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Mayor and City Council of Baltimore v. Azar (Maryland)

(D. Md. No. 1:19-cv-01103)

This case challenges a Final Rule adopted by the U.S. Department of Health and Human Services (HHS) that imposes 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 include a “gag rule” that prohibits recipients of Title X funds from providing their patients with referrals for abortion care, even when a patient specifically requests a referral; 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, such that they must maintain separate facilities, personnel, medical records, workstations, signage, and public identities.  The Final Rule will 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 they may obtain safe abortion care.

The City of Baltimore is challenging 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.

In addition to Baltimore’s case, six other cases challenging the Final Rule are pending across the country:

  • American Medical Association v. Azar, D. Or. No. 6:19-cv-318
  • California v. Azar, N.D. Cal. No. 3:19-cv-01184
  • Family Planning Association of Maine v. U.S. Department of Health and Human Services, D. Me. No. 1:19-cv-00100
  • National Family Planning and Reproductive Health Association v. Azar, E.D. Wash. No. 1:19-cv-03045
  • Oregon v. Azar, D. Or. No. 6:19-cv-00317
  • Washington v. Azar, E.D. Wash. No. 1:19-cv-03049

Plaintiff: Mayor and City Council of Baltimore

Defendants:  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

Co-counsel: Baltimore City Law Department; Arnold & Porter Kaye Scholer LLP; Yale Law School Reproductive Rights and Justice Project

Timeline and Key Documents:

May 4, 2019                   HHS adopts the Final Rule

April 12, 2019                Plaintiff files Complaint

May 30, 2019                 District court enters Preliminary Injunction

June 6, 2019                  Defendants file Notice of Appeal

June 19, 2019                District court enters Order denying Defendants’ motion to stay the injunction pending appeal

July 2, 2019                   Court of appeals enters Order granting Defendants’ motion to stay the injunction pending appeal

September 18, 2019      Court of appeals hears oral argument

[CLICK HERE FOR BRIEFS FILED IN THE FOURTH CIRCUIT]

Mayor and City Council of Baltimore v. Azar—FOURTH CIRCUIT BRIEFS

Brief for Appellants (Secretary of the United States Department of Health and Human Services, et al.)

Amicus Curiae Brief for State of Ohio and Amici States

Brief for Appellee (Mayor and City Council of Baltimore)

Amicus Curiae Brief for City of New York and Local Governments

Amicus Curiae Brief for National Health Law Program, et al.

Amicus Curiae Brief for National Center for Lesbian Rights, et al.

Amicus Curiae Brief for Institute for Policy Integrity at New York University School of Law

Amicus Curiae Brief for National Center for Youth Law

Amicus Curiae Brief for American College of Obstetricians and Gynecologists, et al.

Reply Brief for Appellants