Since Title X was established in 1970, the program’s funding has been restricted from going toward abortions. Clinics such as Planned Parenthood that offer abortions—but also health departments, federally qualified health centers, and other Title X grantees that don’t—use the Title X program. The money is used to provide nonabortion health services, such as cancer screenings and birth control, mostly to poor and uninsured women, on a sliding fee scale. If a woman has no money and no insurance, she can, say, get a Pap smear at a lower cost, with the difference covered by Title X money. Title X also pays for staff, training, and community outreach.

The anti-abortion-rights community sees this existing restriction as still too lax. They argue that Trump’s new rule makes it more certain that no government money will go to an entity that provides abortions, and that the rule allows more faith-based organizations to participate in Title X. “We applaud the decision of the administration to ensure that federal family-planning dollars are not used to subsidize abortion operations,” says Steven Aden, the chief legal officer at Americans United for Life. “Any time abortion is advocated as a means of family planning, that’s tax money going to the promotion of elective abortion.”

In Aden’s view, it will not be difficult for Planned Parenthood and other clinics to separate their clinics into abortion and nonabortion facilities. But these clinics maintain that complying with the new rule is not as simple as it seems.

Opponents of this ban sometimes call it a “gag rule.” Aden told me he disagrees with this description. “There’s no gag rule because if they so desire, Title X recipients can still discuss abortion as one of the options,” he said. Still, Planned Parenthood views the rule’s ban on referrals to abortion providers as medically unethical. Leana Wen, the president of the Planned Parenthood Federation of America, has said that she will refuse Title X funding if the rule holds up in its current form.

Without that funding, says Kristin Metcalf-Wilson, the senior lead clinician for Planned Parenthood of the Great Plains, many clinics in those states would not have the resources to reduce the fees for nonabortion medical procedures for poor, uninsured women.

If Planned Parenthood loses Title X funding and stops accepting patients on a sliding scale, the rule’s opponents argue, other Title X clinics will not have the capacity to absorb those patients. Metcalf-Wilson says the Title X funding is too large an amount for other funders, such as private donors, to make up for.

Other clinics might decide that the new rule’s requirements are too burdensome, and opt to simply forgo the Title X funding, potentially driving up the costs of their services. “I think there are family-planning providers that will find they will qualify for the [Title X] funds, but the terms are not those that are worth it for them,” says Alina Salganicoff, the director of women’s health policy at the Kaiser Family Foundation.