Trump Administration Threatens California Over Insurance Abortion Mandate

President Trump arrives to speak at the 47th annual "March for Life" in Washington, D.C., on Jan. 24, 2020. He is the first U.S. president to address, in person, the country's biggest annual gathering of anti-abortion campaigners. (Nicholas Kamm/AFP via Getty Images)

Saying that California is violating a federal law, the Trump administration on Friday threatened the state with a potential loss of federal health care funds over its requirement that insurance plans cover abortions.

The announcement was timed to coincide with the anti-abortion March for Life in the nation's capital, and came on a day when President Trump became the first president to address the marchers in person. Religious conservatives are a core element of Trump's political coalition, and his administration has gone out of its way to deliver on their demands.

The U.S. Health and Human Services Department said it is issuing a "notice of violation," giving California 30 days to comply with a federal law known as the Weldon amendment. The law bars federal health care funding from being provided to states or entities that practice "discrimination" against a health care organization on the basis that it "does not provide, pay for, provide coverage of, or refer for abortions."

The director of the HHS Office for Civil Rights, Roger Severino, said California is violating that restriction by requiring insurance plans to cover abortions. According to Severino, 28,000 Californians had abortion-free plans prior to the state's requirements and have now lost that option. The federal government has received complaints from an order of nuns — the Missionary Guadalupanas of the Holy Spirit in Los Angeles — as well as Skyline Wesleyan Church near San Diego. Neither group immediately responded to KQED requests for comment.

"If states receive federal funds ... they cannot discriminate against a health plan that declines to cover abortions," Severino said.

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California lawmakers and abortion advocates quickly responded to the notice. Democratic Gov. Gavin Newsom alluded to the political overtones of the announcement and the Republican administration's ongoing feud with California on numerous issues in denying that the state is doing anything wrong.

"Despite a federal opinion four years ago confirming California's compliance with the Weldon amendment, the Trump administration would rather rile up its base to score cheap political points and risk access to care for millions than do what's right," Newsom said in a statement, referring to the Obama administration's decision to reject a similar challenge to the state's mandate. "California will continue to protect a woman's right to choose, and we won't back down from defending reproductive freedom for everybody."

California Attorney General Xavier Becerra said Trump was "using the official levers of government to advance his political agenda."

“Women’s health should never be dangled as bait for the sake of political grandstanding," Becerra said in a statement.

The move, said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California, was "the same tired tactic we have seen from the Trump administration in its attempts to restrict and ban access to abortion."

"Access to abortion is law of the land and California will not back down in our fight to defend and expand, not ban, access to abortion,” Hicks said.

It is unclear why the administration is taking action now over a mandate that has been in place for years and why it has chosen to first target California, which is one of a few states that require abortion coverage in private health insurance plans. Severino also didn't specify which of many streams of federal health care funds — amounting to tens of billions of dollars — might be in jeopardy for California. That could include money for community health centers, Medicaid health insurance for low-income people and basic public health activities like educating parents about vaccines.

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The state has become something of a familiar antagonist for the president. He has repeatedly lambasted its prominent politicians — with tweets targeting House Speaker Nancy Pelosi and Newsom, among others — and repeatedly threatened to cut off its federal relief funds for fighting wildfires.

Federal law has long barred the use of taxpayer money to pay for abortions, except in cases of rape, incest or to save the life of the woman. That bipartisan consensus could change if a Democrat wins the White House in November, since the Democratic candidates have pledged to take a more assertive stance on abortion rights.

The HHS Civil Rights Office headed by Severino has traditionally mainly handled complaints about privacy violations. Under Trump, it added a new division to handle cases of alleged discrimination on the basis of religious or moral scruples.

But a federal judge in New York last year blocked a Trump administration rule that could have opened the way for more clinicians and health care workers to refuse to participate in abortions and other procedures because of religious or moral objections.

U.S. District Judge Paul A. Engelmayer said the administration's claim that there has been a significant increase in complaints about health care industry workers being forced to violate their conscience was "flatly untrue." The Supreme Court has picked up the case for consideration.

This post contains reporting from the Associated Press, NPR and KQED.