North Carolina’s Deceptive CPCs, Abortion Reporting Requirements, and Meta in Texas

CfA Letter Cited in Coverage of Deceptive North Carolina CPCs

This week, The Assembly, a North Carolina-focused investigative newsroom, published an investigation into anti-abortion crisis pregnancy centers (CPCs) operating in the state, which included interviews with women who had negative experiences at the centers while seeking care. Unlike real medical clinics, CPCs are not held to health or safety standards, and frequently use deceptive tactics to discourage women from seeking abortions. Inevitably, these practices can endanger patients, who may not know that many CPC staff are unqualified to diagnose health conditions or confirm the safety of a pregnancy. One woman told The Assembly that she had visited a Raleigh CPC as a 16-year-old, but left after the staff asked her uncomfortable questions about her religion and declined to share information about abortion. Several days later, she missed a message from the CPC informing her that they were about to call police for a “welfare check” at her home, where officers told her guardian that she was pregnant. Ultimately, Essi’s guardian helped her get an abortion––but the CPC’s call could have endangered her, had the circumstances been different.

Patients who visit real medical clinics which bill insurance don’t have to worry about these invasions of privacy, thanks to the Health Insurance Portability and Accountability Act (HIPAA). In its coverage of North Carolina CPCs, The Assembly cited an HHS letter written in response to a complaint filed by CfA, which clarified that the agency’s Office for Civil Rights had no authority to investigate entities which were not covered by HIPAA. CfA originally filed the complaint in August, after 13 women had their personal health information leaked online by a Louisiana-based CPC. In that case, the clinic specifically told clients that they could file an HHS complaint if they felt their rights had been violated.

Indiana Doctor Fights State’s Abortion Reporting Mandate

While patients at many CPCs may not be protected by HIPAA, real providers must still follow HHS guidelines, which now include new rules designed to prohibit the disclosure of protected health information related to legal reproductive health care. In a statement, outgoing HHS Secretary Xavier Becerra described the rules as a means to counteract the “chilling effect” of anti-abortion legislation, and reassure patients seeking legal abortions that they are safe to do so “regardless of whether the care is in their home state or if they must cross state lines to get it.” Now, Indiana OBGYN Dr. Christina Scifres has filed a lawsuit against her state’s Department of Health and members of its Medical Licensing Board, arguing that compliance with the Indiana’s abortion reporting laws would be a violation of the new HIPAA rules.

Though Indiana enacted a near-total abortion ban in 2023, the law makes a narrow medical exception for patients whose pregnancy poses a “serious risk of substantial and irreversible physical impairment of a major bodily function." Dr. Scifres argues that the exhaustive, state-mandated reports for legal abortions performed in Indiana would require the disclosure of personal health information that is protected by the HIPAA rule. If she complied with the federal law, however, she would be in violation of Indiana’s abortion reporting requirements and in danger of losing her medical license.

Policy implications for Meta’s Trust and Safety Relocation to Texas

On Tuesday, Meta CEO Mark Zuckerberg announced that his company’s trust and safety and content moderation teams would be relocating to Texas, as part of a strategy to “build trust” and “do work in places where there is less concern about the bias of our teams.” The move is likely in its early stages, as Meta’s careers website still lists content moderation and platform integrity engineer positions based in California, New York, and Washington. An anonymous employee in the company’s Austin office also told The Austin American-Statesman that they hadn’t been given any information about the relocation.

Meta’s Texas-based trust and safety employees may enjoy fewer rights and lower pay than they would in other regions, if Zuckerberg follows through with his promise. Unlike California, Texas does not have state whistleblower protections for the private sector, meaning employees may be less willing to report violations of state and local law. Oxfam America’s “Best and Worst States to Work” index ranks Texas nearly dead last, citing lower pay, lack of basic worker protections, and policies that limit the organizing power of unions. Texas has also attempted to pass legislation limiting the content moderation abilities of social media platforms, which was quickly struck down by a federal judge and unanimously sent back to the 5th Circuit by the Supreme Court. Texas Attorney General Ken Paxton has also opened a number of investigations into Meta, concerning everything from child safety to the misuse use of biometric data. In this hostile environment, Meta’s willingness to expand Texas operations should concern its US-based content moderation employees and contractors, who have already been affected by layoffs.

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