376 F. Supp. 3d 1119
E.D. Wash.2019Background
- Plaintiffs (State of Washington and NFPRHA and other Title X providers) challenge HHS’s 2019 Final Rule revising Title X regulations, arguing it exceeds statutory authority, is arbitrary and capricious, violates the APA, Title X, the congressional nondirective appropriations language, §1554 of the ACA, and constitutional protections.
- The Final Rule (84 Fed. Reg. 7714) reimposes separation requirements between Title X-funded activities and abortion-related activities and restricts counseling/referral practices; HHS defends the rule as consistent with prior regulations (citing Rust) and with federal conscience provisions.
- Title X’s central purpose is to provide low-income patients access to comprehensive, evidence-based, voluntary family planning; Congress long has required nondirective pregnancy counseling in appropriations riders and §1008 bars Title X funds being used where abortion is a method of family planning.
- Plaintiffs presented evidence that the Final Rule will disrupt the existing Title X provider network, increase costs (including physical/financial separation), force many providers to leave the program, and harm patient access—especially in rural areas and on college campuses.
- The court evaluated the parties’ motions for preliminary injunction under the Ninth Circuit’s sliding-scale Winter framework (likelihood of success, irreparable harm, balance of equities/public interest) and found plaintiffs made a strong showing of irreparable harm and likelihood of success.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Final Rule exceeds statutory authority / violates Title X purpose | Rule subverts Title X’s purpose to equalize access to comprehensive, evidence-based, voluntary family planning by excluding providers that offer abortion-related services or referrals | Rule is within Secretary’s authority and mirrors prior, upheld rules (Rust); conforms to statutory limits on Title X funds for abortion | Court finds plaintiffs made a colorable showing that Rule likely violates Title X’s central purpose and exceeds acceptable exercise of agency authority (preliminary injunction warranted) |
| Whether Rule is arbitrary and capricious under the APA | Agency reversed longstanding policy without adequate reasoning, ignored contemporary medical evidence, failed to consider important factors and comments | Rule is reasonable and consistent with prior HHS positions and conscience statutes | Court finds plaintiffs likely to show arbitrary and capricious rulemaking; agency relied on outdated record and failed reasoned decisionmaking (supports injunction) |
| Whether Rule violates nondirective appropriations mandates and §1554 of the ACA | Rule forces prenatal referrals for all pregnant patients and restricts nondirective counseling; creates unreasonable barriers, impedes access, and interferes with informed consent and provider-patient communication (violating §1554) | Plaintiffs waived §1554 claim by not citing it in comments; Rust forecloses certain challenges | Court concludes plaintiffs made a colorable §1554 and nondirective-mandate claim and that waiver is doubtful; likelihood of success on these statutory claims supports injunction |
| Irreparable harm, balance of equities, and public interest for preliminary relief | Implementation will disrupt/decimate Title X network, increase costs, reduce access for millions (esp. rural and students), and injure public health—harms irreparable | Government argues no concrete, record-backed irreparable harm and that rule should take effect | Court finds irreparable harm likely and that equities/public interest strongly favor preserving status quo; grants nationwide preliminary injunction preserving 2014 Program Requirements under 42 C.F.R. Pt. 59 |
Key Cases Cited
- Rust v. Sullivan, 500 U.S. 173 (1991) (upholding 1988 Title X regulations restricting abortion-related counseling and referrals)
- California v. Azar, 911 F.3d 558 (9th Cir. 2018) (preliminary injunction standards; government-party equities merge)
- Winter v. NRDC, 555 U.S. 7 (2008) (standard for preliminary injunctions)
- Disney Enters., Inc. v. VidAngel, Inc., 869 F.3d 848 (9th Cir. 2017) (articulation of the four-factor injunction test)
- Hernandez v. Sessions, 872 F.3d 976 (9th Cir. 2017) (sliding-scale approach to injunction factors)
- Motor Vehicle Mfrs. Ass'n v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29 (1983) (arbitrary-and-capricious review requires reasoned explanation and consideration of relevant factors)
- L.A. Haven Hospice, Inc. v. Sebelius, 638 F.3d 644 (9th Cir. 2011) (injunctive relief must not be more burdensome than necessary)
- Califano v. Yamasaki, 442 U.S. 682 (1979) (limitations on scope of injunctive relief absent class certification)
- Drakes Bay Oyster Co. v. Jewell, 747 F.3d 1073 (9th Cir. 2014) (when government is a party, equities and public interest factors merge)