The Trump Administration has begun to enforce its abortion gag rule, which strips family planning funds from health care providers that perform abortions, refer to abortion providers, or even discuss abortion with their patients.

Title X, the program Trump’s rule targets, provides funding for contraception, STD testing, breast and cervical cancer screenings, and other reproductive health services for low-income and uninsured people.

The rule has faced legal challenges since it was finalized in February, with multiple federal judges blocking it from taking effect. Last week, however, the Ninth Circuit Court of Appeals lifted the freeze, allowing the rule to finally be enforced even as it continues to face ongoing legal challenges, including from Planned Parenthood.

The rule is seen as a direct attack on Planned Parenthood, which stands to lose as much as $60 million in Title X government funding, but Planned Parenthood of the Rocky Mountains (PPRM) is insulated from the attack given that it hasn’t received any Title X funds for nearly two decades.

In 2001, under Colorado’s Republican Governor, Bill Owens, the Colorado Department of Public Health and Environment (CDPHE) withdrew state family planning funds from PPRM based on its interpretation of the Colorado constitution’s ban on direct or indirect state funding for abortion care. Long-time anti-abortion advocate Jane Norton, who then led the CDPHE, argued that because PPRM provided abortions in the same facilities that used Title X dollars for other non-abortion services, those dollars were indirectly funding abortion care.

The only abortion provider in Colorado that relies on Title X funds is the Boulder Valley Women’s Health Center (BVWHC), meaning they’re the only abortion provider poised to lose any funding now that the new rule has gone into effect. Communications Director Lisa Radelet told the Colorado Times Recorder that losing federal family planning funds means slashing about a fifth of their budget, or half a million dollars.

“We’re now in a position where we’re going to have to raise quite a bit of money through other sources,” said Radelet.

BVWHC serves many low-income patients, with more than half of patients served in 2018 falling below the federal poverty line. In order to continue providing sliding scale family planning services to those patients, Radelet said they’re looking for state funding through CDPHE that isn’t connected to Title X. She said she’s hopeful given the state’s history of success in family planning programming and reducing teen pregnancy and the abortion rate.

“We’re not going to stop providing abortion care, but we don’t plan to stop providing subsidized family planning care either,” she said.

Still, it’s unlikely that state funding will make up for the shortfall. That means they’ll have to seek out other funding sources as well, like private donations and grants.

Despite financial concerns, however, Radelet said it was an “easy decision” for them to pull out of the Title X program, given their longstanding commitment to abortion care.

“We were the first abortion clinic in the state, and that’s such a big part of our mission and history, so we weren’t going to give that up,” she said. “It’s going to be tough, but we made the decision that we weren’t going to compromise patient care in order to take federal money.”

Another aspect of the rule, which hasn’t gotten as much attention in the media, is that it requires parental involvement when teens seek out birth control coverage, watering down teen confidentiality. That’s another no-go for BVWHC, said Radelet, given that they operate a teen clinic.

Radelet says they also took issue with the “gag” part of the rule, which prohibits referring to abortion providers or discussing the procedure with patients.

“That’s just not even an ethical way to practice medicine, to withhold information from patients,” she said. “We didn’t feel like we could ask that of our practitioners to do pregnancy counseling that way.”

While BVWHC is the only abortion provider that relies on Title X, and will thus be barred from receiving those funds going forward, there are more than 70 Title X health care providers in the state that don’t provide abortions, but might refer to abortion providers or discuss pregnancy options with patients. Those clinics will have to decide whether to slash their budgets and pull out of the family planning program, or comply with the gag rule.

While many health care providers are poised to lose funding, anti-abortion crisis pregnancy centers are in luck.

Prior to the Trump Administration’s changes, Title X clinics were required to offer comprehensive information about birth control options. That requirement is now watered down, meaning that crisis pregnancy centers, which typically only support abstinence and fertility awareness methods, and rarely have medical staff, can apply for Title X funding.