Texas banned abortion. Then sepsis rates soared.

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Series: Life of the Mother:How Abortion Bans Lead to Preventable Deaths

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Pregnancy became far more dangerous in Texas after the state banned abortion in 2021, ProPublica found in a first-of-its-kind data analysis.

The rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, ProPublica found.

The surge in this life-threatening condition, caused by infection, was most pronounced for patients whose fetus may still have had a heartbeat when they arrived at the hospital.

ProPublica previously reported on two such cases in which miscarrying women in Texas died of sepsis after doctors delayed evacuating their uteruses. Doing so would have been considered an abortion.

The new reporting shows that, after the state banned abortion, dozens more pregnant and postpartum women died in Texas hospitals than had in pre-pandemic years, which ProPublica used as a baseline to avoid COVID-19-related distortions. As the maternal mortality rate dropped nationally, ProPublica found, it rose substantially in Texas.

ProPublica’s analysis is the most detailed look yet at a rise in life-threatening complications for women losing a pregnancy after Texas banned abortion. It raises concerns that the same pattern may be occurring in more than a dozen other states with similar bans.

To chart the scope of pregnancy-related infections, ProPublica purchased and analyzed seven years of Texas’ hospital discharge data.

“This is exactly what we predicted would happen and exactly what we were afraid would happen,” said Dr. Lorie Harper, a maternal-fetal medicine specialist in Austin.

She and a dozen other maternal health experts who reviewed ProPublica’s findings say they add to the evidence that the state’s abortion ban is leading to dangerous delays in care. Texas law threatens up to 99 years in prison for providing an abortion. Though the ban includes an exception for a “medical emergency,” the definition of what constitutes an emergency has been subject to confusion and debate.

Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.

The new analysis comes as Texas legislators consider amending the abortion ban in the wake of ProPublica’s previous reporting, and as doctors, federal lawmakers and the state’s largest newspaper have urged Texas officials to review pregnancy-related deaths from the first full years after the ban was enacted; the state maternal mortality review committee has, thus far, opted not to examine the death data for 2022 and 2023.

The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.

Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.

While some Texas doctors have told ProPublica they regularly offer to empty the uterus in these cases, others say their hospitals don’t allow them to do so until the fetal heartbeat stops or they can document a life-threatening complication.

Last year, ProPublica reported on the repercussions of these kinds of delays.

Forced to wait 40 hours as her dying fetus pressed against her cervix, Josseli Barnica risked a dangerous infection. Doctors didn’t induce labor until her fetus no longer had a heartbeat.

Physicians waited, too, as Nevaeh Crain’s organs failed. Before rushing the pregnant teenager to the operating room, they ran an extra test to confirm her fetus had expired.

Both women had hoped to carry their pregnancies to term, both suffered miscarriages and both died.

In response to their stories, 111 doctors wrote a letter to the Legislature saying the abortion ban kept them from providing lifesaving care and demanding a change.

“It’s black and white in the law, but it’s very vague when you’re in the moment,” said Dr. Tony Ogburn, an OB-GYN in San Antonio. When the fetus has a heartbeat, doctors can’t simply follow the usual evidence-based guidelines, he said. Instead, there is a legal obligation to assess whether a woman’s condition is dire enough to merit an abortion under a prosecutor’s interpretation of the law.

Some prominent Texas Republicans who helped write and pass Texas’ strict abortion bans have recently said that the law should be changed to protect women’s lives — though it’s unclear if proposed amendments will receive a public hearing during the current legislative session.

ProPublica’s findings indicate that the law is getting in the way of providing abortions that can protect against life-threatening infections, said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington.

“We have the ability to intervene before these patients get sick,” she said. “This is evidence that we aren’t doing that.”

A New View

Health experts, specially equipped to study maternal deaths, sit on federal agencies and state-appointed review panels. But, as ProPublica previously reported, none of these bodies have systematically assessed the consequences of abortion bans.

So ProPublica set out to do so, first by investigating preventable deaths, and now by using data to take a broader view, looking at what happened in Texas hospitals after the state banned abortion, in particular as women faced miscarriages.

“It is kind of mindblowing that even before the bans researchers barely looked into complications of pregnancy loss in hospitals,” said perinatal epidemiologist Alison Gemmill, an expert on miscarriage at Johns Hopkins Bloomberg School of Public Health.

In consultation with Gemmill and more than a dozen other maternal health researchers and obstetricians, ProPublica built a framework for analyzing Texas hospital discharge data from 2017 to 2023, the most recent full year available. This billing data, kept by hospitals and collected by the state, catalogues what happens in every hospitalization. It is anonymized but remarkable in its granularity, including details such as gestational age, complications and procedures.

To study infections during pregnancy loss, ProPublica identified all hospitalizations that included miscarriages, terminations and births from the beginning of the second trimester up to 22 weeks’ gestation, before fetal viability. Since first-trimester miscarriage is often managed in an outpatient setting, ProPublica did not include those cases in this analysis.

When looking at stays for second-trimester pregnancy loss, ProPublica found a relatively steady rate of sepsis before Texas made abortion a crime. In late 2021, the state made it a civil offense to end a pregnancy after a fetus developed cardiac activity, and in the summer of 2022, the state made it a felony to terminate any pregnancy, with few exceptions.

In 2021, 67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis — as in the previous years, they accounted for about 3% of the hospitalizations.

In 2022, that number jumped to 90.

The following year, it climbed to 99.

ProPublica’s analysis was conservative and likely missed some cases. It doesn’t capture what happened to miscarrying patients who were turned away from emergency rooms or those like Barnica who were made to wait, then discharged home before they returned with sepsis.

Our analysis showed that patients who were admitted while their fetus was still believed to have a heartbeat were far more likely to develop sepsis.

“What this says to me is that once a fetal death is diagnosed, doctors can appropriately take care of someone to prevent sepsis, but if the fetus still has a heartbeat, then they aren’t able to act and the risk for maternal sepsis goes way up,” said Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at UW Medicine and an expert in pregnancy complications. “This is needlessly putting a woman’s life in danger.”

Studies indicate that waiting to evacuate the uterus increases rates of sepsis for patients whose water breaks before the fetus can survive outside the womb, a condition called previable premature rupture of membranes or PPROM. Because of the risk of infection, major medical organizations like the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists advise doctors to always offer abortions.

Researchers in Dallas and Houston examined cases of previable pregnancy complications at their local hospitals after the state ban. Both studies found that when women weren’t able to end their pregnancies right away, they were significantly more likely to develop dangerous conditions than before the ban. The study of the University of Texas Health Science Center in Houston, not yet published, found that the rate of sepsis tripled after the ban.

Dr. Emily Fahl, a co-author of that study, recently urged professional societies and state medical boards to “explicitly clarify” that doctors need to recommend evacuating the uterus for patients with a PPROM diagnosis, even with no sign of infection, according to MedPage Today.

UTHealth Houston did not respond to several requests for comment.

ProPublica zoomed out beyond the second trimester to look at deaths of all women hospitalized in Texas while pregnant or up to six weeks postpartum. Deaths peaked amid the COVID-19 pandemic, and most patients who died then were diagnosed with the virus. But looking at the two years before the pandemic, 2018 and 2019, and the two most recent years of data, 2022 and 2023, there is a clear shift:

In the two earlier years, there were 79 maternal hospital deaths.

In the two most recent, there were 120.

Caitlin Myers, an economist at Middlebury College, said it’s crucial to examine these deaths from different angles, as ProPublica has done. Data analyses help illuminate trends but can’t reveal a patient’s history or wishes, as a detailed medical chart might. Diving deep into individual cases can reveal the timeline of treatment and how doctors behave. “When you see them together, it tells a really compelling story that people are dying as a result of the abortion restrictions.”

Texas has no plans to scrutinize those deaths. The chair of the maternal mortality review committee said the group is skipping data from 2022 and 2023 and picking up its analysis with 2024 to get a more “contemporary” view of deaths. She added that the decision had “absolutely no nefarious intent.”

“The fact that Texas is not reviewing those years does a disservice to the 120 individuals you identified who died inpatient and were pregnant,” said Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University. “And that is an underestimation of the number of people who died.”

The committee is also prohibited by law from reviewing cases that include an abortion medication or procedure, which can also be used during miscarriages. In response to ProPublica’s reporting, a Democratic state representative filed a bill to overturn that prohibition and order those cases to be examined.

Because not all maternal deaths take place in hospitals and the Texas hospital data did not include cause of death, ProPublica also looked at data compiled from death certificates by the Centers for Disease Control and Prevention.

It shows that the rate of maternal deaths in Texas rose 33% between 2019 and 2023 even as the national rate fell by 7.5%.

A New Imperative

Texas’ abortion law is under review this legislative session. Even the party that championed it and the senator who authored it say they would consider a change.

On a local television program last month, Republican Lt. Gov. Dan Patrick said the law should be amended.

“I do think we need to clarify any language,” Patrick said, “so that doctors are not in fear of being penalized if they think the life of the mother is at risk.”

State Sen. Bryan Hughes, who once argued that the abortion ban he wrote was “plenty clear,” has since reversed course, saying he is working to propose language to amend the ban. Texas Gov. Greg Abbott told ProPublica, through a spokesperson, that he would “look forward to seeing any clarifying language in any proposed legislation from the Legislature.”

Patrick, Hughes and Attorney General Ken Paxton did not respond to ProPublica’s questions about what changes they would like to see made this session and did not comment on findings ProPublica shared.

In response to ProPublica’s analysis, Abbott’s office said in a statement that Texas law is clear and pointed to Texas health department data that shows 135 abortions have been performed since Roe was overturned without resulting in prosecution. The vast majority of the abortions were categorized as responses to an emergency but the data did not specify what kind. Only five were solely to “preserve [the] health of [the] woman.”

At least seven bills related to repealing or creating new exceptions to the abortion laws have been introduced in Texas.

Doctors told ProPublica they would most like to see the bans overturned so all patients could receive standard care, including the option to terminate pregnancies for health considerations, regardless of whether it’s an emergency. No list of exceptions can encompass every situation and risk a patient might face, obstetricians said.

“A list of exceptions is always going to exclude people,” said Dallas OB-GYN Dr. Allison Gilbert.

It seems unlikely a Republican-controlled Legislature would overturn the ban. Gilbert and others are advocating to at least end criminal and civil penalties for doctors. Though no doctor has been prosecuted for violating the ban, the mere threat of criminal charges continues to obstruct care, she said.

In 2023, an amendment was passed that permitted physicians to intervene when patients are diagnosed with PPROM. But it is written in such a way that still exposes physicians to prosecution; it allows them to offer an “affirmative defense,” like arguing self-defense when charged with murder.

“Anything that can reduce those severe penalties that have really chilled physicians in Texas would be helpful,” Gilbert said. “I think it will mean that we save patients’ lives.”

Rep. Mihaela Plesa, a Democrat from outside Dallas who filed a bill to create new health exceptions, said that ProPublica’s latest findings were “infuriating.”

She is urging Republicans to bring the bills to a hearing for debate and discussion.

Last session, there were no public hearings, even as women have sued the state after being denied treatment for their pregnancy complications. This year, though some Republicans appeared open to change, others have gone a different direction.

One recently filed a bill that would allow the state to charge women who get an abortion with homicide, for which they could face the death penalty.

Do you live in a state that has passed laws affecting abortion in the last few years? In the time since, have you or a loved one experienced delayed health care while pregnant or experiencing a miscarriage?

ProPublica would like to hear from you to better understand the unintended impact of abortion bans across the country. Email our reporters at reproductivehealth@propublica.org to share your story.

We understand this may be difficult to talk about, and we have detailed how we report on maternal health to let you know what you can expect from us.

Lucas Waldron contributed graphics. Mariam Elba contributed research.

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A right-wing think tank claimed to be a church — and now members of Congress want to investigate

Forty members of Congress on Monday asked the IRS and the Treasury to investigate what the lawmakers termed an “alarming pattern” of right-wing advocacy groups registering with the tax agency as churches, a move that allows the organizations to shield themselves from some financial reporting requirements and makes it easier to avoid audits.

Reps. Jared Huffman, D-Calif., and Suzan DelBene, D-Wash., raised transparency concerns in a letter to the heads of both agencies following a ProPublica story about the Family Research Council, a right-wing Christian think tank based in Washington, D.C., getting reclassified as a church. Thirty-eight other lawmakers, including Reps. Adam Schiff, D-Calif., Debbie Wasserman Schultz, D-Fla., Rashida Tlaib, D-Mich., and Jamie Raskin, D-Md., signed onto the letter.

“FRC is one example of an alarming pattern in the last decade — right-wing advocacy groups self-identifying as ‘churches’ and applying for and receiving church status,” the representatives wrote, noting the organization’s policy work supporting the overturning of Roe v. Wade and its advocacy for legislation seeking to ban gender-affirming surgery.

“Tax-exempt organizations should not be exploiting tax laws applicable to churches to avoid public accountability and the IRS’s examination of their activities,” they wrote.

The Family Research Council did not respond to requests for comment. The IRS told ProPublica that it does not comment on congressional correspondence.

The FRC’s website describes the organization as “a nonprofit research and educational organization dedicated to articulating and advancing a family-centered philosophy of public life,” noting that it provides “policy research and analysis for the legislative, executive, and judicial branches of the federal government.”

The FRC sought and received reclassification from a standard tax-exempt charity to an “association of churches” in 2020.

In its application for church status, the organization said it met 11 of the 14 characteristics that the IRS uses to determine whether an organization is a church, including an established place of worship — a chapel in the organization’s Washington office building, at which it said it holds services attended by more than 65 people. (Someone who answered the phone at the office said the group doesn’t offer church services.) The organization said its association comprises nearly 40,000 “partner churches” that must affirm a statement of faith to join; it did not offer the names of those partners on its form to the IRS or provide them to ProPublica.

The representatives’ letter asks the IRS to review the FRC’s status change and to examine its review process for organizations similarly seeking to switch their status to become a church or association of churches.

“It’s disturbing that a letter like this is even necessary,” Huffman said. “Unfortunately our IRS has been so worn down and beaten up by the right wing that they have essentially ceased all scrutiny of organizations that self-report as churches.”

The IRS classifies churches and associations of churches as tax-exempt charitable organizations, meaning that they do not have to pay federal taxes and that donors can deduct contributions from their own taxes. However, churches are exempt from submitting Form 990, the annual financial disclosure that nonprofit organizations use to list board members, key staffer salaries, large payments to independent contractors and grants given by the organization.

And unlike for other tax-exempt organizations, a high-level Treasury official must sign off on any audit of a church.

“We understand the importance of religious institutions to their congregants and believe that religious freedom is a cherished American value and constitutional right. We also believe that our tax code must be applied fairly and judiciously,” Huffman and DelBene wrote.

In their letter, the representatives asked for feedback from the IRS on whether it needs additional direction from Congress to enforce rules surrounding tax-exempt organizations and churches. Huffman said that he hopes to pursue legislative action if the IRS isn’t able to address these concerns, but that the letter is a first step.

“You need to start here — give the agency a chance to clean up its mess,” he said.

Right-wing think tank Family Research Council is now a church in the eyes of the IRS

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

The Family Research Council’s multimillion-dollar headquarters sit on G Street in Washington, D.C., just steps from the U.S. Capitol and the White House, a spot ideally situated for its work as a right-wing policy think tank and political pressure group.

From its perch at the heart of the nation’s capital, the FRC has pushed for legislation banning gender-affirming surgery; filed amicus briefs supporting the overturning of Roe v. Wade; and advocated for religious exemptions to civil rights laws. Its longtime head, a former state lawmaker and ordained minister named Tony Perkins, claims credit for pushing the Republican platform rightward over the past two decades.

What is the FRC? Its website sums up the answer to this question in 63 words: “A nonprofit research and educational organization dedicated to articulating and advancing a family-centered philosophy of public life. In addition to providing policy research and analysis for the legislative, executive, and judicial branches of the federal government, FRC seeks to inform the news media, the academic community, business leaders, and the general public about family issues that affect the nation from a biblical worldview.”

In the eyes of the Internal Revenue Service, though, it is also a church, with Perkins as its religious leader.

According to documents obtained via the Freedom of Information Act and given to ProPublica, the FRC filed an application to change its status to an “association of churches,” a designation commonly used by groups with member churches like the Southern Baptist Convention, in March 2020. The agency approved the change a few months later.

The FRC is one of a growing list of activist groups to seek church status, a designation that comes with the ability for an organization to shield itself from financial scrutiny. Once the IRS blessed it as an association of churches, the FRC was no longer required to file a public tax return, known as a Form 990, revealing key staffer salaries, the names of board members and related organizations, large payments to independent contractors and grants the organization has made. Unlike with other charities, IRS investigators can’t initiate an audit on a church unless a high-level Treasury Department official has approved the investigation.

The FRC declined to make officials available for an interview or answer any questions for this story. Its former parent organization, Focus on the Family, changed its designation to become a church in 2016. In a statement, the organization said it made the switch largely out of concern for donor privacy, noting that many groups like it have made the same change. Many of them claim they operated in practice as churches or associations of churches all along.

Warren Cole Smith, president of the Christian transparency watchdog MinistryWatch, said he believes groups like these are seeking church status with the IRS for the protections it confers.

“I don’t believe that a lot of the organizations that have filed for the church exemption are in fact churches,” he said. “And I don’t think that they think that they are in fact churches.”

The IRS uses a list of 14 characteristics to determine if an organization is a church or an association of churches, though it notes that organizations need not meet all the specifications. The Family Research Council answered in the affirmative for 11 of those points, saying that it has an array of “partner churches” with a shared mission: “to hold all life as sacred, to see families flourish, and to promote religious freedom.” The group says there is no set process for a church to become one of the partners that make up its association, but it says partners (and the FRC’s employees) must affirm a statement of faith to do so. It claims there are nearly 40,000 churches in its association, made up of different creeds and beliefs — saying that this models the pattern of the “first Christian churches described in the New Testament of the Bible.”

Unlike the Southern Baptist Convention, whose website hosts a directory of more than 50,000 affiliated churches, the FRC’s site does not list these partners or mention the word “church” anywhere on its home page. The FRC’s application to become an association of churches didn’t include this list of partner churches, nor did it provide the names to ProPublica.

To the question of whether the organization performs baptisms, weddings and funerals, the FRC answered yes, but it said it left those duties to its partner churches. Did it have schools for religious instruction of the young? That, too, was the job of the partner churches.

The FRC says it does not have members but a congregation made up of its board of directors, employees, supporters and partner churches. Some of those partner churches, it says, do have members.

Does the organization hold regular chapel services? According to the FRC’s letter to the IRS, the answer is yes. It wrote that it holds services at its office building averaging more than 65 people. But when a ProPublica reporter called to inquire about service times, a staffer who answered the phone responded, “We don’t have church service.” Elsewhere in the form, it says that the employees make up those who attend its services.

The organization’s claim to be an association of churches is disingenuous, said Frederick Clarkson, who researches the Christian right at nonpartisan social justice think tank Political Research Associates.

“The FRC can say whatever bullshit things they want to,” he said. “The IRS should recognize it as a bad argument.”

Three experts told ProPublica that the IRS is failing to use its full powers to determine who gets the special privileges afforded to churches. And when a group like the FRC appears to push the limits of what charities are allowed to do — particularly relating to their partisan political activity — the IRS doesn’t often step in to crack down. The IRS did not answer a list of detailed questions for this story or make anyone available for an interview.

David Cary Hart, an activist and writer who received the FRC’s reclassification documents via a Freedom of Information Act request, wrote a letter to the IRS questioning the decision, saying the approval “defies regulatory logic.”

When ProPublica relayed details of the FRC’s new church designation to Senate Finance Committee Chairman Sheldon Whitehouse, D-R.I., he decried the loss of transparency and lax IRS oversight. “It is far too easy for powerful special interests to hide their donors using webs of nonprofits,” he said in a statement. “Form 990 filings provide valuable, and often the only, insight into a tax-exempt organization’s income and spending. But lax enforcement at the IRS and DOJ encourage more game-playing, which leaves the door wide open for enterprising dark-money schemes to exploit the system further.”

A Wave of Conversions

The current wave of nonprofit-to-church conversions appears to have gained steam after 2013, when the head of the Billy Graham Evangelistic Associationaccused the IRS of targeting BGEA and another charity he heads with audits after the group took out newspaper ads supporting a North Carolina constitutional amendment defining marriage as between one man and one woman. The groups, BGEA and Samaritan’s Purse, retained their tax-exempt status, and in 2015, they applied for church status and got it.

In 2018, Liberty Counsel, a Florida-based legal nonprofit, was reclassified as an “association of churches” — though it had been categorized as a “church auxiliary” affiliated with Jerry Falwell’s megachurch since 2006, granting the organization many of the same exemptions that churches get. The organization represents Kim Davis, the Kentucky county clerk who refused to issue licenses for same-sex marriages. Just days after the Supreme Court cited a Liberty Counsel brief in its June decision overturning Roe v. Wade, a staffer for the organization was recorded saying she prays with conservative justices inside the court building — raising questions about conflicts of interest. (Liberty Counsel denies that the staffer prayed with justices.) In a written statement, founder and chairperson Mathew Staver said that the organization’s legal work is just one part of its activity, and that it made the change “to accurately reflect the operation of the ministry.”

The American Family Association, a Tupelo, Mississippi-based group that runs the influential American Family Radio network, as well as a film studio and magazine, changed its designation to a church in early 2022, according to IRS data. The association sends out frequent “action alerts” to subscribers asking them to sign petitions opposing government appointees or boycott media and brands that it has identified as supporting LGBTQ rights or abortion access. The organization declined to respond to a request for comment.

In its letter to the IRS, the FRC argued that the classification change would protect its religious liberty rights. As an example, it pointed to Treasury Department rules exempting church organizations from the mandatory coverage requirements for contraceptives.

Churches also have a “ministerial exemption” to hiring discrimination laws for religious leaders — meaning, for example, that a Catholic church may exclude women when hiring priests. Courts have interpreted this protection broadly, shielding churches from claims of discrimination for sexual orientation as well. Recent Supreme Court rulings have broadened the umbrella of staffers who may be included under the exemption.

According to IRS data, the FRC has submitted a 990 tax return for its 2021 fiscal year, but the agency has not yet released the filing. The organization is also a member of the Evangelical Council for Financial Accountability, a voluntary membership organization that collects revenue, expenses, assets and a small number of other top-line financials from its members. The organization does not collect more detailed financial data reported on the 990.

Over the five years ending June 2020, the FRC saw average revenues of $15.9 million each year, and it spent an average of $15.6 million. In its fiscal year 2021, the FRC reported to ECFA, it brought in $23.1 million and spent $20 million. In the most recent 990, Perkins made about $300,000.

The IRS did not answer questions about how many groups apply to become a church and how many applications it denies. Samuel Brunson, a law professor specializing in religion and tax exemption at Loyola University Chicago, said the federal government, and especially the IRS, are typically very cautious when it comes to making judgments about defining religion.

“The First Amendment makes [defining a religion] really hard,” he said.

Brunson pointed to the Satanic Temple, which received IRS church recognition in 2019, as an example of an organization that people may not consider one. The group has made headlines over the years for mounting First Amendment challenges such as suing to have a statue of the goat-headed occult icon Baphomet placed next to statues of the Ten Commandments in public places. The temple is now suing Texas, claiming that the state’s abortion restrictions inhibit the liberty of the organization’s members to practice their religious rituals.

Lucien Greaves, a founder of the Satanic Temple, said groups like Liberty Counsel and the FRC have for years implied his organization is too political to be a church — one of the reasons the group finally sought official recognition. The fact that those same organizations are now themselves churches, he said, is hypocritical.

“People act like ... we’re trying to get away with something: ‘Look, these guys want to be a church, and yet they’re active in these public campaigns,’” he said. “And they never apply those same questions to the other side.”

Politics and the Pulpit

The Southern Poverty Law Center classifies the FRC, Liberty Counsel and the American Family Association as hate groups for their anti-LGBTQ stances and advocacy. But Clarkson, the researcher, said focusing on that designation misses the larger sphere of the FRC’s political influence. In recent years, he said, the FRC’s rhetoric and actions have influenced politics away from democracy and in a direction that is “distinctly theocratic.”

“Abortion and LGBT issues are not the war,” he said. “They’re battles in the war.”

IRS rules prohibit public, tax-exempt charities including churches from “directly or indirectly participating in, or intervening in, any political campaign on behalf of (or in opposition to) any candidate for elective public office.” That rule, known as the Johnson Amendment, dates back to 1954. Short of explicit political endorsements, these groups may participate in what’s known as “issue advocacy” including voter education. They can also lobby for political causes connected to their core missions, as long as the lobbying activity is not a “substantial part” of their activities.

To run its more direct political activities, the FRC has another tax-exempt organization, called a social welfare organization, that actively endorses candidates and lobbies for legislation — Family Research Council Action. The arms separate out messaging on two websites, with the FRC hosting issues-based content supporting its Christian worldview and linking to the Family Research Council Action website for content that explicitly endorses candidates.

Family Research Council Action is registered at the same address as the FRC and shares all five of the part-time employees it lists on its tax form, including Perkins. This is legal so long as the organizations are careful to separate activities and accounting, such that tax-deductible charity dollars aren’t supporting political work by the social welfare organization, said Philip Hackney, a tax law professor at the University of Pittsburgh. Experts say ideally a group like Family Research Council Action would have at least one independent staffer to indicate that it’s actually operating as an independent entity.

But FRC Action lists zero full-time employees on its most recent tax filing. When Perkins — who is president of both organizations — is speaking, he rarely makes a delineation about whether he is speaking as the head of the FRC or the head of Family Research Council Action.

But even for charitable operations, the lines around political activities are open to interpretation. While the FRC and other evangelical groups have pushed for the removal of all restrictions on political speech by churches for years, the FRC also releases guidelines encouraging pastors to discuss political matters while staying within the bounds of the law, noting that “there are legal limits to what churches may do, but your hands are not completely tied. In fact, you may be surprised at how much influence you can have.”

On Perkins’ radio show, “Washington Watch,” he hosts a bevy of pro-Donald Trump lawmakers and political figures every day. Its annual Pray Vote Stand Summit, formerly known as the Values Voter Summit, is one of the largest and most influential gatherings for those on the Christian right, where politicians, including Trump during his presidency, talk strategy with religious organizers. In 2021, the event’s schedule included “The Battle for America’s Classrooms: Fighting Indoctrination on a National Scale,” “The End of Roe and Beyond: The Outlook for the Unborn in America” and “A Mandate for Disaster: How States Are Fighting Biden’s Vaccine Tyranny” — the last event featuring the Ohio and Arkansas attorneys general and Perkins. The event was hosted by both the FRC and FRC Action.

In December 2020, Perkins — reportedly a close confidant of Trump’s during his presidency — signed a letter containing the false claims that state officials violated election laws and that “there is no doubt President Donald J. Trump is the lawful winner of the presidential election.” The letter called on state lawmakers to appoint a new slate of electors to override the election President Joe Biden won. Perkins signed as “President, Family Research Council.”

Experts say it’s not clear whether seeking to influence an election after it’s already happened would run afoul of the nonprofit campaign prohibitions.

But it’s rare for a nonprofit to face a challenge for political campaign speech. A 2020 Government Accountability Office report found that, between 2010 and 2017, the IRS examined just 226 of more than 1.5 million tax-exempt organizations for political activity. It sent a written warning to 56% of the organizations it examined and took additional action in just 10% of cases.

Scrutinizing the fuzzy line between FRC and FRC Action, or getting involved in how far out of the gray area a charity may have strayed, is not something that authorities are keeping a close eye on, said Frances Hill, a law professor specializing in tax and election law at the University of Miami. “It would take some sort of an earthquake to make the IRS use its time looking into these matters,” she said.