Mayor and City Council of Baltimore v. Azar (Maryland)
D. Md. No. 1:19-cv-01103 / 4th Cir. Nos. 19-01614, 20-01215 / Sup. Ct. No. 20-429, 20-454
This case challenged a Final Rule adopted by the U.S. Department of Health and Human Services (HHS) during the Trump-Pence administration that imposed restrictions on organizations receiving grants pursuant to Title X of the Public Health Services Act (Title X), 42 U.S.C. §§ 300 -300a-6.
Established in 1970, Title X is a federal grant program dedicated to providing individuals with comprehensive family planning and related preventive health services. These services include birth control; wellness exams; cervical and breast cancer screenings; and testing and treatment for sexually transmitted infections (STIs). Title X benefits low-income people; the uninsured; and communities that have historically faced barriers to healthcare access. More than four million U.S. residents rely on Title X-funded healthcare providers for affordable birth control and preventive health services.
The restrictions imposed by the Final Rule included a “gag rule” that prohibited recipients of Title X funds from providing their patients with referrals for abortion care; and “separation requirements” mandating that recipients of Title X funds be “physically and financially separate” from any person or entity who provides, refers for, or advocates for abortion care, including by maintaining separate facilities, personnel, medical records, workstations, signage, and public identities. The Final Rule threatened to harm the intended beneficiaries of Title X by limiting the number of healthcare providers willing and able to serve them, and preventing them from obtaining accurate information about where to obtain safe abortion care.
The City of Baltimore challenged the Final Rule to prevent these harms from impacting its residents. The Baltimore City Health Department, founded in 1793, is the oldest continuously operating health department in the United States. It operates a network of health centers that serve over 7,500 Title X clients annually.
On February 14, 2020, the district court issued a permanent injunction blocking the federal government from enforcing the Final Rule in Maryland. The full court of appeals affirmed that ruling.
In addition to Baltimore’s case, seven other cases challenged the Final Rule:
- American Medical Association v. Azar, D. Or. No. 6:19-cv-00318 / 9th Cir. No. 35386 / Sup. Ct. No. 20-429
- California v. Azar, N.D. Cal. No. 3:19-cv-01184 / 9th Cir. No. 19-15974 / Sup. Ct. No. 20-539
- Essential Access Health, Inc. v. Azar, 3:19-cv-01195 / 9th Cir. No. 19-15979 / Sup. Ct. No. 20-429
- Family Planning Association of Maine v. U.S. Department of Health and Human Services, D. Me. No. 1:19-cv-00100 / 1st Cir. No. 20-1781
- National Family Planning and Reproductive Health Association v. Azar, E.D. Wash. No. 1:19-cv-03045 / 9th Cir. No. 19-35394 / Sup. Ct. No. 20-429
- Oregon v. Azar, D. Or. No. 6:19-cv-00317 / 9th Cir. No. 19-35386 / Sup. Ct. No. 20-539
- Washington v. Azar, E.D. Wash. No. 1:19-cv-03040 / 9th Cir. No. 19-35394
Baltimore’s case is the only one that produced a permanent injunction.
On February 22, 2021, the Supreme Court granted HHS’s petition to review the Baltimore case and consolidated it for oral argument with the Ninth Circuit cases listed above. But after the Biden-Harris administration announced its intention to repeal the Final Rule, the Supreme Court dismissed the case.
On November 8, 2021, a new Title X rule took effect, which explicitly repealed the prior rule.
Mayor and City Council of Baltimore
Secretary of the United States Department of Health and Human Services, in his official capacity; United States Department of Health and Human Services; Deputy Assistant Secretary for the Office of Population Affairs, in her official capacity; Office of Population Affairs
Timeline and Key Documents:
November 8, 2021
May 17, 2021
Supreme Court dismisses the case
February 22, 2021
Supreme Court grants certiorari petition and consolidates this case with others from the Ninth Circuit under lead docket number 20-429
December 23, 2020
December 14, 2020
October 7, 2020
September 3, 2020
May 7, 2020
En banc court of appeals hears oral argument
April 15, 2020
March 31, 2020
March 30, 2020
March 4, 2020
February 26, 2020
February 24, 2020
February 14, 2020
September 18, 2019
Court of appeals hears oral argument
July 2, 2019
June 19, 2019
June 6, 2019
May 30, 2019
May 4, 2019
HHS adopts the Final Rule
April 12, 2019
FOURTH CIRCUIT BRIEFS
Appellants’ Briefs (Secretary of the United States Department of Health and Human Services, et al.)
Appellee’s Brief (Mayor and City Council of Baltimore)
Amicus Briefs Supporting Appellants
Amicus Briefs Supporting Appellee
- City of New York and Local Governments
- National Health Law Program, et al.
- National Center for Lesbian Rights, et al.
- Institute for Policy Integrity at New York University School of Law
- National Center for Youth Law
- American College of Obstetricians and Gynecologists, et al.