Planned Parenthood announced on Tuesday that it will no longer be part of the federal Title X program, which provides contraception and other family planning services to low-income individuals. The group, which treats more than 40% of the roughly 4 million people who benefit from Title X, said it could not in good conscience abide by new administration rules that restrict how its clinics could talk about abortion.
Planned Parenthood is suing President Donald Trump’s administration in court to block this “gag rule,” which allows Title X recipients to still talk about abortion with their patients, but prohibits them from giving people information about where to get an abortion, such as the name of a provider or the location of a clinic.
Aside from a court order, the best hope for the group is Congress. The House has already passed a funding bill that blocks the gag rule. The road will be much steeper, if not impossible, in the GOP-controlled Senate. But if it’s going to go anywhere, it needs to start in the Senate Committee on Health, Education, Labor and Pensions, which oversees the Title X program.
And if it’s going to get out of committee, it will likely need the support of Susan Collins (R-Maine), putting Planned Parenthood in a complicated relationship with a senator who is increasingly the focus of progressive anger.
Collins is one of the few GOP senators who support abortion rights. Luckily for Planned Parenthood, she and Sen. Lisa Murkowski (R-Alaska) sit on the committee, giving abortion rights supporters a majority. Both Collins and Murkowski oppose the gag rule and sent a letter to Health and Human Services Secretary Alex Azar about it last year.
“The best way to reduce the number of abortions is to expand access to family planning services,” Collins said in a statement to HuffPost. “That’s why I have long been a strong supporter of Title X family planning, and why I have repeatedly opposed attempts to impose gag orders or burdensome requirements for separate facilities on both clinics in the United States and family planning programs supported by foreign aid.”
A number of progressive groups have supported Collins over the years, believing that she was one of the few reasonable Republicans left in the caucus who supported issues like LGBTQ equality, the environment and abortion.
The relationship has long been fraying, with activists asking why progressive organizations weren’t working harder to elect a Democrat who would be on their side all the time.
“We can replace lawmakers like Mitch McConnell, Susan Collins, and Steve King,” read an email sent out Wednesday morning by the group EMILY’s List, which works to elect Democratic women who support abortion rights.
The most dramatic break came last year, when Collins voted to confirm Brett Kavanaugh to the Supreme Court. Reproductive rights supporters were especially dismayed by Collins’ vote, since it put in place a conservative majority that could overturn Roe v. Wade or, at the very least, dramatically weaken abortion rights in the country. Collins had also voted to confirm conservative Neil Gorsuch to the Supreme Court in 2017, and she’s been a reliable vote to confirm Trump judges to lower courts who have anti-abortion records.
NARAL Pro-Choice America has already backed Maine House Speaker Sara Gideon (D), one of Collins’ challengers in 2020. It had endorsed her in 2002 and stayed neutral in her 2008 and 2014 races.
Planned Parenthood Action Fund will not endorse Collins in 2020. The group endorses only candidates who have a perfect record on their congressional scorecard, and Collins does not.
But it’s not yet clear whether the group will endorse Gideon, or another Collins challenger, as a forceful message of disillusionment with the senator. It’s been widely reported that the organization backed Collins in 2002, but Planned Parenthood Action Fund said it never endorsed her, although it did give her $5,000 for the campaign. So there was support, but not a formal endorsement. It then endorsed her Democratic challenger in 2008, and stayed neutral in her 2014 race.
But in 2017, even after her vote for Gorsuch, Planned Parenthood gave her an award, recognizing her for being “an outspoken champion for women’s health.”
Planned Parenthood also has a more complicated relationship with Collins than straight-up advocacy groups do; the group still has to operate clinics across the country and relies on people like the senator for funding for programs. Maintaining at least a cordial working relationship with Collins ― and other GOP politicians ― is something Planned Parenthood arguably has to do for its survival.
The GOP senator has also backed, and helped save, Planned Parenthood over the years. In July 2017, for example, she was one of the key Republican votes that killed her party’s legislation to repeal Obamacare. One of the reasons she opposed it was that it would have defunded Planned Parenthood.
“If Planned Parenthood were defunded, other family planning clinics in Maine, including community health centers, would see a 63 percent increase in their patient load,” she said at the time. “Some patients would need to drive greater distances to receive care, while others would have to wait longer for an appointment. ... This is about interfering with the ability of a woman to choose the health care provider who is right for her.”
But her record isn’t perfect. She has also voted to approve, or move forward on, measures that would, among other things, take away funding from Planned Parenthood or Title X.
It’s a tricky balance for Planned Parenthood, and some other progressive groups: If Collins loses but the GOP retains control of the Senate, an anti-abortion Republican would likely take her place on the HELP Committee. And Collins is also next in line to chair the powerful Appropriations Committee. But if there’s a chance to defeat Collins and get a more reliable Democrat in the chamber, isn’t it worth it?
Democrats need to flip at least three seats to retake control of the Senate, and Maine is one of their top targets. Money is already pouring into the race, with Democrats determined to defeat her, and Republicans rewarding her for her vote for Kavanaugh.
“Defunding family planning providers and endangering the health care of tens of thousands of low-income Mainers ― those are the devastating results we’re seeing in the era of Sen. Collins and President Trump,” said Alex Stack, spokesman for the Maine Democratic Party.
“This comes after Senator Collins voted for more than 32 of Trump’s anti-choice judges, including two Supreme Court justices who now threaten the future of Roe v. Wade,” he added. “Any pro-choice credibility Senator Collins once had is long gone.”
Of course, defeating the gag rule needs more than just Collins and Murkowski. Aside from Planned Parenthood, there are now eight states now saying they will no longer accept the federal funds.
The fallout from the Title X gag rule could be significant. In some states, like Alaska, Connecticut, Minnesota and Utah, Planned Parenthood manages the Title X networks. In some rural areas, it’s the only provider for communities to receive family planning services.
On Tuesday, Alexis McGill Johnson, acting president of Planned Parenthood, said a mobile health clinic in Ohio will no longer be able to operate and go into the community to provide testing for sexually transmitted infections. She also said some patients would have long wait times for care or may forgo services.
“When the Senate understands what’s happening, and when they hear from their supporters, they will be way more engaged around this,” McGill Johnson said. “Susan Collins and Lisa Murkowski are both on record opposing the gag rule, so we will continue to reach out to them and their offices to garner support. But this impacts every senator’s home state.”
This article originally appeared on HuffPost.