It is appalling that the federal government wants to rob individuals of the right to complete medical information and full access to the critical health care services they rely on.”

In a statement, Becerra said the rule would deny “patients access to critical health care services and prevents doctors from providing comprehensive and accurate information about medical care.”

Supporters of the rule, which include numerous religious and antiabortion organizations, have pointed to how the Supreme Court upheld similar regulations in 1991’s Rust v. Sullivan in a 5-4 decision. But those regulations, introduced under President Ronald Reagan and tied up in legal challenges, were in effect only several weeks before the arrival of the Bill Clinton administration, which promptly eliminated them.

The legal argument

One of the main legal arguments in both lawsuits is a provision of the Affordable Care Act, which wasn’t in place 28 years ago, that forbids regulations that create “unreasonable barriers to the ability of individuals to obtain appropriate medical care.”

The multistate lawsuit also described the requirement of physical and financial separation as onerous. In a news statement, Oregon officials explained, for example, that “it would require health clinics to open another location, or create a separate entrance for patients, have separate examination rooms, hire separate personnel to work at separate workstations, maintain a separate phone number and website, and have separate electronic medical systems in order to continue to accept Title X funds.”

The lawsuit also takes issue with the rule’s mandate that every pregnant patient get a referral for prenatal care “regardless of the needs or the wishes of the patient.”

In addition to Oregon, the states participating in the lawsuit are Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin. The District of Columbia is also a party to the lawsuit.

The 21 states are just some of the parties — including the American Civil Liberties Union and the Center for Reproductive Rights — that have vowed to sue over the rule, which was published Monday in the Federal Register.

Becerra said that California is home to the largest Title X provider network in the nation, serving about 1 million women, and contends that the rule places its clinics “in an untenable situation.”

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