American Medical Assn. v. Cochran, Sec. of H&HS

In 2019, the Department of Health and Human Services (HHS) issued a Rule imposing major changes on the Title X family planning program. See 84 Fed. Reg. 7,714 (Mar. 4, 2019). The Rule both prohibits and compels certain pregnancy-related speech between a Title X provider and her patient, proscribing abortion-related information but requiring information about non-abortion options—regardless of what the patient wants. The Rule also imposes burdensome physical separation requirements on any Title X provider engaging in abortion-related activities outside the Title X program. 1. Whether the Rule is arbitrary and capricious. 2. Whether the Rule violates the Title X appropriations act, which requires that “all pregnancy counseling” under Title X 'shall be nondirective.' 3. Whether the Rule violates Section 1554 of the Affordable Care Act, 42 U.S.C. § 18114, which requires that HHS 'shall not promulgate any regulation' that harms patient care in any one of six ways, including by 'interfer[ing] with communications' between a patient and her provider.

Respondents challenged a Health and Human Services (HHS) rule that prohibited medical facilities that receive federal funds under Title X from referring patients to abortion treatments. The Fourth Circuit and Ninth Circuit examined this matter, coming to opposing conclusions. The Ninth Circuit en banc found that the rule was supported by statutory restrictions that Title X funds not be used for abortion services. See 42 USC 300(a)(6). The Fourth Circuit en banc found that the rule controverted the “nondirective mandate” of the Affordable Care Act where abortion could not be referred. See 42 USC 18114. Both parties petitioned the U.S. Supreme Court for review, citing this circuit-split. HHS argues that the rule conformed to its given statutory authority and that its understanding of Title X restrictions was reasonable. Respondent argues that the rule was “arbitrary and capricious” because the agency record did not answer concerns that the rule may cause doctors to disobey their medical ethics and that the rule was contrary to the “nondirective mandate” because it prohibited doctors from advising their patients of "all available options."