As President Joe Biden works to overhaul U.S. health care policy, few challenges loom larger for his health secretary than restoring access to family planning while parrying legal challenges to abortion proliferating across the country.
Physicians, clinics and women’s health advocates are looking to Xavier Becerra, Biden’s nominee to run the Department of Health and Human Services, to help swiftly unwind Trump-era funding cuts and rules that decimated the nation’s network of reproductive health providers over the past four years.
But Becerra, who as California’s attorney general fought the Trump administration’s family planning restrictions, faces increasingly conservative federal courts that have backed efforts to restrict reproductive health services, including a Supreme Court dominated by Republican appointees.
The new administration must also contend with an energized anti-abortion movement looking to leverage political power in red state legislatures to finally achieve its decades-long quest to ban abortion outright.
Any Biden administration moves to preserve abortion and other family planning services could set up new legal battles between the federal government and states.
“It’s a minefield,” said Mary Ziegler, a law professor at Florida State University who has written extensively about the history of the nation’s abortion debate.
“Expectations on both sides are extremely high,” she said. “And the Supreme Court may force the issue to the top of the agenda if it does something aggressive to restrict abortion.”
The outlines of the brewing showdown came further into focus Tuesday as Becerra faced opposition from a number of Republicans on the Senate health committee on the first of two days of confirmation hearings.
“For many of us, your record has been … very extreme,” Sen. Mike Braun (R-Ind.) told Becerra at the hearing, accusing him of being “against pro-life.”
By contrast, Becerra has drawn strong support from abortion rights groups, which have applauded his efforts challenging Trump restrictions on family planning services. “He will be a great partner,” said Alexis McGill Johnson, president of the Planned Parenthood Federation of America.
Becerra, whose wife, Dr. Carolina Reyes, is an obstetrician, was scheduled to appear before the Senate Finance Committee on Wednesday, after which his nomination is expected to move to the floor or the Senate for consideration by the whole body.
Successive presidential administrations since the 1980s have restricted or expanded federal support for family planning, depending on which party controlled the White House.
Organizations such as Planned Parenthood that long received federal money through the half-century-old Title X program were forced out of it when the Trump administration effectively barred recipients of federal aid from providing abortions or counseling women about the procedure.
That, in turn, led to widespread cutbacks at clinics across the country and huge drops in the number of people able to get family planning services, according to health care providers.
“We’re seeing so many fewer clients,” said Brenda Thomas, chief executive of Arizona Family Health Partnership, which coordinates the state’s Title X program. Thomas said the number of patients in Arizona’s program dropped 24% in 2019 after the Trump administration issued the new rules and declined an additional 40% in 2020, as the covid-19 pandemic further hampered services.
Biden has pledged to rewrite the family planning regulations so clinics providing reproductive health services can return to the program.
“Both sides have really learned how to maximize use of courts,” said Alina Salganicoff, who directs women’s health policy at KFF, a health policy nonprofit. (KHN is an editorially independent program of KFF.)
“If anyone understands the legal challenges, it’s Becerra,” Salganicoff said. “But these are thorny issues. There are questions about how the Biden administration can move forward and how fast. And there’s no question they are going to be sued.”
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
Noam N. Levey: nevey@kff.org, @NoamLevey
Rachel Bluth: rbluth@kff.org, @RachelHBluth
