Planned Parenthood is calling the Trump administration's bluff.

Faced with a Health and Human Services rule that would have prevented its clinicians from referring patients for abortion, the family planning organization announced on Monday, Aug. 19, it will no longer participate in Title X, the decades-old federal funding mechanism to provide low-income Americans with funds for birth control, STD testing, cancer screenings and family planning.

The federal program will now move forward without the provider responsible for treating 40 percent of its recipients nationally, 90 percent of its recipients in Minnesota.

“We are proud to have served nearly 1 million Minnesotans through Title X since its inception nearly 50 years ago," said Sarah Stoesz, president and CEO of Planned Parenthood North Central States. "It’s baffling that our president and vice president are forcing Planned Parenthood out of this crucial public health program, a move that will lead to more unintended pregnancies, sexually transmitted diseases and cancer. We will do everything in our power to fight this rule for one simple reason: it is a direct attack on the health of our state and our country.”

The decision by Planned Parenthood to walk away from millions in federal money will be felt by 53,000 low-income women seeking free or reduced-rate contraception, pelvic exams and crisis counseling in clinics supported by Title X funding in Minnesota, according to Jennifer Aulwes, communications director of Planned Parenthood Minnesota, North Dakota and South Dakota.

"The Title X program is really the safety net," Aulwes said. "If someone doesn't qualify for any other family planning assistance in the state of Minnesota, they rely on it to help cover their cost of care or to cover it entirely. When you're talking about an age group between 19 and 29 years old, paying nothing or $10 for your care is a whole lot different than paying $50 for your care. These are young people, these are college students."

The $286 million program, created as part of the Johnson Administration's War on Poverty, directly funded non-abortion related reproductive health services for 26,047 recipients at Planned Parenthood Clinics in Minnesota last year. Over half of these recipients utilized the seven Planned Parenthood clinics in the Twin Cities metro area, but large numbers of low-income women also were served with Title X funds in greater Minnesota.

Planned Parenthood in Minnesota operates clinics in Alexandria, Apple Valley, Bemidji, Brooklyn Park, Duluth, Eden Prairie, Grand Rapids, Mankato, Minneapolis, Moorhead, St. Paul, Richfield, St. Cloud, Virginia, Willmar and Woodbury. The move will remove funding that in 2018 supported over 900 patients in Rochester, 1,100 patients in St. Cloud, 1,300 patients in Mankato, 1,600 patients in Duluth, and 3,000 patients in Moorhead, which also treats patients from Fargo.

"One of the specific populations affected by this are North Dakota residents who travel to Moorhead ," Aulwes said. "Those folks don't qualify for any Minnesota-based family planning program, but they do qualify for Title X and make up about 60 percent of the patients we see in Moorhead."

Planned Parenthood had been given until Monday to submit plans showing how they would comply with a new Trump Administration rule implemented in February and slated to take effect in September. The rule required all recipients of Title X to separate financially from facilities offering abortion, and to cease to refer patients to abortion resources in clinical conversations.

In limiting what clinicians can say to patients in the privacy of medical offices , a restriction of the sort normally invoked as a cautionary tale by opponents of government-funded health care, the latter rule struck a variety of professional associations as a bridge too far. Among those who filed letters of opposition were The American College of Obstetricians and Gynecologists, The American College of Physicians, The American Academy of Pediatrics and The Society for Adolescent Health and Medicine.

Also opposing the changes to Title X was the American Medical Association, which wrote in a statement last February that "the patient-physician relationship relies on trust, open conversation and informed decision making and the government should not be telling physicians what they can and cannot say to their patients."

"The rule we're saying we cannot ethically comply with," says Aulwes, "is a rule that would essentially force our providers to withhold information about abortion from our patients, and of course we can't do that ... That would be unethical for a medical provider to do that. Our patients count on us to give them a full range of information."

With such a wholesale fall-off in utilization for the nation's decades-old reproductive health assistance, critics say it's not clear whether the departure of Planned Parenthood from the program was the latest expression of the ongoing clash between supporters and opponents of the right to abortion, or a new front on an emerging campaign to weaken family planning.

In 2017, the Trump administration rescinded mandatory coverage of birth control in the Affordable Care Act, a move that has been halted for the time being in the courts. In May of this year, the HHS announced a new rule to allow health care workers to cite personal belief in refusing to provide medical procedures including birth control.

"In general terms this is an attack on access to birth control." say Aulwes. "The legislation that enacted this program was signed in 1971 by President Nixon. It was a bipartisan effort to make sure that low-income Americans had access to birth control, because it was recognized that was in the best interest of the public health. To find ourselves in 2019 having to go backwards on that is incredibly alarming, and a total disservice to the people of this country."