WASHINGTON — The Trump administration warned California on Friday that it must stop requiring health insurance plans in the state to provide abortion coverage or risk losing federal money.
The move — the latest clash between the White House and the nation’s largest state — opens a new front in a long-running national debate over whether abortion services must be covered by health insurance.
It threatens to further restrict Californians’ access to abortion services, which must be offered in health plans that cover individuals and employees of small business in the state.
The state’s rules, which broadly parallel regulations in five other states, including New York, Illinois and Washington, do not apply to larger employer plans or to federally funded insurance plans, including Medicare and Medicaid.
“If California wants to provide abortion services, it can do so,” said Roger Severino, who directs the Office for Civil Rights in the Department of Health and Human Services. “What the state is not free to do is force people to pay for other people’s abortions.”
California has 30 days to repeal its abortion mandate, Severino said.
The announcement came as President Donald Trump, who is aggressively courting religious conservatives ahead of his reelection campaign, on Friday became the first sitting president to address the annual March for Life in Washington.
The administration has not detailed which federal funds could be jeopardized by a refusal to comply.
Access to abortion has long been a bedrock of California health policy, and the state enshrines a right to privacy in its constitution.
But opponents of abortion rights have long chafed at abortion coverage mandates in California and other states, arguing that they force opponents of the procedure to pay for them with their tax or premium dollars, violating their conscience.
California’s rule — issued in 2014 by the state’s managed care department — was challenged by two religious groups: Skyline Wesleyan Church, a large evangelical congregation in La Mesa, Calif., and the Missionary Guadalupana of the Holy Spirit, a Los Angeles order of Catholic nuns.
A lawsuit by the Catholic order was dismissed by a California court.
Severino said the administration determined it would have to step in to protect the conscience rights of the nuns and the church.
“We are the last hope for people whose rights have been violated,” he said.
The notice from the Health and Human Services Department to California Gov. Gavin Newsom, California Attorney General Xavier Becerra and other state officials charges that the state’s mandate violates the so-called Weldon amendment.
The amendment, which has been added to federal spending bills since 2004, specifies that federal funds may not be provided to any state or local governments that subject “any institutional or individual healthcare entity to discrimination on the basis that the healthcare entity does not provide, pay for, provide coverage of, or refer for abortions.”
The Trump administration alleges that the state’s requirement that health plans cover abortion services effectively discriminates against health insurance plans that don’t cover these services.
Becerra, who is representing the state in numerous disputes with the Trump administration, blasted the warning Friday.
“The President & VP are once again attacking women’s health in order to grandstand at today’s anti-choice rally,” the state attorney general said in a Twitter post. “Make no mistake, this action against CA is just one more attempt to chip away at women’s rights & access to abortion.…
“While it’s unfortunate that the President’s moral compass always points to sowing division for cheap political gain, California won’t be deterred. We will fight this by any means necessary.”
The administration’s moves also drew condemnation from groups supporting abortion rights.
“This is the same tired tactic we have seen from the Trump administration in its attempts to restrict and ban access to abortion,” said Jodi Hicks, president of Planned Parenthood Affiliates of California.
“California law guarantees the right to abortion access and coverage, as aligned with the U.S. Supreme Court’s ruling in Roe v. Wade. Furthermore, California courts have declared that health plans must treat abortion and pregnancy care equally, as they are both basic healthcare services under California law.”
The administration’s latest move follows a successful effort by conservatives to challenge California’s treatment of faith-based crisis pregnancy centers, which ended up at the U.S. Supreme Court.
California in 2015 enacted legislation forcing such pregnancy centers, which strongly oppose abortion rights, to let women know that the procedure was an option for them.
The Supreme Court in 2018 backed a challenge from one of the centers that alleged the rule violated its free-speech rights.
And last year, the Trump administration gave a California family planning grant to Obria Group, a rival to Planned Parenthood that does not support modern family planning methods such as the use of contraceptives.
Speaking at the March for Life Friday in Washington, Trump promised to keep up the fight to roll back access to abortion.
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“Unborn children have never had a stronger defender in the White House,” Trump told the cheering crowd, reciting a litany of policies and actions he has taken to restrict abortion rights domestically and abroad.
The administration’s initiatives challenging abortion providers such as Planned Parenthood have won wide acclaim among religious conservatives, who have emerged as a key electoral base for Trump.
The White House has prominently touted the president’s moves to curtail abortion access, including limits on international aid for family planning groups that even discuss abortion and the nomination of conservative federal judges endorsed by the antiabortion movement.
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