Planned Parenthood v. Sanchez , 403 F.3d 324 ( 2005 )


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  •                                                           United States Court of Appeals
    Fifth Circuit
    F I L E D
    REVISED MARCH 30, 2005
    IN THE UNITED STATES COURT OF APPEALS           March 11, 2005
    Charles R. Fulbruge III
    FOR THE FIFTH CIRCUIT                   Clerk
    No. 03-50930
    PLANNED   PARENTHOOD   OF   HOUSTON AND SOUTHEAST TEXAS;
    PLANNED   PARENTHOOD   OF   NORTH TEXAS;
    PLANNED   PARENTHOOD   OF   SAN ANTONIO AND SOUTH CENTRAL TEXAS;
    PLANNED   PARENTHOOD   OF   WEST TEXAS;
    PLANNED   PARENTHOOD   OF   THE TEXAS CAPITAL REGION;
    PLANNED   PARENTHOOD   OF   CENTRAL TEXAS,
    Plaintiffs-Appellees,
    versus
    EDUARDO J SANCHEZ, Texas Commissioner of Health,
    Defendant-Appellant.
    Appeal from the United States District Court
    for the Western District of Texas
    USDC No. A-03-CA-415-SS
    Before HIGGINBOTHAM, DENNIS, and CLEMENT, Circuit Judges.
    PATRICK E. HIGGINBOTHAM, Circuit Judge:
    The Texas Legislature restricted the distribution of federal
    family planning funds.          Finding this state legislation likely
    preempted by federal spending statutes, the district court granted
    a preliminary injunction against its enforcement.          The district
    court concluded that the state legislation could not be interpreted
    to permit various Planned Parenthood organizations to continue
    1
    receiving federal funds by creating independent affiliates.                   We
    disagree.      Persuaded that the state legislation does admit of this
    potentially saving construction, we remand for further proceedings.
    I
    The State of Texas voluntarily participates in several federal
    programs that provide funds for family planning services.                 Among
    these programs are Title X of the Public Health Service Act,1 which
    provides project grants to public and private agencies for family
    planning services, and Title XX of the Social Security Act,2 which
    provides block grants to the states for social services, including
    family planning.        The regulations for Title X specify that funds
    may not be used to finance abortions or abortion-related activity.3
    Both parties agree that any Title XX funds used to match Title X
    funds are subject to the same restrictions.            Furthermore, Title XX
    funds may not be used for the provision of medical care.4                    The
    State also receives Medicaid funding under Title XIX of the Social
    1
    42 U.S.C. § 300 et seq.
    2
    42 U.S.C. § 1397 et seq.
    3
    Title X provides that “[n]one of the funds appropriated under this
    subchapter shall be used in programs where abortion is a method of family
    planning.” 42 U.S.C. § 300a-6.
    4
    42 U.S.C. § 1397d(a)(4) (“[G]rants made under this subchapter may not be
    used by the State, or by any other person with which the State makes arrangements
    to carry out the purposes of this subchapter . . . for the provision of medical
    care (other than family planning services, rehabilitation services, or initial
    detoxification of an alcoholic or drug dependent individual) unless it is an
    integral but subordinate part of a social service for which grants may be used
    under this subchapter.”).
    2
    Security Act,5 which provides medical care to the needy through a
    cooperative federal-state program.
    The Texas Department of Health (TDH)6 distributes federal
    family program grants under Titles X and XX.            On May 8, 2003, TDH
    sent letters to the family planning contractors that had been
    approved to receive funding under TDH’s federal family planning
    program      grants.7     Appellees--six    Planned    Parenthood     entities
    located in various parts of Texas that had been contractors in
    Texas’s family planning program for many years--were among the
    groups approved for funding.           Pursuant to Title X’s statutory
    requirements, Appellees strictly segregated their Title X programs
    from their abortion-related activities to ensure that no federal
    funds were used for abortions.8         Thus, Appellees provided Title X
    and XX family planning services using the federal funds disbursed
    by TDH, and provided abortion services using private funding.
    There is no evidence in the record to suggest that Title X or XX
    funds were ever improperly commingled with private abortion funds.
    5
    42 U.S.C. § 1396 et seq.
    6
    TDH became part of the Texas Department of State Health Services (TDSHS)
    on September 1, 2004. See Act of June 10, 2003, 78th Leg., R.S., Tex. H.B. 2292.
    Eduardo J. Sanchez, previously the Texas Commissioner of Health, is now the
    Commissioner of the TDSHS.      For simplicity we will continue refer to the
    defendant as TDH.
    7
    The letters stated that the “funding award is subject to change as a
    result of legislation and/or changes in appropriations.”
    8
    One of the Appellees, Planned Parenthood of the Texas Capital Region, had
    not yet begun providing abortions but intended to “break ground” on the
    construction of an abortion clinic in September 2003.
    3
    Just under one month later, on June 2, 2003, the Texas
    Legislature passed the Texas General Appropriations Act.9               The Act
    included Rider 8, a provision restricting distribution of federal
    family planning money, including Title X and XX funds.10                Rider 8
    provides:
    8.    Prohibition on Abortions
    a. It is the intent of the Legislature that no
    funds shall be used to pay the direct or
    indirect costs (including overhead, rent,
    phones and utilities) of abortion procedures
    provided by contractors of the department.
    b. It is also the intent of the legislature
    that no funds appropriated under Strategy
    D.1.2, Family Planning, shall be distributed
    to individuals or entities that perform
    elective abortion procedures or that contract
    with or provide funds to individuals or
    entities for the performance of elective
    abortion procedures.
    c. If the department concludes that compliance
    with b. would result in a significant
    reduction in family planning services in any
    public health region of the state, the
    department may waive b. for the affected
    region to the extent necessary to avoid a
    significant reduction in family planning
    services to the region. This waiver provision
    shall expire on August 31, 2004, and no waiver
    shall extend beyond that date.
    d. The department shall include in its
    financial audit a review of the use of
    appropriated funds to ensure compliance with
    this section.
    9
    78th Leg., R.S., Tex. H.B. 1. The Governor signed the Act on June 22,
    2003 and it became effective on September 1, 2003.
    10
    Rider 8 applies to all TDH contractors receiving funds under Strategy
    D.1.2, which includes federal funds granted to TDH pursuant to Title X, Title XIX
    and Title XX. The parties focus primarily on Rider 8’s effect on Title X funds.
    4
    TDH immediately began efforts to implement Rider 8.                On June
    10, 2003, TDH sent letters to previously approved family planning
    contractors, including Appellees, requiring them to sign and return
    an affidavit by June 30, 2003.               The affidavit was a pledge by a
    contractor applying for Title X and XX funds that, as of September
    1, 2003, it would perform no elective abortion procedures and that
    it would not contract with or provide funds to individuals or
    entities for the performance of abortions. Appellees were informed
    that unless they made this pledge they would be ineligible for
    participation in the funding programs.
    Appellees filed suit on June 26, 2003, seeking immediate
    injunctive relief. Appellees focused on section (b) of Rider 8 and
    raised three basic arguments: (1) that Rider 8(b) imposes an
    unconstitutional condition on Appellees’ eligibility for funds; (2)
    that it imposes an unconstitutional burden on a woman’s right to
    obtain an abortion; and (3) that it violates the Supremacy Clause11
    by   imposing      additional    eligibility     requirements    on    Appellees’
    receipt of federal funds that are inconsistent with the federal
    funding statutes.
    The district court issued a temporary restraining order on
    June 30, 2003.         A few days later, on August 4, 2003, the court
    entered      a   preliminary     injunction     barring   TDH   from   enforcing
    11
    U.S. CONST. art. VI, cl. 2.
    5
    paragraphs (b) and (c) of the Rider.12               The court determined that
    Appellees      had    demonstrated     a       likelihood   of   success    on   the
    unconstitutional condition claim and the Supremacy Clause claim.
    In reaching this conclusion the court held that Rider 8 could not
    be interpreted to allow Appellees effectively to continue receiving
    federal funds by creating independent “affiliates”--that is, legal
    entities separate from those performing abortions.
    TDH appeals the court’s holding as to the unconstitutional
    condition and Supremacy Clause claims, and asserts that Rider 8 can
    be interpreted to allow affiliates.                Appellees, in turn, contend
    that the district court erred in concluding that Rider 8 imposes no
    undue burden on women’s right to obtain an abortion.
    II
    We     review   the   ultimate   decision       to    grant   a   preliminary
    injunction for an abuse of discretion.13                A decision grounded in
    erroneous legal principles is reviewed de novo.14
    To obtain a preliminary injunction plaintiffs must show (1) a
    substantial likelihood of success on the merits, (2) a substantial
    threat that plaintiffs will suffer irreparable injury if the
    12
    Planned Parenthood of Cent. Tex. v. Sanchez, 
    280 F. Supp. 2d 590
    (W.D.
    Tex. 2003).
    13
    See Doran v. Salem Inn, Inc., 
    422 U.S. 922
    , 931-32 (1975) (“[W]hile the
    standard to be applied by the district court in deciding whether a plaintiff is
    entitled to a preliminary injunction is stringent, the standard of appellate
    review is simply whether the issuance of the injunction . . . constituted an
    abuse of discretion.”); Karaha Bodas Co., L.L.C. v. Perusahaan Pertambangan
    Minyak Dan Gas Bumi Negara, 
    335 F.3d 357
    , 363 (5th Cir. 2003).
    14
    See Karaha Bodas 
    Co., 335 F.3d at 363
    .
    6
    injunction is not granted, (3) that the threatened injury outweighs
    any damage that the injunction might cause the defendant, and (4)
    that the injunction will not disserve the public interest.15                    A
    preliminary injunction is an “extraordinary remedy” and should only
    be granted if the plaintiffs have “‘clearly carried the burden of
    persuasion’ on all four requirements.”16
    III
    We turn to the Supremacy Clause claim.            Appellees assert that
    Rider 8 is invalid under the Supremacy Clause because it adds
    eligibility requirements to the receipt of federal funds that are
    inconsistent       with   federal     law.     The   district   court   found   a
    substantial likelihood of success on the merits.             In our review, we
    first explain why this is a preemption claim.                   Then we examine
    whether      the   district   court    had    jurisdiction   and   whether   the
    Appellees stated a claim, as well as the role of 42 U.S.C. § 1983
    in this case.
    A
    Where, as here, a state law purportedly conflicts with federal
    statutes enacted under the Spending Clause,17 courts often proceed
    15
    
    Id. 16 Id.
    (quoting Miss. Power & Light Co. v. United Gas Pipe Line Co., 
    760 F.2d 618
    , 621 (5th Cir. 1985)).
    17
    U.S. CONST. art. 1, § 8, cl. 1 (“The Congress shall have Power To lay and
    collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the
    common Defence and general Welfare of the United States . . . .”).
    7
    without invoking “preemption.”18        Some courts have explicitly found
    that preemption was not an issue in such cases,19 while others have
    expressed ambivalence.20        The growing consensus, however, is to
    analyze such claims under traditional preemption doctrine.21                 The
    First Circuit gave the following explanation:
    18
    See, e.g., Townsend v. Swank, 
    404 U.S. 282
    (1971) (holding state law
    invalid by virtue of conflict with federal Spending Clause legislation but
    without reference to “preemption”); King v. Smith, 
    392 U.S. 309
    (1968) (same).
    19
    See, e.g., Jane Does 1 Through 4 v. State of Utah Dep’t of Health, 
    776 F.2d 253
    , 256 (10th Cir. 1985) (finding state parental consent conditions
    violated Title X, but noting that “[w]e do not see a preemption issue in this
    case”).
    20
    See, e.g., N.Y. State Dep’t of Soc. Servs. v. Dublino, 
    413 U.S. 405
    , 411
    n.9 (1973) (noting that “pre-emption” is used “in a rather special sense” because
    the litigation addresses whether a state has gone too far in placing conditions
    on the receipt of federal funds, rather than the “arguable federal pre-emption
    of a wholly independent state program dealing with the same or a similar
    problem”).
    Another court expressed the following:
    It would not seem to be of any consequence whether this
    is described as “preemption” in the sense used in the
    traditional doctrine, or as an application of the
    Supremacy Clause to the administration of state-federal
    programs derived from the voluntary nature of state
    participation in the programs. The latter is a more
    realistic treatment . . . .
    . . . .
    . . . If the [state chooses] to participate, there
    is thereby accepted a limitation or restriction on state
    statutes or regulations which conflict with the federal
    statutes.     This has consequences similar to the
    traditional preemption doctrine but as mentioned they
    come about by a choice made by the state.
    Planned Parenthood Ass’n of Utah v. Dandoy, 
    810 F.2d 984
    , 988 (10th Cir. 1987)
    (citation omitted).
    21
    See, e.g., Pharm. Research & Mfrs. of Am. v. Walsh, 
    538 U.S. 644
    , 661-68
    (2003) (plurality) (addressing potential conflict between state statute and
    Medicaid as preemption question); 
    id. at 684-85
    (O’Connor, J., joined by
    Rehnquist, C.J., and Kennedy, J., dissenting) (also utilizing preemption
    framework); Lawrence County v. Lead-Deadwood Sch. Dist. No. 40-1, 
    469 U.S. 256
    ,
    259 n.6, 260 (1985).
    8
    The vast majority of preemption cases
    involve situations in which Congress has
    exercised its power under the Commerce Clause.
    Here,    however,   we   are   dealing   with   a
    congressional exercise of the spending power,
    not the commerce power, and the dynamics
    between preemption and Congress’s reliance on
    the spending power differ appreciably from
    those applicable in the Commerce Clause
    context. The principal difference is that
    whereas preemptive legislation enacted under
    the    Commerce    Clause   trumps   state    law
    throughout the United States ex proprio
    vigore, preemptive legislation enacted under
    the spending power presents states with a
    choice: they may either accept federal funds
    (and    subject   themselves   to   requirements
    imposed by federal law) or decline such funds
    (and avoid the necessity of abiding by those
    requirements).22
    Because TDH has “willingly tapped into the federal fisc,”23 we
    use the terminology and framework of preemption in analyzing
    Appellees’ Supremacy Clause claim, as did the district court
    below.24
    B
    We next ask whether the district court properly exercised
    jurisdiction       over    Appellees’          preemption    claim     and    whether
    Appellees’ efforts state a claim.               We answer in the affirmative.
    1
    22
    O’Brien v. Mass. Bay Transp. Auth., 
    162 F.3d 40
    , 42-43 (1st Cir. 1998)
    (citation omitted) (citing LAURENCE H. TRIBE, AMERICAN CONSTITUTIONAL LAW § 6-29, at 508
    (2d ed. 1988)); cf. Frew ex rel. Frew v. Hawkins, 
    540 U.S. 431
    , (2004) (upholding
    enforcement of consent decree as federal law against state agency, TDH, that
    entered into it).
    23
    
    O’Brien, 162 F.3d at 43
    .
    24
    See 
    Sanchez, 280 F. Supp. 2d at 596-605
    .
    9
    It     is    well-established     that   the    federal    courts    have
    jurisdiction under 28 U.S.C. § 1331 over a preemption claim seeking
    injunctive and declaratory relief.25 In Shaw v. Delta Airlines, the
    Supreme Court held:
    A plaintiff who seeks injunctive relief from
    state regulation, on the ground that such
    regulation is pre-empted by a federal statute
    which, by virtue of the Supremacy Clause of
    the Constitution, must prevail, thus presents
    a federal question which the federal courts
    have jurisdiction under 28 U.S.C. § 1331 to
    resolve.26
    We recently affirmed this principle, holding that when a plaintiff
    seeks “injunctive relief based on a federal statute, federal
    question jurisdiction clearly exists based on Shaw.”27              Several of
    our sister circuits have explicitly agreed.28
    2
    25
    See, e.g., Verizon Md., Inc. v. Pub. Serv. Comm'n of Md., 
    535 U.S. 635
    ,
    641-43 (2002); Lawrence 
    County, 469 U.S. at 259
    n.6; Shaw v. Delta Air Lines,
    Inc., 
    463 U.S. 85
    , 96 n.14 (1983).
    26
    
    Shaw, 463 U.S. at 96
    n.14.
    27
    Gillis v. Louisiana, 
    294 F.3d 755
    , 760 (5th Cir. 2002) (citation
    omitted); see also Hope Med. Group for Women v. Edwards, 
    63 F.3d 418
    (5th Cir.
    1995) (assuming jurisdiction exists for federal courts to adjudicate plaintiffs’
    claims that state abortion law conflicts with federal spending statute).
    28
    See Qwest Corp. v. City of Santa Fe, 
    380 F.3d 1258
    , 1264 n.1 (10th Cir.
    2004) (where preemption “is the basis for a federal claim in [plaintiff’s]
    complaint in federal court, [Shaw and Verizon] make clear that there is federal
    question jurisdiction in these circumstances”); Local Union No. 12004, United
    Workers of Am. v. Massachusetts, 
    377 F.3d 64
    , 74 (1st Cir. 2004) (“[A] claim of
    preemption . . . does constitute a federal question under § 1331.”); Ill. Ass’n
    of Mortgage Brokers v. Office of Banks & Real Estate, 
    308 F.3d 762
    , 765 (7th Cir.
    2002) (finding that § 1331 provides jurisdiction over preemption claim); St.
    Thomas-St. John’s Hotel & Tourism Ass’n, Inc. v. Government of the United States
    Virgin Islands, 
    218 F.3d 232
    , 241 (3d Cir. 2000) (same).
    10
    TDH argues that, even with federal jurisdiction over the
    claim, it was improper for the district court to resolve it because
    Appellees were not seeking to vindicate any right or to enforce any
    duty running to them--a necessary host, in the view of TDH, to
    Appellees’ assertion that Rider 8 was preempted by federal Spending
    Clause legislation.         We disagree.
    Cognizant of the distinction between the inquiry into federal
    court jurisdiction and whether a claim has been stated, we remind
    that “[i]t is firmly established [by Supreme Court precedent] that
    the absence of a valid (as opposed to arguable) cause of action
    does not implicate subject-matter jurisdiction, i.e., the courts’
    statutory      or   constitutional       power      to      adjudicate      the   case.”29
    Recently,      however,      a      majority     of      the      Supreme     Court      in
    Pharmaceutical Research and Manufacturers of America v. Walsh
    implicitly rejected the contention that asserting the preemptive
    force of federal Spending Clause legislation is itself no claim.30
    In that case, the plaintiff alleged that a state regulation was
    preempted by Medicaid, a federal Spending Clause statute.                               The
    lower court, in discussing the plaintiff’s standing, observed that
    29
    Verizon Md., 
    Inc., 535 U.S. at 642-43
    (internal quotation marks and
    citation omitted); see also Steel Co. v. Citizens for Better Env’t, 
    523 U.S. 83
    ,
    96 (“[N]onexistence of a cause of action was no proper basis for a jurisdictional
    dismissal.”); Bell v. Hood, 
    327 U.S. 678
    , 682 (1946) (“Jurisdiction . . . is not
    defeated . . . by the possibility that the averments might fail to state a cause
    of action on which petitioners could actually recover. For it is well settled
    that the failure to state a proper cause of action calls for a judgment on the
    merits and not for a dismissal for want of jurisdiction.”).
    
    30 538 U.S. at 661-69
       (plurality);     
    id. at 684-90
      (O’Connor,   J.,
    dissenting).
    11
    the plaintiff had “not asserted an action to enforce rights under
    the Medicaid statute . . . but rather a preemption-based challenge
    under the Supremacy Clause.             In this type of action, it is the
    interests protected by the Supremacy Clause, not by the preempting
    statute, that are at issue.”31                 A plurality of four Justices,
    apparently accepting these conclusions, reached the merits of the
    plaintiff’s claim,32 as did the three dissenting Justices.33 In sum,
    seven      Justices     assumed    both      that    the    federal    courts     have
    jurisdiction and that a claim was stated for Spending Clause
    preemption,       tacitly    rejecting       the    suggestion   advanced    by   two
    concurring Justices--and today espoused by TDH--that no claim was
    stated.34
    Following        Walsh,   the   D.C.     Circuit     addressed   and   quickly
    dispensed       with    a   defendant     state      agency’s    contention       that
    31
    Pharm. Research & Mfrs. of Am. v. Concannon, 
    249 F.3d 66
    , 73 (1st Cir.
    2001), aff’d sub nom. Pharm. Research & Mfrs. of Am. v. Walsh, 
    538 U.S. 644
    (2003).
    32
    
    Walsh, 538 U.S. at 661-69
    (plurality) (finding state law not preempted).
    33
    
    Id. at 684-90
    (O’Connor, J., dissenting) (arguing that state regulation
    was preempted).
    34
    See 
    Walsh, 538 U.S. at 675
    (Scalia, J., concurring) (“I would reject
    petitioner’s statutory claim on the ground that the remedy for the States’s
    failure to comply with the obligations it has agreed to undertake under the
    Medicaid Act is set forth in the act itself: termination of funding by the
    Secretary of the Department of Health and Human Services. Petitioner must seek
    enforcement of the Medicaid conditions by that authority . . . .” (citations
    omitted)); 
    id. at 683
    (Thomas, J., concurring) (expressing doubt as to “whether
    third parties may sue to enforce Spending Clause legislation--through pre-emption
    or otherwise”). These arguments have great purchase, and they might also apply
    in the Title X context, see, e.g., 42 C.F.R. § 59.7(b); 42 C.F.R. § 59.10; 42
    C.F.R. § 50.404(a)(1); however, their persuasive force is wasted on the inferior
    courts. Rather, they must persuade at least three other Justices.
    12
    plaintiffs “have no private right of action for injunctive relief
    against the state” based on the preemptive effect of a federal
    Spending         Clause   statute.35    The   court      explained   that   “[b]y
    addressing the merits of the parties’ arguments without mention of
    any jurisdictional flaw . . . seven Justices [in Walsh] appear to
    have sub silentio found no flaw.”36
    Outside the Spending Clause context, the Supreme Court has
    repeatedly entertained federal preemption claims seeking injunctive
    and declaratory relief.37          Shaw itself indicates that the federal
    courts have jurisdiction “to resolve” such claims.38                 In Verizon
    Maryland, Inc. v. Public Service Commission of Maryland, the Court
    recently reinforced this understanding in holding that there was
    jurisdiction to resolve Verizon’s claim that a state utility
    commission’s order was inconsistent with federal law.39                The Court
    noted:
    Whether the text of [the federal statute] can
    be so construed [to provide for federal court
    review] is a question we need not decide. For
    we agree with the parties’ alternative
    35
    Pharm. Research & Mfrs. of Am. v. Thompson, 
    362 F.3d 817
    , 819 n.3 (D.C.
    Cir. 2004).
    36
    
    Id. 37 See,
    e.g., Lorillard Tobacco Co. v. Reilly, 
    533 U.S. 525
    (2001); Crosby
    v. Nat’l Foreign Trade Council, 
    530 U.S. 363
    (2000); 
    Shaw, 463 U.S. at 96
    n.14;
    see also David Sloss, Constitutional Remedies for Statutory Violations, 89 IOWA
    L. REV. 355, 380 & n.141 (2004) (collecting cases).
    38
    
    Shaw, 463 U.S. at 96
    n.14 (emphasis added).
    
    39 535 U.S. at 642
    .
    13
    contention, that even if [the federal statute]
    does not confer jurisdiction, it at least does
    not divest the district courts of their
    authority under 28 U.S.C. § 1331 to review the
    Commission’s order for compliance with federal
    law.40
    The Court explicitly held that there was jurisdiction to entertain
    the preemption claim, and implicitly accepted that the plaintiffs
    had a right of action to bring such a claim.41
    Our precedent likewise supports an implied right of action in
    this case. In Gillis v. Louisiana, after examining the plaintiff’s
    petition for injunctive relief based on federal preemption and
    concluding that we had jurisdiction to consider it, we addressed
    the merits without pausing to examine the footing of the claim.42
    Similarly, in Hope Medical Group for Women v. Edwards, we decided
    the question of whether state law conflicted with federal Spending
    Clause legislation, again gliding by the question of whether a
    40
    
    Id. 41 TDH’s
    suggestion that Verizon is distinguishable because “the plaintiffs
    identified contractual rights that were violated and therefore gave them a cause
    of action under the Supremacy Clause based on their existing rights” is
    unpersuasive. Verizon did not sue to enforce its contractual rights, and none
    of its claims was based on its alleged contractual rights.         As the Court
    explained:
    Verizon alleged in its complaint that the Commission
    violated the Act and the FCC ruling when it ordered
    payment of reciprocal compensation for ISP-bound calls.
    Verizon sought a declaratory judgment that the
    Commission’s order was unlawful, and an injunction
    prohibiting its enforcement.    We have no doubt that
    federal courts have jurisdiction under § 1331 to
    entertain such a suit.
    
    Id. 42 294
    F.3d 759-60 (suit removed to federal court from state court).
    14
    claim had been stated.43          Finally, in Self-Insurance Institute of
    America v. Korioth, we confronted a claim that a Texas statutory
    provision was preempted by ERISA, noting that “[t]he question of
    preemption is particularly one for the federal courts and arises as
    much    from       the   Constitution     as    from    ERISA.”44    In   exercising
    jurisdiction and upholding the plaintiff’s standing, we held that
    the non-profit organization had proffered “allegations of actual
    injury that are likely to be remedied with favorable court action”
    and remanded the case for an “inquiry into the merits.”45                        While
    Gillis, Hope Medical and Korioth do not directly address the issue
    of whether a valid cause of action existed, we assumed that one
    did.        Today we hold that one does.
    Other circuits have similarly recognized an implied cause of
    action        to    bring    preemption        claims   seeking     injunctive    and
    declaratory relief even absent an explicit statutory claim.46                     One
    
    43 63 F.3d at 423-38
    .
    44
    
    993 F.2d 479
    , 484 (5th Cir. 1993).
    45
    
    Id. at 484-85.
    46
    See Local Union No. 
    12004, 377 F.3d at 74-75
    (“A plaintiff may assert
    federal preemption as an affirmative cause of action to enjoin state officials
    from interfering with federal rights. . . . Verizon and Shaw make clear that in
    suits against state officials for declaratory and injunctive relief, a plaintiff
    may invoke the jurisdiction of the federal courts by asserting a claim of
    preemption, even absent an explicit statutory cause of action.”); 
    Thompson, 362 F.3d at 819
    n.3 (rejecting the argument that plaintiffs asserting preemption
    based on Spending Clause legislation have “no private right of action for
    injunctive relief against the state”); Village of Westfield v. Welch’s, 
    170 F.3d 116
    , 124 n.4 (2d Cir. 1999) (“Without deciding whether Welch has a private right
    of action under the [federal statute], we note that Welch has asserted several
    federal causes of action--including claims based on the Supremacy Clause . . .
    --that do not depend on the existence of a private right of action under the
    [federal statute].”); Bud Antle, Inc. v. Barbosa, 
    45 F.3d 1261
    , 1269 (9th Cir.
    15
    leading authority sums it up as follows:
    While there may be some lack of harmony in the
    case law, the rule that there is an implied
    right of action to enjoin state or local
    regulation that is preempted by a federal
    statutory or constitutional provision--and
    that such an action falls within the federal
    question jurisdiction--is well-established.47
    1994) (“Even in the absence of an explicit statutory provision establishing a
    cause of action, a private party may ordinarily seek declaratory and injunctive
    relief against state action on the basis of federal preemption.”); First Nat’l
    Bank of E. Ark. v. Taylor, 
    907 F.2d 775
    , 776 n.3 (8th Cir. 1990) (“[T]he Supreme
    Court has . . . made clear that a party may apply directly to federal court for
    relief based on an affirmative claim of preemption.” (citing Lawrence 
    County, 469 U.S. at 259
    n. 6; 
    Shaw, 463 U.S. at 96
    n.14)).
    47
    RICHARD H. FALLON, DANIEL J. MELTZER, & DAVID L. SHAPIRO, HART & WECHSLER’S THE
    FEDERAL COURTS & THE FEDERAL SYSTEM 903 (5th ed. 2003).
    While the Supreme Court has not explained the source of this right of
    action, one school of thought holds that the Supremacy Clause itself creates an
    implied cause of action. Professors Wright, Miller and Cooper argue that “[t]he
    best explanation of Ex Parte Young and its progeny is that the Supremacy Clause
    creates an implied right of action for injunctive relief against state officers
    who are threatening to violate the federal Constitution or laws.” 13B CHARLES A.
    WRIGHT, ARTHUR R. MILLER, & EDWARD H. COOPER, FEDERAL PRACTICE AND PROCEDURE: JURISDICTION 2D
    § 3566, at 102 (1984).         Some courts share this view.          See, e.g., Burgio &
    Campofelice v. N.Y. State Dep’t of Labor, 
    107 F.3d 1000
    , 1006 (2d Cir. 1997)
    (“[T]he Supremacy Clause creates an implied right of action for injunctive relief
    against state officers who are threatening to violate [federal law].”); see also
    BellSouth Telecomms., Inc. v. MCImetro Access Transmission Servs., Inc., 
    317 F.3d 1270
    , 1289 (11th Cir. 2003) (Tjoflat, J., dissenting) (disputing majority’s
    finding of jurisdiction but characterizing Shaw as “holding that plaintiffs may
    assert a private right of action directly under the Supremacy Clause of the
    Constitution”); League of Women Voters v. Blackwell, 
    340 F. Supp. 2d 823
    , 828
    (N.D. Ohio 2004) (“[T]he Supremacy Clause provides the cause of action and
    federal jurisdiction.”); but see Legal Envtl. Assistance Found., Inc. v. Pegues,
    
    904 F.2d 640
    , 643 (11th Cir. 1990) (rejecting the proposition that a
    “constitutional cause of action should be implied directly from the Supremacy
    Clause”); Mashpee Tribe v. Watt, 
    542 F. Supp. 797
    , 806 (D. Mass. 1982) (“The
    Supremacy Clause does not support direct causes of action . . . . It only gives
    priority to federal rights created by a federal statute when they conflict with
    state law.”), aff’d, 
    707 F.2d 23
    (1st Cir. 1983).
    Another possible source is the Declaratory Judgment Act, 28 U.S.C.
    §§ 2201-2202, upon which courts have occasionally explicitly relied. See, e.g.,
    First Nat’l Bank of E. 
    Ark., 907 F.2d at 776
    (affirming lower court’s declaration
    that state’s action was preempted by the National Bank Act where “[j]urisdiction
    was invoked pursuant to 28 U.S.C. §§ 1331 and 2201”); Doe v. Pickett, 480 F.
    Supp. 1218, 1223 (S.D. W. Va. 1979) (entering judgment pursuant to §§ 2201-2202
    that state cannot impose parental consent requirement on use of Title X funds).
    While the Declaratory Judgment Act “is not an independent ground for jurisdiction
    [and] permits the award of declaratory relief only when other bases for
    16
    We have little difficulty in holding that Appellees have an
    implied right of action to assert a preemption claim seeking
    injunctive and declaratory relief.
    C
    TDH further argues that plaintiffs must meet the requirements
    for an action under § 1983,48 as recently enunciated in Gonzaga
    University v. Doe.49        We are not persuaded.
    As an initial matter, TDH mischaracterizes the nature of
    Appellees’ claim.        Appellees are not asking the courts to enforce
    their “right” under § 1983 to secure enforcement of Title X, as TDH
    asserts.         Rather,    Appellees’        Supremacy   Clause   argument   is
    fundamentally different: they argue that Rider 8 imposes conditions
    on the receipt of federal funds that are incompatible with Title X.
    Therefore, we need not be concerned that the Supremacy Clause does
    not of its own force create rights enforceable under § 1983.50
    Next, we note that Gonzaga, by its terms, applies only to
    jurisdiction are present,” Jones v. Alexander, 
    609 F.2d 778
    , 781 (5th Cir. 1980)
    (citing, inter alia, Skelly Oil Co. v. Phillips Petroleum Co., 
    339 U.S. 667
    , 671
    (1950)), it might well provide a cause of action where, as here, jurisdiction is
    well-established. While the district court was correct in noting that the DJA
    did not supply jurisdiction, it did not address the potential for the DJA to
    supply a right of action. See 
    Sanchez, 280 F. Supp. 2d at 602
    .
    48
    42 U.S.C. § 1983 (creating private cause of action against one who,
    “under color of any statute, ordinance, regulation, custom, or usage, of any
    State or Territory” causes a “deprivation of any rights, privileges, or
    immunities secured by the Constitution and laws”).
    49
    
    536 U.S. 273
    (2002).
    50
    See Golden State Transit Corp. v. Los Angeles, 
    493 U.S. 103
    , 107-08
    (1989).
    17
    § 1983 claims.       With respect to the plaintiff’s claim for damages,
    the Supreme Court held that “unless Congress ‘speak[s] with a clear
    voice,’ and manifests an ‘unambiguous’ intent to confer individual
    rights, federal funding provisions provide no basis for private
    enforcement by § 1983.”51        The Supremacy Clause claim advanced here
    by Appellees is not based on a claim of right under Title X, nor is
    it a claim for damages; it is a preemption claim.                 The Gonzaga
    Court gave no indication that it intended to alter its prior
    practice regarding such claims, as we have explained.52
    In sum, we affirm the district court’s finding of jurisdiction
    and we hold that Appellees have an implied right of action to seek
    injunctive relief from a state statute purportedly preempted by
    federal Spending Clause legislation.          Such a claim for relief does
    not require a showing, as per Gonzaga, that a § 1983 action would
    also be proper.         We express no opinion on the district court’s
    holding as to the availability of § 1983 in this case.
    51
    Gonzaga 
    Univ., 536 U.S. at 280
    .
    52
    
    See supra
    Part III.B.2; see also Ill. Ass'n of Mortgage 
    Brokers, 308 F.3d at 765
    (finding it unnecessary in adjudicating preemption claim to determine
    whether the federal statute at issue creates rights enforceable under § 1983);
    cf. 
    Concannon, 249 F.3d at 73
    (noting in discussing standing that “regardless of
    whether the Medicaid statute’s relevant provisions were designed to benefit [the
    plaintiff, it] can invoke the statute’s preemptive force”), aff’d sub nom. Walsh,
    
    538 U.S. 644
    ; St. Thomas-St. John Hotel & Tourism 
    Ass’n, 218 F.3d at 241
    (noting
    in discussing standing that “[w]e know of no governing authority to the effect
    that the federal statutory provision which allegedly preempts enforcement of
    local legislation by conflict must confer a right on the party that argues in
    favor of preemption.     On the contrary, a state or territorial law can be
    unenforceable as preempted by federal law even when the federal law secures no
    individual substantive rights for the party arguing preemption.” (emphasis
    added)).
    18
    IV
    We turn now to the merits of Appellees’ preemption claim,
    beginning with core principles.
    A
    By virtue of the Supremacy Clause, it is a “fundamental
    principle of the Constitution . . . that Congress has the power to
    preempt state law.”53           Preemption doctrine requires an examination
    of   Congressional           intent.54        Federal      regulations       have   no   less
    preemptive effect than federal statutes.55                         State action may be
    preempted by federal law in three ways: “by express language in a
    congressional enactment, by implication from the depth and breadth
    of a congressional scheme that occupies the legislative field, or
    by   implication        because        of     a       conflict   with   a    congressional
    enactment.”56       Implied conflict preemption occurs when “compliance
    with        both   federal       and        state       regulations     is    a     physical
    impossibility” or where state law “stands as an obstacle to the
    accomplishment and execution of the full purposes and objectives of
    53
    
    Crosby, 530 U.S. at 372
    .
    54
    Fid. Fed. Sav. & Loan Ass’n v. de la Cuesta, 
    458 U.S. 141
    , 152 (1982).
    55
    
    Id. at 152-53.
           56
    Lorillard Tobacco 
    Co., 533 U.S. at 541
    (citations omitted); accord
    English v. Gen. Elec. Co., 
    496 U.S. 72
    , 79 (1990) (listing three categories of
    preemption); AT&T Corp. v. Public Util. Comm’n of Tex., 
    373 F.3d 641
    , 645 (5th
    Cir. 2004) (same). As the Supreme Court has hastened to point out, however, “the
    categories of preemption are not ‘rigidly distinct.’” 
    Crosby, 530 U.S. at 372
    n.6
    (quoting 
    English, 496 U.S. at 79
    n.5).
    19
    Congress.”57
    Implied conflict preemption of the obstacle variety is at
    issue      in   this   case    as   Appellees   are   claiming   that   TDH   has
    impermissibly added conditions and impediments to the receipt of
    federal funds.         It is the prerogative of Congress, within limits,
    to attach conditions to federal funds:
    There is of course no question that the
    Federal Government, unless barred by some
    controlling constitutional prohibition, may
    impose the terms and conditions upon which its
    money allotments to the States shall be
    disbursed,   and  that   any   state  law   or
    regulation inconsistent with such federal
    terms and conditions is to that extent
    invalid.58
    We start with “a presumption that the state statute is valid,
    and ask whether petitioner has shouldered the burden of overcoming
    that presumption.”59          The mere fact that a state program imposes an
    additional “modest impediment” to eligibility for federal funds
    57
    Pac. Gas & Elec. Co. v. State Energy Res. Conservation & Dev. Comm’n,
    
    461 U.S. 190
    , 204 (1983) (internal quotation marks omitted) (quoting Fla. Lime
    & Avocado Growers, Inc. v. Paul, 
    373 U.S. 132
    , 142-43 (1963); Hines v.
    Davidowitz, 
    312 U.S. 52
    , 67 (1941)); see also Wells Fargo Bank of Tex. NA v.
    James, 
    321 F.3d 488
    , 491 n.3 (5th Cir. 2003) (explaining that implied conflict
    preemption occurs “where the state law mandates or places irresistible pressure
    on the subject of the regulation to violate federal law, where compliance with
    both regulations is physically impossible, where the state regulation frustrates
    or hectors the overall purpose of the federal scheme, or where the federal scheme
    expressly authorizes an activity which the state scheme disallows” (citations
    omitted)).
    58
    
    King, 392 U.S. at 333
    n.34.     Congress has wide latitude to attach
    conditions to funds, as long as they are not “unduly coercive” or “impermissibly
    sweeping.” Sabri v. United States, 
    124 S. Ct. 1941
    , 1947 (2004); see South Dakota
    v. Dole, 
    483 U.S. 203
    , 206 (1987).
    59
    
    Walsh, 538 U.S. at 661-62
    (citation omitted) (citing Davies Warehouse
    Co. v. Bowles, 
    321 U.S. 144
    , 153 (1944)).
    20
    does not provide a sufficient basis for preemption.60               However, a
    state eligibility standard that altogether excludes entities that
    might otherwise be eligible for federal funds is invalid under the
    Supremacy Clause.61 State participation in federal funding programs
    is voluntary, but once a state has accepted federal funds, it is
    bound by the strings that accompany them.62
    B
    60
    
    Id. at 667
    (rejecting Medicaid Act preemption challenge to state statute
    imposing prior authorization requirement on access to prescription drugs financed
    by federal funds); see also 
    Dublino, 413 U.S. at 422
    (rejecting preemption
    challenge to state statute imposing employment requirements as conditions for
    continued eligibility for AFDC benefits).
    61
    See Blum v. Bacon, 
    457 U.S. 132
    , 145-46 (1982) (holding provisions of
    New York welfare program that conflicted with federal Social Security regulations
    invalid under the Supremacy Clause); Carleson v. Remillard, 
    406 U.S. 598
    , 604
    (1972) (holding California regulation that conflicted with the Social Security
    Act invalid under the Supremacy Clause and noting that “there is no congressional
    authorization for States to exclude these so-called military orphans from AFDC
    benefits”); 
    Townsend, 404 U.S. at 286
    (“[A] state eligibility standard that
    excludes persons eligible for assistance, under federal AFDC standards violates
    the Social Security Act and is therefore invalid under the Supremacy Clause.”);
    
    King, 392 U.S. at 320
    (holding Alabama statute conflicted with Social Security
    Act “by flatly denying AFDC assistance to otherwise eligible dependent
    children”).
    The Court summarized this line of cases as follows:
    In [Carleson, Townsend, and King,] it was clear that
    state law excluded people from AFDC benefits who the
    Social Security Act expressly provided would be
    eligible. The Court found no room either in the Act’s
    language or legislative history to warrant the States’
    additional eligibility requirements. Here, by contrast,
    the Act allows for complementary state work incentive
    programs and procedures incident thereto--even if they
    become conditions for continued assistance. Such
    programs and procedures are not necessarily invalid, any
    more than other supplementary regulations promulgated
    within the legitimate sphere of state administration.
    
    Dublino, 413 U.S. at 421-22
    (emphasis added).
    62
    See Hope Med. Group for 
    Women, 63 F.3d at 421
    (“Although a state’s
    participation in the Medicaid program is voluntary, participating states must
    abide by the requirements imposed by Title XIX and regulations issued by the
    [corresponding federal agency].”).
    21
    1
    We first examine the question of affiliates.                According to
    TDH, Rider 8 can be read to allow Appellees to continue to receive
    funds     by    creating   separate    affiliates--e.g.   by    dividing     into
    “Family Planning” entities and “Abortion Services” entities.                 The
    district court concluded that “[s]uch a suggestion is absurd in
    light of the stated purpose of Rider 8--to eradicate the supposed
    imprimatur of state funding of abortion that currently exists--
    which would be undermined if recipients could avoid Rider 8 simply
    by creating affiliates and making no substantive changes.”63
    However, nothing in the plain language of Rider 8 precludes
    the creation of affiliates.           The district court’s observation that
    “under Rider 8, funding recipients cannot provide any funds to or
    contract with an abortion provider” does not answer the question.64
    Rider     8     only   prohibits   contracting   for   the     performance    of
    abortions.        It does not prohibit all contracting with an entity
    that performs abortions.           As such, Rider 8 does not preclude a
    family planning services provider from maintaining a contract with
    TDH while simultaneously creating a separate legal entity that
    performs abortions and receives no federal funds.
    In Planned Parenthood of Mid-Missouri & Eastern Kansas, Inc.
    v. Dempsey, the Eighth Circuit examined a Missouri state statute,
    63
    
    Sanchez, 280 F. Supp. 2d at 611
    .
    64
    
    Id. 22 similar
    to Rider 8, that prohibited organizations or affiliates of
    organizations that provided or promoted abortions from receiving
    state family-planning funds.65            The court ultimately concluded that
    the state         law   was    not   unconstitutional,     but   it    reached   this
    decision only by interpreting the regulation to allow grantees to
    create independent affiliates that could perform abortions.66                    The
    court came to this conclusion despite language in the Missouri
    statute that, unlike Rider 8, seemed to foreclose the formation of
    affiliates.67
    We have less difficulty concluding that Rider 8 admits of an
    interpretation          that    allows    service    providers        to   affiliate.
    Appellees’ argument that Rider 8 must be read to prevent all
    contracting with entities that perform abortions is without merit.
    Accordingly, the district court’s conclusion that Rider 8 prohibits
    affiliation is in error.
    65
    
    167 F.3d 458
    (8th Cir. 1999).     The state statute at issue there
    restricted the Missouri Department of Health’s expenditure of state funds:
    [N]one of these funds may be expended for the purpose of
    performing, assisting or encouraging for abortion, and
    further provided that none of these funds may be
    expended to directly or indirectly subsidize abortion
    services or administrative expenses, as verified by
    independent audit. None of these funds may be paid or
    granted to organizations or affiliates of organizations
    which provide or promote abortions. None of the funds
    may be expended for directly referring for abortion
    . . . .
    89th Leg., 2d Sess., Mo. H.B. 1010, § 10.715(1), quoted in 
    Dempsey, 167 F.3d at 463
    .
    66
    
    Dempsey, 167 F.3d at 461-64
    .
    67
    
    Id. 23 2
    Whether Rider 8 permits the formation of separate entities and
    its effect if it does not permit them is the controlling question
    on this appeal.           That is because, as we will explain, we are
    persuaded that, absent the possibility of affiliates, Rider 8 would
    likely be preempted.              Under an interpretation that forecloses
    affiliates, Rider 8 denies participation by entities--abortion
    providers--that are deemed eligible by Title X and the associated
    regulations.68         Rider      8’s   eligibility   standard,      by   excluding
    entities eligible under Title X, would violate that statute and
    therefore be invalid under the Supremacy Clause.69
    Appellees      point    to   three    provisions   in   the    statute   and
    regulations which evince a congressional intent to allow abortion
    providers to obtain funding.                 First, § 300a-6 specifies that
    “[n]one of the funds appropriated under this subchapter shall be
    used in programs where abortion is a method of family planning.”70
    This    provision,      Appellees       contend,   illustrates    that     Congress
    intended only to limit the use of funding, not the identity of
    recipients.        Had Congress wished to bar abortion providers from
    receiving funding, it presumably could have included its own Rider
    68
    Although Appellees also support their Supremacy Clause claim by
    reference to Title XIX and Title XX, as the instant disposition will not change,
    we express no opinion beyond Title X.
    69
    See 
    Townsend, 404 U.S. at 286
    .
    70
    42 U.S.C. § 300a-6.
    24
    8-style provision in Title X instead of a provision like § 300a-6.71
    Second, Appellees point to a provision in the Department of
    Health       and    Human    Services   (DHHS)     regulations    that   explicitly
    provides as follows:
    § 59.3 Who is eligible to apply for a family
    planning services grant?
    Any public or nonprofit private entity in a
    State may apply for a grant under this
    subpart.72
    As Appellees stress, by its terms, this provision allows any
    applicant to apply for funds, even applicants who perform abortions
    with private funds or in separate facilities.
    Finally, Appellees point to regulations adopted by DHHS on
    July        3,    2000,     entitled    the    “Standards   of    Compliance    for
    Abortion-Related Services in Family Planning Services Projects.”73
    These standards “revise the regulations that apply to grantees
    under       the    federal    family    planning    program”     and   “establish[]
    requirements for recipients of family planning services grants
    under [Title X].”74           Overall, “[t]he effect of the revisions . . .
    is to revoke the compliance standards, promulgated in 1988 and
    popularly known as the ‘Gag Rule,’ that restricted family planning
    71
    Such a provision might, of course, be unconstitutional on other grounds.
    72
    42 C.F.R. § 59.3.
    73
    See 65 Fed. Reg. 41,270.
    74
    
    Id. at 41,270
    (citing 42 U.S.C. § 300).
    25
    grantees from        providing   abortion-related         information          in    their
    grant-funded projects.”75        After discussing and rejecting the “Gag
    Rule,”     which    was   evaluated    by    the   Supreme    Court       in    Rust    v.
    Sullivan,76 the regulations carefully define how an entity can
    comply with the prohibition on the use of Title X funds “in
    programs where abortion is a method of family planning.”77                             The
    compliance regulations state, in particular, that there need not be
    complete physical separation between a Title X project and private
    abortion activities as long as the abortion activities receive no
    Title X funding and the Title X activities do not promote or
    encourage       abortion.78       In     these     standards,       the        Secretary
    exhaustively        considers    the     statute’s      requirements           and     the
    government’s interest in ensuring that funds are not used to
    provide abortions and concludes that the financial audits of grant
    recipients are sufficient to uphold the government’s interest. The
    Secretary’s comments are clearly premised on the notion that
    abortion providers will receive funding.                     Indeed, one of the
    Secretary’s        explicit   concerns      is   that   hospitals     that      provide
    abortions not be put to needless expense by having to create
    75
    
    Id. 76 500
    U.S. 173 (1991).
    77
    65 Fed. Reg. at 41,270-77 (quoting 42 U.S.C. § 300a-6).
    78
    
    Id. at 41,275-76.
    26
    separate facilities for family planning services.79            The discussion
    makes clear that abortion providers are eligible for funding.
    These standards represent the interpretation of the statute by the
    Secretary of the DHHS, and thus are entitled to great deference.80
    The Supreme Court’s decision in Rust also supports Appellees’
    reading of the relevant congressional intent.                The Court held,
    first, that DHHS may require physical and financial separation of
    abortion activities and family planning services without violating
    the plain language of Title X.81 The Court explained, however, that
    Title X draws a distinction between Title X projects and Title X
    grantees:
    The Secretary’s regulations do not force the
    Title X grantee to give up abortion-related
    speech; they merely require that the grantee
    keep such activities separate and distinct
    from Title X activities.   Title X expressly
    distinguishes between a Title X grantee and a
    Title X project. The grantee, which normally
    is a health-care organization, may receive
    funds from a variety of sources for a variety
    of purposes.   The grantee receives Title X
    funds, however, for the specific and limited
    79
    
    Id. 80 See
    United States v. Mead Corp., 
    533 U.S. 218
    , 226-27 (2001)
    (“[A]dministrative implementation of a particular statutory provision qualifies
    for Chevron deference when it appears that Congress delegated authority to the
    agency generally to make rules carrying the force of law, and that the agency
    interpretation claiming deference was promulgated in the exercise of that
    authority.”); In re Cajun Elec. Power Coop., Inc., 
    109 F.3d 248
    , 254 (5th Cir.
    1997) (finding preemption by first examining “whether the Secretary meant to pre-
    empt [the state agency’s] rate order, and, if so, whether that action is within
    the scope of the Secretary’s delegated authority”); see also 
    Thompson, 362 F.3d at 821
    ; Planned Parenthood Affiliates of Mich. v. Engler, 
    73 F.3d 634
    , 638 (6th
    Cir. 1996).
    81
    
    Rust, 500 U.S. at 187-90
    .
    27
    purpose of establishing and operating a Title
    X project. The regulations govern the scope
    of the Title X project’s activities, and leave
    the   grantee    unfettered   in   its   other
    activities. The Title X grantee can continue
    to perform abortions, provide abortion-related
    services, and engage in abortion advocacy; it
    simply is required to conduct those activities
    through programs that are separate and
    independent from the project that receives
    Title X funds.82
    The Supreme Court examined Title X and, even with the restrictive
    Gag Rule then in place, expressly stated that grant recipients
    could continue to provide abortion services outside the scope of
    the Title X project.        The Court concluded:
    By requiring that the Title X grantee
    engage in abortion-related activity separately
    from activity receiving federal funding,
    Congress has . . . not denied it the right to
    engage    in   abortion-related    activities.
    Congress has merely refused to fund such
    activities out of the public fisc, and the
    Secretary has simply required a certain degree
    of separation from the Title X project in
    order to ensure the integrity of the federally
    funded program.83
    Under Title X, then, abortion providers are eligible to receive
    family planning funding; Title X requires only that they use that
    funding for legitimate Title X purposes.
    TDH provides little to dispute Appellees’ argument.              Its
    principal argument focuses on Title X’s prohibition on the use of
    Title X funds to pay for abortions.          As the argument goes, Rider 8
    82
    
    Id. at 196
    (citations omitted) (last emphasis added).
    83
    
    Id. at 198.
    28
    furthers    this    end    by    ensuring      that     federal        funds    are      used
    correctly.         TDH    also   points     to    Rust’s        vindication         of    the
    government’s power to impose regulations requiring physical and
    financial separation of family planning and abortion facilities.
    TDH insists that Rider 8 falls within Rust’s safe-harbor.
    TDH’s argument is not persuasive.                 While it is no doubt true
    that an affiliate-prohibiting Rider 8 would help ensure that funds
    are not misappropriated, it nonetheless would disqualify entities
    that Title X regards as eligible for funding without any showing
    that the entity has misused funds.                Rust, moreover, provides no
    support for Appellees because, while Rust approved of regulations
    requiring physical and financial separation and limiting doctors’
    reference to abortion, those regulations were promulgated by the
    federal    government.84         Here,    Texas       is    attempting         to    impose
    regulations that restrict the scope of a federal program.                                 And
    Rider 8--still       assuming     arguendo       that      it   does    not    allow      for
    affiliates--would do far more than require physical separation; it
    would require that entities not engage in abortion activities even
    with private funds and in separate facilities.                         In the end, TDH
    84
    See 
    Rust, 500 U.S. at 178-81
    ; see also Regan v. Taxation with
    Representation of Wash., 
    461 U.S. 540
    (1997) (Congress, exercising spending
    power, can refuse to fund lobbying activities where organizations are free to
    establish a separate affiliate to engage in lobbying without the use of federal
    funds); Planned Parenthood Fed’n of Am. v. Heckler, 
    712 F.2d 650
    , 663 (D.C. Cir.
    1983) (“Although Congress is free to permit the states to establish eligibility
    requirements for recipients of Title X funds, Congress has not delegated that
    power to the states. Title X does not provide, or suggest, that states are
    permitted to determine eligibility criteria for participants in Title X
    programs.” (internal quotation marks and citation omitted)).
    29
    provides nothing to counter Appellees’ argument that Title X--both
    by   its    express    terms   and    as   interpreted   by   the   DHHS--allows
    abortion providers to receive funding.
    To be entitled to a preliminary injunction, Appellees must
    show a substantial likelihood that they will succeed on their
    claim.      On an affiliate-precluding interpretation of Rider 8, the
    district court would not abuse its discretion in so concluding,
    given that Rider 8’s eligibility requirements would seriously
    undermine and obstruct Congress’s intent in distributing funds
    under Title X.
    3
    As just described, without affiliates, Rider 8 is likely
    doomed to preemption, so we ask if there is an alternative.                    We
    turn to that inquiry, mindful that we “will not rewrite a . . . law
    to conform it to constitutional requirements.”85               For example, in
    a case involving an abortion statute, the Nebraska Attorney General
    offered a “saving” interpretation not supported by the statute’s
    text or legislative history, and the Supreme Court rejected the
    invitation, explaining that “we are without power to adopt a
    narrowing       construction     of    a    state   statute    unless   such   a
    construction is reasonable and readily apparent.”86 Where, as here,
    language in a statute is ambiguous and “an otherwise acceptable
    85
    Reno v. ACLU, 
    521 U.S. 844
    , 884-85 (1997) (internal quotation marks and
    citation omitted).
    86
    Stenberg v. Carhart, 
    530 U.S. 914
    , 944 (2000).
    30
    construction       of   a   statute   would   raise   serious   constitutional
    problems,” we must “construe the statute to avoid such problems”
    unless such a construction would be plainly contrary to legislative
    intent.87 In this case we are not merely deferring to a “convenient
    litigation position”88 on the part of TDH--although it may be just
    that.      Our own reading of Rider 8 leads us to the conclusion that
    affiliates are permitted.
    In Dempsey, the court similarly sought to interpret a state
    statute so as to avoid running afoul of federal law.89                 In that
    case, the statute at issue regulated only state funds and, thus,
    did not address federal preemption issues but rather focused only
    on   unconstitutional         conditions.       Nonetheless,     the   court’s
    willingness to interpret the statute to allow for affiliates in
    order to avoid constitutional problems is instructive.90 Similarly,
    we must choose the interpretation of Rider 8 that has a chance of
    87
    Edward J. DeBartolo Corp. v. Fla. Gulf Coast Bldg. & Constr. Trades
    Council, 
    485 U.S. 568
    , 575 (1988).
    88
    Cf. Bowen v. Georgetown Univ. Hosp., 
    488 U.S. 204
    , 213 (1988)
    (“Deference to what appears to be nothing more than an agency’s convenient
    litigating position would be entirely inappropriate.”).
    
    89 167 F.3d at 461-64
    .
    90
    The Dempsey opinion is a stretch.     The Missouri statute explicitly
    stated that “[n]one of these funds may be paid or granted to organizations or
    affiliates of organizations which provide or promote abortions.” 89th Leg., 2d
    Sess., Mo. H.B. 1010, § 10.715(1) (emphasis added), quoted in 
    Dempsey, 167 F.3d at 463
    . The court stated that “nothing [in this statute] expressly prohibits
    grantees from maintaining an affiliation with an abortion service provider, so
    long as the affiliated abortion service provider does not directly or indirectly
    receive State family-planning funds.” 
    Dempsey, 167 F.3d at 463
    . Perhaps the
    court concluded that the statute barred affiliates but not “independent”
    affiliates, but even this is less than persuasive.
    31
    avoiding federal preemption.
    4
    At this point, under the affiliate-permissible interpretation
    of Rider 8, there are two possibilities: either the affiliate
    requirement is a relatively empty formalism or it is a more
    substantial obstacle.      The former is permissible, while the latter
    likely is not.
    Given the district court’s view that Rider 8 did not permit
    affiliation, the vitality of the alternative was not developed.
    From the limited record, we cannot say whether there is nonetheless
    a substantial likelihood that Rider 8 would in practical terms work
    the same mischief in this case as it would if it disallowed
    affiliation entirely.      Recall that Appellees had been approved as
    contractors to receive federal funds when Rider 8 was enacted.
    Assuming that affiliation is prospectively an option for providers
    in general, it is not clear on this record whether Appellees had
    that opportunity.     TDH evidenced its intent to enforce Rider 8 as
    to these providers when it sent them letters in early June, giving
    Appellees roughly twenty days to return an affidavit swearing that
    they would not provide abortions or contract for their provision.
    Given that TDH made no mention at that time of the possibility of
    affiliation, it is not clear that Appellees could have avoided
    forfeiting their contracts by affiliating, nor is it clear that
    there was sufficient time to do so even had they been so inclined.
    We   note   that   Rider   8’s   effect   on   these   previously-approved
    32
    providers might prove to be different from the impact of a purely
    prospective application of Rider 8 on new contract determinations.
    On remand, unless Appellees can show that the burden of
    forming affiliates in forthcoming years would in practical terms
    frustrate their ability to receive federal funds, Rider 8 should be
    upheld and the injunction dissolved.              While creating affiliates
    might entail some time and expense, and might not be the most
    convenient arrangement, this extra effort alone would not relegate
    the state statute to preemption.91
    Given the disposition in this case, we need not address the
    district court’s treatment of the remaining requirements for a
    preliminary injunction: threat of injury to the Appellees, to TDH,
    and to the public interest.
    V
    The case is REMANDED and the district court is directed to
    proceed with a trial on the merits.          The injunction granted below
    must be dissolved unless the Appellees carry their burden of
    demonstrating that insisting on the use of affiliates would so
    hinder   their    operations     as   to   work    in   practical   terms    an
    impermissible prohibition by the State of Texas upon the ability of
    these Appellees to continue their abortion services using their own
    91
    Cf. 
    Dempsey, 167 F.3d at 464
    (“The Constitution does not guarantee that
    recipients of State funds will not be required to ‘expend effort’ to comply with
    funding restrictions.” (citation omitted)); Legal Aid Soc’y of Haw. v. Legal
    Servs. Corp., 
    145 F.3d 1017
    , 1027 (9th Cir. 1998) (White, J. (Retired), sitting
    by designation) (“The [Rust] Court did not find it constitutionally significant
    that the restrictions required the recipient of Title X funds to expend effort
    to comply with the restrictions.”).
    33
    funds with no direct or indirect federal funding.
    REMANDED with instructions.
    34
    

Document Info

Docket Number: 03-50930

Citation Numbers: 403 F.3d 324

Judges: Clement, Dennis, Higginbotham

Filed Date: 3/30/2005

Precedential Status: Precedential

Modified Date: 8/2/2023

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