The Biden-Harris administration has withheld millions in federal funds from Oklahoma due to the state’s refusal to provide abortion referrals to pregnant women.
Earlier this year, the pro-life state sued the Biden-Harris Department of Health and Human Services (HHS) and its Secretary, Xavier Becerra, seeking the reinstatement of over $4.5 million in family-planning grants. The case was escalated through the courts, eventually reaching the U.S. Supreme Court. On Tuesday, the Supreme Court denied Oklahoma’s request, with Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch indicating they would have granted the application.
Background
The grant program at the center of the dispute was established in 1970 under Title X of the Public Health Service Act, with Congress giving HHS the authority to set eligibility requirements. In 2021, the Biden-Harris HHS renewed two conditions: family-planning projects must provide pregnant women with “neutral, factual information and nondirective counseling” about their options, including abortion. Additionally, projects must offer referrals for all options when requested.
In 2022, Oklahoma was approved for one such grant, running from April 2022 to March 2023. However, Oklahoma’s abortion ban took effect a few months into the grant term, coinciding with the Supreme Court’s Dobbs ruling, which stated that there is no constitutional right to abortion.
Following the Dobbs decision, the Biden-Harris HHS quickly informed Oklahoma and other grant recipients that the ruling did not exempt them from the requirement to refer pregnant women for abortions to receive federal grant money. Oklahoma refused, citing state law, and revised its policies accordingly. The HHS rejected these changes and suggested Oklahoma could comply by providing pregnant women with the number of an abortion referral hotline. Oklahoma refused this compromise, resulting in the Biden-Harris administration terminating the grant—a strategy it has also used in Tennessee.
‘Diminishing healthcare services in this way harms the public interest.’
Oklahoma challenged the HHS decision. When a federal judge declined to compel the Biden-Harris administration to release the funds, Oklahoma appealed to the 10th Circuit Court of Appeals in Denver. The court ruled 2-1 in favor of HHS, allowing the agency to continue withholding the money.
Arguments
Oklahoma argued that the HHS violated the Weldon Amendment, which prohibits federal agencies and programs from discriminating against healthcare entities that do not “provide, pay for, provide coverage of, or refer for abortions.” Oklahoma claimed it was stripped of all Title X funds because its State Department of Health (OSDH) “declined to refer for abortions after Oklahoma’s historic abortion prohibition was revitalized in the wake of Dobbs v. Jackson Women’s Health Organization.”
The state also asked the Supreme Court to consider whether HHS had violated the Weldon Amendment and the Constitution’s spending clause by requiring abortion referrals. Oklahoma further argued that Congress’ spending power does not allow it to delegate grant eligibility requirements to HHS, according to the New York Times.
U.S. Solicitor General Elizabeth Prelogar, representing the Biden-Harris administration, countered that the Weldon Amendment had not been violated because the OSDH is “not protected” under the amendment. Prelogar also argued that the requirement for abortion referrals did not violate the Constitution’s spending clause because Congress “routinely conditions federal grants on compliance with requirements contained in agency regulations, and this Court has repeatedly upheld such requirements.”
Prelogar suggested to the justices that despite Oklahoma’s characterization of the funds as critical to the state’s healthcare system, this dispute had “modest practical stakes.”
Several pro-life and religious medical associations previously filed an amicus curiae with the 10th Circuit, emphasizing that the HHS rule “threatens to reduce the resources available to members of the public who seek fertility services, family-planning information, and other medical services from healthcare professionals who share their beliefs about abortion and the sanctity of human life. Diminishing healthcare services in this way harms the public interest.
