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15333 Culver Blvd, Ste. 340-819 Irvine, CA 92604

949.734.0859 CMP.org

31July2018OfficeoftheAssistantSecretaryforHealthOfficeofPopulationAffairs,Attention:FamilyPlanningU.S.DepartmentofHealthandHumanServices,HubertH.HumphreyBuilding,Room716G200IndependenceAvenueSWWashington,DC20201DearSecretaryAzar,AssistantSecretaryADMGiroir,ActingDirectorHuber:Iamwritingtocommentinsupportoftheproposedrule“CompliancewithStatutoryProgramIntegrityRequirements,”HHS-OS-2018-0008-0001,torevisetheOfficeofPopulationAffairs’TitleXregulationstobettercomplywithandimplementtheclearstatutorydirectivesof42U.S.C.300etseq.toprotecttaxpayersfrombeingforcedtosubsidizeelectiveabortion.TheCenterforMedicalProgress(CMP)isanon-profitcitizenjournalismorganizationdedicatedtomonitoringandreportingonmedicalethicsandadvances,withaspecialfocusonbioethicalissuesthatimpacthumandignity.CMPisresponsibleforthegroundbreaking,long-terminvestigativejournalismstudy“TheHumanCapitalProject”,whichdocumentedsenior-levelleadershipatTitleXproviderPlannedParenthoodcallouslynegotiatingtheharvestingandsaleoflate-termabortedfetalbodypartsinviolationoffederallaw.1CMP’sundercovervideosexposingPlannedParenthood’ssaleofabortedbabybodypartspromptedtwonational-scopeinvestigationsbytheSenateJudiciaryCommittee2andtheHouseEnergy&CommerceCommittee’sSelectInvestigativePanel,whichfound“systematicviolations”offederallawatmultipleTitleXproviderPlannedParenthoodaffiliates.3TheCongressionalinvestigationsmadecriminalreferralstotheFBIandU.S.DepartmentofJusticeforTitleXprovidersPlannedParenthoodMarMonte,PlannedParenthoodNorthernCalifornia,PlannedParenthoodLosAngeles,PlannedParenthoodPacificSouthwest,theirparentorganizationPlannedParenthoodFederationofAmerica,andtheirbusinesspartners.41Seehttp://www.centerformedicalprogress.org/human-capital/2HumanFetalTissueResearch:ContextandControversy,Dec.2016,https://www.grassley.senate.gov/sites/default/files/judiciary/upload/22920%20-%20FTR.pdf3SelectInvestigativePanelFinalReport,30Dec.2016,https://energycommerce.house.gov/news/letter/select-investigative-panel-final-report/Seepgs.xxi,18,181,365.4Seehttps://www.grassley.senate.gov/news/news-releases/grassley-refers-planned-parenthood-fetal-tissue-procurement-organizations-fbiandhttps://energycommerce.house.gov/news/press-release/select-panel-refers-numerous-entities-further-investigation-possible/

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LastDecember,theDOJannounceditwasfollowinguponthecriminalreferralsandinvestigatingthesales,5andtwocompaniesthatobtainedfetalorgansandtissuesfromlate-termabortionsatTitleXproviderPlannedParenthoodOrange&SanBernardinoCountiesadmittedguiltforsellingthefetaltissueagainstthelawina$7.8millionsettlementwiththeOrangeCountyDistrictAttorney’sOffice.6OCDAcreditedCMP’sinvestigativereportingwithpromptingthesuccessfulcase.7ThefiveCaliforniaPlannedParenthoodaffiliatesimplicatedintheCongressionalinvestigationsandcriminalreferralscollectivelyreceivedover$5millioninTitleXfundingin2016alone.8TitleX’sextensivecomminglingwithPlannedParenthood’sabortion-as-family-planningandbabypartsbusinessinCaliforniaillustratestheunconscionableabuseoftaxpayerdollarsthatfullimplementationandenforcementofSection1008oughttoprevent.CMPcommentsinsupportoftheproposednewrule,andtohighlighttheneedforfullenforcementoftheTitleXstatutetofulfillthestatute’spolicygoalthatthepublicnotbeforcedtosubsidizetheabortionindustry.

ABORTIONASFAMILYPLANNINGINCALIFORNIATITLEXPROGRAMSInTitleX’sstatutoryauthorization,42U.S.C.300a-6states,“Noneofthefundsappropriatedunderthissubchaptershallbeusedinprogramswhereabortionisamethodoffamilyplanning.”Underthecurrentregulatoryimplementation,however,theclearwordsofthisstatuteareadeadletter.Eachofthe7regionalPlannedParenthoodaffiliatesinCaliforniaperformsabortions,andaccordingtothemostrecentTitleXdirectory,virtuallyeverysingleoneofPlannedParenthood’sapproximately100clinicsinCaliforniaisaTitleXsite.TheseTitleXsitesincludesomeofthemostnotoriouslate-termabortionclinicsinCaliforniaoperatedbyPlannedParenthood:thePlannedParenthoodclinicsinRiverside,SanDiego,andOrangeallperformelectiveabortionsupto6months,9andeachofthemislistedinthedirectoryasaTitleXsite.10TheHouseSelectInvestigativePanelreleasedamonthlyinvoicefromPlannedParenthoodMarMonteseekingpaymentfromitsbusinesspartnerStemExpressforfetaltissue“ProductsOfConception”thatStemExpresshadharvestedatPlannedParenthoodMarMonteclinics.Every

5“JusticeDept.InvestigatingFetalTissueTranfersbyPlannedParenthoodandOthers,”NicholasFandos,TheNewYorkTimes,8Dec.2017,https://www.nytimes.com/2017/12/08/us/politics/planned-parenthood-fetal-tissue-transfers-federal-investigation.html6“Firmsreach$7.8-millionsettlementoverallegationsofsellingfetaltissue,”DanielLanghorne,TheLosAngelesTimes,9Dec.2017,http://www.latimes.com/local/lanow/la-me-fetal-tissue-20171209-story.html7OCDApressrelease,8Dec.2017,http://orangecountyda.org/civica/press/display.asp?layout=2&Entry=54068SeeEssentialAccessHealthIRSForm990,2016,pg.34,http://rct.doj.ca.gov/Verification/Web/Download.aspx?saveas=222412.pdf&document_id=09027b8f80300fa79Seehttps://www.plannedparenthood.org/health-center/california/riverside/92506/riverside-center-2187-90110/abortionandhttps://www.plannedparenthood.org/health-center/california/san-diego/92101/first-avenue-specialty-services-michelle-wagner-center-4036-90110/abortionandhttps://www.plannedparenthood.org/health-center/california/orange/92866/orange-health-center-3264-90160/abortion10Seepages155-156,https://www.hhs.gov/opa/sites/default/files/Title-X-Family-Planning-Directory-June2018.pdf

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singlePlannedParenthoodMarMontecliniclistedontheinvoiceasasiteforharvestingandsellingfetaltissue,isaTitleXsite:

PlannedParenthoodMarMonteinvoicetoStemExpress,LLCforpaymentforabortedfetaltissue.ExhibitD1fromHouseSelectInvestigativePanelhearing,“ThePricingofFetalTissue,”20April2016.https://energycommerce.house.gov/hearings/pricing-fetal-tissue/

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AllTitleXgrantmoneyinCaliforniapassesthroughEssentialAccessHealth(EAH),theprimarygranteewhichthendistributestothenumeroussub-recipients,includingPlannedParenthoodaffiliates.In2016,4outofthe5topsub-recipientsofTitleXgrantsthroughEAHwerePlannedParenthoodaffiliates.11All7ofCalifornia’sregionalPlannedParenthoodaffiliatesareTitleXsub-recipientsunderEAH,andtogethertheyreceivedover$5.6millionin2016—wellover25%ofEAH’stotalapproximately$20milliongranteachyear.12ForeverydollarinTitleXmoneyspentinCalifornia,about$0.28goestoPlannedParenthood.EAHitselfisanorganizationthatembracestheconceptofabortionasfamilyplanning.In2016,EAH,co-sponsoredCaliforniaAB1954,the“DirectAccesstoReproductiveHealthAct”,underwhich“healthinsuranceplansareprohibitedfromrequiringenrolleestosecureareferralpriortoaccessingservicesrelatedto[…]abortion”.13Infact,ofEAH’s13legislativeprioritiesin2016,6ofthemhadtodowithexpandingelectiveabortionaccess.14EAHoffersanonlineContinuingEducationCreditmedicalcoursein“BestPracticesinPregnancyOptionsEducation”,whichinstructsproviders:“Qualitypregnancyoptionseducationincludesprovidingmedicallyaccurate,unbiased,non-judgmentalinformationaboutabortion”,andspecifiesthat“FamilyPlanningStaff”shouldattendthiscourse.15OfEAH’s15BoardDirectors,almosthalfofthemhaveclosetiestoPlannedParenthood.Meanwhile,2ofthe5officialsonEAH’sExecutiveTeamarelongtimePlannedParenthoodexecutives—CEOJulieRabinovitzistheformerCOOofPlannedParenthoodofIllinois,andCommunicationsDirectorAmyMoywasformerlythePublicRelationsmanagerforPlannedParenthoodGoldenGate.16ItisunsurprisingthatEAHisdedicatedtobothPlannedParenthood’scontinuedfundingwithtaxpayerdollarsandPlannedParenthood’spromotionofabortionasfamilyplanning.Foritspart,PlannedParenthoodwasaPresentingSponsorofEAH’s50thanniversary.17

ORGANIZATIONALSEPARATIONNECESSARYTOFULLYIMPLEMENTSECTION100811See2016IRSForm990forEssentialAccessHealth,Ibid.12Seehttps://www.hhs.gov/opa/grants-and-funding/archive/past-grant-awards/index.html13EAHFactSheetonCaliforniaAB1954,http://www.essentialaccess.org/sites/default/files/AB1954_Direct_Access_to_Reproductive_Health_Act_Fact_Sheet.pdf14EAH2016LegislativePriorities,http://www.essentialaccess.org/sites/default/files/EssentialAccessHealth_Legislative_Priorities_2016.pdf15EAHContinuingEducationonlinecoursedescription,“BestPracticesinPregnancyOptionsEducation,”https://www.essentialaccess.org/learning-exchange/best-practices-pregnancy-options-education-online-course16EssentialAccessHealthtiestoabortion-as-family-planningadvocacyandPlannedParenthood,BoardDirectors:JenniferBlum,MPH,GynuityHealthProjects,http://gynuity.org/about/staff/blum/;Dr.KimberlyGregory,overseesMaternal-FetalMedicinerotationatPPLA,https://apps.acgme.org/ads/Public/Programs/Detail?programId=31825;Dr.PratimaGupta,abortionproviderwithPhysiciansforReproductiveHealth,https://twitter.com/prhdocs/status/610475107102945280;KimMeredith,formerChiefDevelopmentOfficerforPPFA,https://pacscenter.stanford.edu/person/kim-meredith/;MonaShah,PPFAChampionsforWomen’sHealthAward,2014,https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-honors-congressional-staffers-champions-womens-health-award;AllisonSonenshine,longtimechairofPPOSBCBoardofDirectors,https://www.linkedin.com/in/allyson-sonenshine-ab4268/;SandraShewry,formerCAHealthDepartment,defendedPPfromFalseClaimsActlawsuit,http://articles.latimes.com/2008/mar/08/local/me-billing8;ExecutiveStaff:CEOJulieRabinovitz,formerSeniorVPofBusinessOperations,PPIL,https://www.linkedin.com/in/julie-rabinovitz-mph-0351a925/;VPPublicAffairsAmyMoy,formerVPPublicRelationsPPGoldenGate,https://www.linkedin.com/in/amy-moy-1677523/17Seehttps://www.essentialaccess.org/set-future-motion

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InPartIV.IoftheSupplementaryInformationtotheproposedrule,theDepartment“seekspubliccommentastowhetheradditionalregulatoryprovisions,suchasarequirementforaTitleXclinictooperateunderadistinctnamefromafacilitythatprovidesabortionasamethodoffamilyplanning,orfororganizationalseparation,arenecessarytoensurecompliancewithsection1008.”BasedontheexperienceofCalifornia’sTitleXsubsidizationoflargePlannedParenthoodabortionaffiliates,totalorganizationalseparationisnecessarytoenforcetheproposedrule’sphysicalandfinancialseparationrequirementsandtofullyimplementtherequirementsoftheTitleXstatute.ThefollowingtablesummarizestheCaliforniaPlannedParenthoodaffiliates,theirtotalamountofTitleXgrantsin2016,thenumberoftheseaffiliates’TitleXclinicslistedintheOPADirectorythatalsoperformelectiveabortions,andtheannualnumberofabortionsperformedbythePlannedParenthoodaffiliate/TitleXsub-recipient:

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TitleXSub-Recipient TotalGrants(2016)18

ABClinicTitleXSites,and

(%totalSites)19

Abortions(mostrecent

year)20PlannedParenthoodMarMonte $1,743,498 26

(79%) 17,884

PlannedParenthoodNorthernCalifornia $952,900 17

(100%) Unreported

PlannedParenthoodLosAngeles $1,052,689 16

(76%) 12,686

PlannedParenthoodOrange&SanBernardinoCounties $663,020 9

(100%) 8,601

PlannedParenthoodofthePacificSouthwest $658,087 14

(88%) 16,999

PlannedParenthoodPasadena&SanGabrielValley $219,915 3

(75%) ~800

PlannedParenthoodCaliforniaCentralCoast $362,625 5

(100%) Unreported

TOTAL: $5,652,734 90(86%)

atleast56,970

Fully86%ofPlannedParenthoodTitleXsitesinCaliforniaarealsoabortionclinics,whichisunsurprisinggiventheinstitutionalcultureandbusinessmodelofthePlannedParenthoodbrand.21Whileintheabstract,physicaland/orfinancialseparationbetweenabortionservicesandTitleXprogramsmightseemsufficienttocarryoutthedirectivesofSection1008,forabortion-centricproviderslikePlannedParenthood,nothingshortoftotalorganizationalseparationislikelytoprotecttaxpayersfromproppinguptheorganization’sabortionbusiness.TitleXproviderPlannedParenthoodMarMonteisboththelargestPlannedParenthoodaffiliateinthecountry,andalsothelargestTitleXsub-recipientinCalifornia.Planned

18From2016IRSForm990forEssentialAccessHealth,Ibid.19FromOPATitleXFamilyPlanningDirectory,June2018,https://www.hhs.gov/opa/sites/default/files/Title-X-Family-Planning-Directory-June2018.pdfandPlannedParenthooddirectory,https://www.plannedparenthood.org/health-center20Frommostrecentaffiliatereports,availableathttps://www.plannedparenthood.orgexceptforPPPSGV,personalreportfromDr.MaryGatter,formerMedicalDirector,http://www.centerformedicalprogress.org/wp-content/uploads/2015/05/PPFA020615_transcript.pdf21“AbortionmandatecostsPlannedParenthoodafewaffiliates,”M.AlexJohnson,NBCNews,6Dec.2012,http://usnews.nbcnews.com/_news/2012/12/06/15702142-abortion-mandate-costs-planned-parenthood-a-few-affiliates

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ParenthoodMarMonteperformsnearly18,000abortionseveryyear,22and79%ofPPMM’sTitleXsitesperformabortions.PlannedParenthoodMarMonte’sabortionrevenueandTitleXrevenuearebothpaiddirectlytoPlannedParenthoodMarMontethecorporation,aswasthemoneythatStemExpresspaidtoPlannedParenthoodMarMonteinexchangeforabortedfetalbodyparts.PlannedParenthoodMarMonte,Inc.paysitsMedicalDirectortomanageboththeabortionpracticeandtheTitleXoperations,itpaysthecontractphysicianswhoperformabortions,anditpaysforclinicinfrastructureandclinicmanagementwheretheabortionsareperformed.23Theassets,grants,andrevenuesheldbyanaffiliatelikePlannedParenthoodMarMontedirectlyenableitsmassiveabortionprogrambecausetheabortionprogramiscoextensivewiththePlannedParenthoodaffiliateitself.Additionally,anyPlannedParenthoodaffiliatemustpayduesbacktothenationalofficeatPlannedParenthoodFederationofAmerica,24whichinturnoffersgrantsbacktoaffiliatestoexpandabortionservicesandrequirestheycomplywithitsdirectives.Inlightofthesefacts,totalorganizationalseparationislikelyrequiredtokeepabortionproviderslikePlannedParenthoodfromsimplyplayingshellgameswithpublicfunding.

CONCLUSIONTheDepartment’supdatestoOPA’sTitleXregulationsarelongoverdueinordertofullycomplywiththeclearlawandpolicyoftheTitleXstatuteat42U.S.C.300a-6,andtoprotectAmericantaxpayersfrombeingforcedtosubsidizeprogramsthatpeddleabortionasamethodoffamilyplanning.Sincerely,

DavidDaleidenFounder&ProjectLeadTheCenterforMedicalProgress

22PlannedParenthoodMarMonteAnnuelReport,FY2017,https://www.plannedparenthood.org/uploads/filer_public/74/0c/740cbaa6-0d5a-42be-a5e3-3fd852cdddf4/ar17_final_lowres.pdf23SeePlannedParenthoodMarMonte2015IRSForm990,http://rct.doj.ca.gov/Verification/Web/Download.aspx?saveas=1330757.PDF&document_id=09027b8f802f33d124SeePPFAAnnualReport,https://www.plannedparenthood.org/uploads/filer_public/d4/50/d450c016-a6a9-4455-bf7f-711067db5ff7/20171229_ar16-17_p01_lowres.pdf