Tennessee AG sues HHS over family planning funding block.
Tennessee Attorney General Challenges Termination of Title X Funding in Lawsuit Against HHS
Tennessee Attorney General Jonathan Skrmetti has taken legal action against the Department of Health and Human Services (HHS) and HHS Secretary Xavier Becerra, filing a formal complaint to contest the termination of the state’s Title X funding. The complaint, filed in U.S. District Court for the Eastern District of Tennessee, accuses the federal government of attempting to force states into implementing pro-abortion policies that go against legal and constitutional limits.
“This case involves the federal government’s latest effort to coerce States into carrying out pro-abortion policy in violation of statutory, constitutional, and administrative-law limits,” the complaint reads.
The dispute arises from Tennessee’s refusal to comply with federal regulations that require abortion referrals, a decision based on the state’s current ban on the procedure.
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In a letter dated March 20, the HHS Title X program director informed state health officials that funding for the Tennessee Department of Health would not be continued for Fiscal Year 2023 due to non-compliance with Title X regulations. The letter stated that Tennessee was unable to fulfill the terms and conditions of the award, leading to the decision not to provide continuation funding.
The lawsuit, initiated on Oct. 24, aims to overturn HHS’s decision, alleging that it violates federal law and constitutional rights and reflects arbitrary decision-making by the department.
“We are suing to stop the federal government from playing politics with the health of Tennessee women,” stated Mr. Skrmetti. He emphasized that in 2022, HHS praised Tennessee’s Department of Health for its ability to administer Title X funds effectively and without interruption.
“This year, the federal government illegally diverted those funds to Planned Parenthood,” Mr. Skrmetti continued. ”Our lawsuit is necessary to ensure that Tennessee can continue its 50-year track record of successfully providing these public health services to its neediest populations.”
Factual Matters
Title X is a federal program that provides funding for family planning and related health services. Tennessee has been a longstanding participant in this program, receiving approximately $7 million annually to support vital public health initiatives.
Tennessee submitted its policy for a positive pregnancy test as proof of compliance, which includes offering information and counseling on all legal options in the state. However, HHS objected to the inclusion of the phrase “legal in the state of Tennessee,” deeming it unacceptable as Title X recipients must adhere to federal regulations regarding nondirective options counseling and referrals.
Tennessee’s View
The state argues in the lawsuit that HHS guidance represents the federal government’s attempt to force states into implementing pro-abortion policies that violate legal and constitutional limits.
Mr. Skrmetti asserts that a state’s decision to permit or restrict abortion carries significant moral implications, citing the Supreme Court’s 2022 ruling that overturned Roe v. Wade.
“In Tennessee, voters have opted to vindicate an interest in valuing all life by restricting elective abortions and promoting policies that will help women carry pregnancies to term,” the suit reads. “Out of respect for the deeply held opposition to abortion shared by Tennessee and countless others, Congress has long barred federal funds from aiding abortions.”
Mr. Skrmetti further argues that Title X funding is primarily intended for counseling and family planning services for the less fortunate, with strict restrictions on funds being used for abortion as a method of family planning.
“Since the mid-1990s, all Title X appropriations bills have expressly banned funding for elective abortions,” he wrote. “And each has further required that ‘all pregnancy counseling’ conducted under Title X ‘shall be nondirective’—thus prohibiting Title X recipients from encouraging women to seek abortions.”
Mr. Skrmetti points out the inconsistent policies of different presidential administrations regarding abortion referrals, with some prohibiting referrals in 2019 and others issuing the opposite policy in 2021.
Tennessee’s Claims
The lawsuit’s first claim argues that HHS acted arbitrarily and capriciously by abruptly terminating Tennessee’s Title X funding without providing a reasonable explanation. The complaint asserts that HHS reversed its previous conclusion without proper justification, leaving the state in the dark about the decision’s rationale.
The lawsuit also alleges that HHS’s interpretation of Title X regulations, particularly regarding counseling and referrals for abortion options, is inconsistent with existing regulations. Furthermore, HHS is accused of failing to follow proper rulemaking procedures, including notice-and-comment, when implementing this interpretation.
“HHS unlawfully unveiled its new interpretation only as part of HHS’s decision to terminate Tennessee’s Title X funding,” the suit states.
The lawsuit also argues that HHS’s actions violate several aspects of the U.S. Constitution. It claims that the termination of Tennessee’s funding goes against the spending clause by imposing conditions unrelated to the program’s intended purposes. Additionally, the state contends that HHS’s actions compel abortion-related speech, infringing upon First Amendment and 10th Amendment rights.
The state attorney general’s office highlights the arbitrary nature of HHS’s decision to terminate Title X funding for Tennessee. The complaint raises concerns about HHS’s inconsistency in relation to its prior conclusions that the state was in compliance with program requirements. It also questions HHS’s failure to consider the feasibility of referrals and the impact of state-level abortion-related restrictions.
HHS has not yet responded to the complaint in federal court, and the agency has declined to comment on the pending litigation.
How does Tennessee argue that HHS’s objection to the inclusion of the phrase “legal in the state of Tennessee” interferes with state law and the state’s right to regulate abortion?
Engineered its position on abortion referrals and used it as a pretext to withhold funding from Tennessee, despite acknowledging the state’s effective administration of Title X funds in the past.
The second claim asserts that HHS’s actions violate the Constitution’s Spending Clause, as Tennessee complied with the terms and conditions of the Title X award by submitting its policy for positive pregnancy test as proof of compliance. The state argues that HHS’s objection to the inclusion of the phrase “legal in the state of Tennessee” is an unwarranted interference with state law and an infringement on the state’s right to regulate abortion.
The lawsuit also alleges that HHS’s guidance contradicts federal regulations, which require nondirective counseling and referrals. Tennessee argues that the inclusion of the phrase “legal in the state of Tennessee” does not violate these regulations, as it simply informs patients of the legal options available to them within the state.
The state seeks injunctive relief, asking the court to prevent HHS from terminating Tennessee’s Title X funding and to declare HHS’s actions unlawful. Additionally, the state seeks a declaration that Tennessee’s policy for positive pregnancy test compliance is valid and complies with federal regulations.
The lawsuit highlights the ongoing contentious debate over abortion rights in the United States. It underscores the tension between federal and state powers, with Tennessee asserting its right to implement policies that reflect the values and preferences of its citizens. The outcome of this case could have far-reaching implications for the implementation of Title X funding and the balance of power between the federal government and the states.
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