The Trump administration says it's reversing an Obama administration rule aimed at protecting Planned Parenthood and other providers from states seeking to freeze them out of funding.
The Health and Human Services Department said the move was restoring flexibility to states, but health advocacy groups said the action is clearly aimed at shutting down women's access to abortions and, potentially, other healthcare as well.
"This is part of the Trump administration's commitment to roll back regulations instituted by the Obama administration to radically favor abortion," Charmaine Yoest, assistant secretary for public affairs at HHS, told reporters in a telephone briefing.
In April 2016, the Obama HHS department told states they were in violation of federal law if they withheld payments from any qualified health provider, including Planned Parenthood.
"On Friday, CMS (the Center for Medicare and Medicaid Services) issued a State Medicaid Director Letter restoring state flexibility to establish reasonable standards for their Medicaid programs," HHS said in a statement.
"The letter rescinded an April 2016 guidance (State Medicaid Directors Letter #16-005), which limited states' long-standing authority to regulate providers operating within their states."
Federal law already forbids the use of federal funds for abortions. But anti-abortion rights groups and many conservative politicians oppose the use of any tax dollars to pay Planned Parenthood and other providers for any patient care.
"Additionally, HHS' Office for Civil Rights (OCR) is announcing a new proposed rule to enforce 25 existing statutory conscience protections for Americans involved in HHS-funded programs, which protect people from being coerced into participating in activities that violate their consciences, such as abortion, sterilization, or assisted suicide," HHS said.
On Thursday, HHS said it wascreating a new division to protect the religious rights of healthcare providers.
Officials who spoke to reporters said they did not know what effect, if any, the new policies would have on provision of birth control. Many groups sued the federal government when they were required by the 2010 Affordable Care Act to provide birth control to employees as part of health insurance coverage.
HHS officials were also unable to say if the rules would apply to healthcare providers who do not want to tend to lesbian, gay, bisexual or transgender people.
"We want people from all walks of life to be served and to be able to be served," said Roger Severino, director of HHS's Office of Civil Rights.
"Today's actions represent promises kept by President Trump and a rollback of policies that had prevented many Americans from practicing their profession and following their conscience at the same time," said acting HHS Secretary Eric Hargan.
"Americans of faith should feel at home in our health system, not discriminated against, and states should have the right to take reasonable steps in overseeing their Medicaid programs and being good stewards of public funds."
But critics saw a different motivation.
"This will mean that more states will try to ban Planned Parenthood from serving Medicaid patients in their states," said Alina Salganicoff of the nonpartisan Kaiser Family Foundation.
The American College of Obstetricians and Gynecologists said provision of care should be based on science, not on beliefs.
"ACOG strongly opposes the denial of Medicaid coverage to low-income Americans who receive primary and preventive care from qualified providers, including Planned Parenthood," it said.
Dawn Laguens, executive vice president of the Planned Parenthood Action Fund, said states can now move to close clinics.
"Without Planned Parenthood, many of our patients would lose access to health care altogether — either because there are no other providers in their community or because other clinics cannot serve all of our patients," she said.
"The Trump-Pence administration has taken action after action to infringe on our freedoms and take away rights, including allowing employers to deny birth control coverage to employees; cutting teen pregnancy prevention programs; taking away protections for sexual assault survivors and transgendered people; implementing andexpanding the global gag rule, which puts vulnerable women around the world at risk; and setting up a new office designed to ensure that individuals can be denied access to basic health care and information based on their providers' personal beliefs."
Gretchen Borchelt of the National Women's Law Center said the new policies were rolling back rights gained by women and LGBT people.
"This proposed rule would recklessly, callously, and illegally broaden existing laws to allow doctors, nurses, insurance plans, hospitals — and nearly any other employee in health care settings that receive any federal funds — to use their religious or moral beliefs to determine the essential care a patient receives," she said.
Maggie Garrett, legislative director of Americans United for Separation of Church and State, said the action put religious beliefs ahead of medical need.
"Women and LGBTQ patients are clearly the target of today's discriminatory rule, but its reach goes even further and could negatively affect the health care of many others. Religious freedom is fundamental, but so is the right of patients to access the health care they need. This rule betrays both," Garrett said.