Thousands of Crisis Pregnancy Centers Caught Lying About HIPAA

12.11.24

Click to skip ahead: In the Courts, how Idaho Republicans are arguing against life-saving abortions. In the Nation, how a Trump administration will deal with EMTALA. Data & Privacy Attacks reveals how crisis pregnancy centers are lying to women about HIPAA protections. In the States, news from Indiana, Tennessee, South Carolina and Texas. Finally, in Keep An Eye On, how abortion ‘coercion’ might be used to lobby against abortion medication.

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In the Courts: Emergency Abortion

A federal court heard arguments yesterday on emergency abortions and whether states should be forced to save women’s lives. Yes, this is a real thing that Republicans are spending time and taxpayer money on—the ability to ban life-saving abortions.

You can read background on the case here, but the short version is that the fight is over the Emergency Medical Treatment and Labor Act (EMTALA). Idaho Republicans don’t want the federal law to interfere with their abortion ban, which has caused all sorts of mayhem in the state—from women being airlifted for life-saving care in other states, to Idaho losing a quarter of their OBGYNs (who understandably don’t want to work in a state where they could be arrested for doing their jobs).

The Supreme Court heard arguments in the case earlier this year and—in a pretty shitty move—kicked it back to the lower courts. I will never forget this, from Justice Ketanji Brown Jackson’s dissent:

“While this court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires. This Court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it. And for as long as we refuse to declare what the law requires, pregnant patients in Idaho, Texas, and elsewhere will be paying the price.”

If you remember what it was like to hear the anti-abortion arguments in front of the Supreme Court—where we literally had to listen as people calmly discussed how many organs would be okay for women to lose in service of protecting their pregnancy—then you won’t be surprised at how wild the claims were this time around.

One of the lawyers representing Idaho, for example, was John Bursch from the Alliance Defending Freedom—perhaps the most powerful (and terrifying) conservative legal group in the country.

Listen to this exchange that Bursch had with a judge who asked whether women could still obtain abortions if they were at risk of losing a limb:

Bursch’s claim that there’s no “real world scenario” where women might lose a limb because they’re denied abortion care is just flat out wrong. As Susan Rinkunas at Jezebel points out, a woman in Texas had her hands and feet amputated after she developed sepsis following a c-section.

And as Catherine Carroll, lawyer for the U.S., argues later, we have very much watched patients losing or damaging vital organs from fallopian tubes to kidneys.

There is something so incredibly chilling about listening to people calmly discuss destroying women’s bodies piece by piece, body part by body part. As if they’d be content to pick pregnant people apart until only a fetus is left.

The other thing I noticed about the arguments was the sheer number of times we heard the term ‘unborn child.’ While the idea of women losing vital organs was treated as some silly aside, embryos and fetuses were granted full rhetorical personhood in the courtroom. It was this exchange though, between Carroll and Trump appointee Judge Lawrence VanDyke, that sent me over the edge:

To be clear, this is a judge characterizing women who have been flown out of state to save their lives as “mothers who want to kill their babies.”

I’m sorry to repeat this over and over—and I know listening to this awfulness is so much worse than reading it on the page. But that’s precisely why I’m sharing the quotes this way. We can’t forget the absolute mundanity with which they’re discussing our bodies, rights and lives.

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For more on EMTALA and the ‘pro-life’ vision for America, read yesterday’s newsletter:

They're Killing Us

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In the Nation

What will fights like the one over EMTALA mean once Donald Trump takes office? The expectation is that the Trump administration will drop the case against Idaho, maybe even before the Ninth Circuit comes down with a ruling. At least, that’s what anti-abortion groups are counting on.

Carolyn McDonnell from Americans United for Life told POLITICO, “President-elect Trump said he wants to leave abortion as a state’s issue, so it’s unlikely that he’ll just continue litigating the case—that’s not really an option.”

We also know that Project 2025 has very specific plans for the way hospitals should treat emergency life-threatening pregnancies. Namely, they want doctors to trump fetal rights over women’s lives. The conservative roadmap claims that EMTALA requires hospitals to “explicitly protect unborn children,” and that those who don’t could lose all of their federal funding and face civil penalties.

In fact, not only does Project 2025 allow for states to let women die, it calls for a Trump government to end any investigations “into cases of alleged refusals to perform abortions.” In other words, hospitals being investigated for refusing women life-saving care won’t be held accountable.

In better news, Democrats are trying to pass legislation to protect reproductive health data before Trump takes office and Republicans control the legislature. The 19th reports that Sen. Elizabeth Warren is introducing a bill to “put guardrails on the largely unregulated industry buying and selling consumer data.”

The Health and Location Data Protection Act would prohibit data brokers from selling or sharing people’s health and location data.

“Shutting down interstate travel might be unconstitutional and practically impossible. But if patients don’t know how to get abortion pills, or where to travel out of state, the barriers that ban states have erected will be much more effective.” - Law professor Mary Ziegler in Slate, about the growing anti-abortion attacks on speech

Data & Privacy Attacks

I love it when something from the newsletter has real-life tangible impact: Thanks to an Abortion, Every Day exposé, Louisiana’s Attorney General is being urged to investigate the Unexpected Pregnancy Center for revealing private medical information and lying to clients about that information being HIPAA protected. What’s more, AED’s investigation has led to a pretty dramatic revelation about the country’s largest network of crisis pregnancy centers. (Read until the end of the section for details.)

Some background: This past May, AED published an investigation into Heartbeat International, an umbrella organization to thousands of crisis pregnancy centers. I reported that this anti-abortion powerhouse had been collecting and recklessly sharing women’s private health data with corporate employees, thousands of center trainees and—in one case—anyone with an internet connection. The short version is that the group posted training videos using real client records, exposing the private medical information of 13 women who went to Louisiana’s Unexpected Pregnancy Center—down to the dates of their last menstrual periods!

It’s actually worse than it sounds, so if you missed the piece when it was first published, you should read it now:

EXCLUSIVE: Health Data Breach at America’s Largest Crisis Pregnancy Org

The other piece of AED’s investigation centered around how crisis pregnancy centers lie to women about their medical privacy: HIPAA doesn’t apply to nearly any crisis pregnancy centers because they’re not real medical clinics. Still, these groups routinely tell women that their information is protected under HIPAA.

These fake clinics know that invoking HIPAA makes them seem more medically credible, even though they’re well aware that they’re not beholden to the same privacy laws that real OBGYNS and reproductive health clinics are.

Such was the case with the Unexpected Pregnancy Center in Louisiana; the group’s privacy policy told clients that they could file any HIPAA complaints with the Office for Civil Rights at U.S. Department of Health and Human Services (HHS). And so the Campaign for Accountability (CfA) filed a complaint on behalf of the 13 women whose personal information was made public on the internet.

Lo and behold, the HHS got back to CfA, telling them they couldn’t investigate the center because their clients absolutely are not protected by HIPAA. That’s why CfA is now asking Louisiana AG Liz Murrill to investigate the center’s false claims and the data breach.

(To no one’s surprise, the Unexpected Pregnancy Center suddenly removed the HIPAA language from their privacy policy once they realized reporters were asking questions.)

Here’s the most important takeaway: The HHS letter didn’t just say the Louisiana center isn’t governed by HIPAA—it also revealed that Heartbeat International “does not meet the definition of a covered entity or a business associate."

That means the thousands of crisis pregnancy centers affiliated with Heartbeat International are not beholden to HIPAA, and that any who claim as much are lying—perhaps illegally so.

And there’s more! CfA Executive Director Michelle Kuppersmith explained:

"While the letter speaks directly only to the Unexpected Pregnancy Center and Heartbeat International, hundreds if not thousands of CPCs have virtually indistinguishable business models and are affiliated with Heartbeat, and many of these similarly suggest HHS has oversight over their data privacy practices. Now that HHS has clearly explained its lack of jurisdiction, attorneys general must step in and hold CPCs who attempt to deceive women accountable.”

This is a huge deal. These centers are well-funded, embedded in communities nationwide, and central to Republicans’ post-Roe strategy. Stripping them of power and credibility is a vital part of fighting back.

In the States

A Tennessee Republican has introduced a new bill that would mandate a person who “mails or delivers” abortion medication into the state be civilly liable for $5 million. We know what this is about: targeting abortion funds and blue state providers who are mailing abortion pills into the state or helping patients get the care they need. As I’ve said so many times‚ they’re going after the helpers.

A few notable things about this legislation: First, the bill doesn’t just target people who “mail” abortion medication into Tennessee—it also includes anyone who “delivers” the pills. With abortion rights activists preparing for potential enforcement of the Comstock Act, this could be a way to preempt those who might transport abortion medication by driving or other means to circumvent bans on shipping the drugs.

Rep. Gino Bulso’s bill also attempts to establish fetal personhood by defining human life as beginning at fertilization. Ashley Coffield, CEO of Planned Parenthood of Tennessee and North Mississippi, called this “a worst-case scenario that could put patients in prison and force them to pay hefty fines for receiving abortion care.” What’s more, defining life at fertilization could impact access to birth control, given Republicans’ ongoing lie that some forms of contraception are actually abortifacients.

But that’s not all I’m worried about. Bulso’s bill also uses the language of “equal protection,” declaring that “an unborn child is entitled to the full and equal protection of the laws that prohibit violence against any other person.” How is that different than run-of-the-mill fetal personhood? Well, as I’ve outlined previously, “equal protection” is anti-abortion code for classifying abortion as homicide and prosecuting abortion patients as murderers.

And while Bulso claims his bill “only pertains to civil action,” he hinted at broader ambitions when asked by Tennessee reporters about potential criminal penalties for abortion. The Republican lawmaker confirmed he has additional abortion legislation planned for this session but refused to provide specifics.

I really do think Trump’s election is going to further embolden these maniacs, and we’re going to see even more radical legislation seeking to explicitly punish and criminalize abortion patients.

While we’re talking about efforts to criminalize abortion patients, I just need to point something out again: I still haven’t seen one mainstream outlet publish anything about the fact that South Carolina Republicans have introduced legislation to make abortion—and maybe even birth control—punishable by the death penalty. This is what normalizing looks like—silence.

Meanwhile, the Indiana Supreme Court is sidestepping the religious freedom challenge against the state’s abortion ban, meaning the case will remain in the lower courts and that the temporary block on the ban’s enforcement will also stay in place. But remember, that block on the ban only applies to the women who filed the suit.

For those who need a refresher: The ACLU of Indiana sued the state on behalf of Hoosier Jews for Choice, who argue that the ban infringes on their religious rights under the Religious Freedom Restoration Act. A trial court and the state court of appeals agreed that the ban likely violates the RFRA, because not all religions believe life begins at conception or that abortion is wrong. (What I love is that this is a law adopted under Mike Pence that pro-choicers are now using to their benefit.)

From the IndyStar:

“Eventually, if the plaintiffs are successful, hospitals could develop a system of tracking patients who ask for an exemption to the state's abortion law on religious grounds, [ACLU legal director Ken] Falk said. He recalled a case defending Jewish kosher prisoners who sued for access to kosher food. In that case the Department of Corrections developed an application for them to fill out explaining how a kosher diet fits into their religious practice.”

Here’s something else interesting, especially for those in Indiana who may need an abortion: The case was granted class-action status, so the ACLU recommends that anyone who believes that the ban infringes on their religious rights should reach out to their legal team at at intake@aclu-in.org.

In Texas, members of the state’s maternal mortality committee are defending the decision to forgo examining 2022 and 2023 data—deaths from the first two years after the state enacted a total abortion ban.

Dr. Carla Ortique, the OBGYN who chairs the committee told the Austin American-Statesman, “There was absolutely no nefarious intent.” But we know that several members of the committee went to the Washington Post anonymously to voice their concerns—and that the move comes at the same time that Republicans in multiple states are disbanding or tampering with the boards in an effort to cover up women’s deaths.

Every single person on Georgia’s maternal mortality committee was fired, for example, because Republicans were pissed off that ProPublica reporters found out about two women killed by the state’s ban. And Texas politicians recently placed anti-abortion extremist Ingrid Skop on their committee—a woman who doesn’t believe abortion bans ever hurt women.

So it’s a little hard to believe that neglecting to report on 2022 and 2023 had nothing at all to do with abortion. Even if the intentions weren’t nefarious (which I don’t buy), former Texas committee member Nakeenya Wilson said, “The two years that we are skipping are the two most crucial years for reproductive health in this country's history.”

Quick hits:

• A North Dakota Republican says he’s going to introduce a “middle ground” bill on abortion access;

• Ohio Republicans want to stop local government funding for abortion access;

• And the legal fight over North Carolina’s restrictions on abortion medication has been delayed by the courts.

Keep An Eye On

It’s worth paying attention to what’s happening over in the UK right now, where anti-abortion groups are calling on the government to ban abortion medication by mail. The move comes after a 40-year old man was jailed for surreptitiously giving a pregnant woman abortion medication, causing her to lose her pregnancy.

The guy got the pills from a woman friend who pretended to need an abortion in order to get a prescription. So naturally, Right To Life UK has jumped into action—saying that the attack never would happened if women weren’t allowed to self-manage their abortions at home.

You know that American anti-abortion groups have been making the same argument since Roe was overturned—claiming that abortion medication enables abusers. They remain mum, of course, about the fact that it’s more likely that an abuser forces his victim into pregnancy. And as the British Pregnancy Advisory Service correctly points out, women shouldn’t be punished “for the actions of abusive men.”

Given conservatives’ increased focus on ‘coerced abortion,’ it’s safe to assume that this strategy will take an even firmer hold in state and national efforts to ban abortion. You can also count on anti-abortion groups and lawmakers glomming onto individual stories of abuse as they ramp up their campaign against telehealth and medication abortion, specifically.

After all, that’s how Louisiana Republicans made abortion medication a controlled substance: a lawmaker relayed the story of his sister’s abusive husband slipping the pills in her drink. All of which is to say, we know that they don’t give a shit about abused women—but it’s a good time to get our own talking points in order to make other people understand as much.