Beyond Reproductive Rights: What’s at Stake in Congressional Decisions on Medicaid Funding Restrictions

By Yash Joshi '26

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Equitable sexual and reproductive healthcare can be considered functional to the success of a society, not only because it is regarded as a universal human right, but also because of its direct role in individual health, public health, and economic development. In 2024, over 2 million patients across the United States received care from Planned Parenthood clinics that offer a variety of reproductive health services, including STD testing, birth control, abortions, and gender affirming care. (1) As the largest nonprofit organization offering reproductive services in the United States, Planned Parenthood serves as a critical source of care for millions of people, particularly those who have low incomes, are uninsured, or live in underserved areas. (2) Unsurprisingly, however, many disagree with accessibility to these services.

The polarizing nature of Planned Parenthood primarily stems from its status as the largest provider of abortion services in the United States. (3) Policymakers who oppose abortions and other controversial services use federal funding restrictions to limit access to such care indirectly. (4) At its core, the goal is not budgetary efficiency or legal necessity, but to disincentivize and isolate abortion providers and make it difficult for them to operate. The Trump administration has catalyzed this shift in the healthcare landscape. The One Big Beautiful Act (H.R. 1) includes provisions to penalize Medicaid providers that offer abortion and family planning services. (5) Section 71113 of H.R. 1 represents a financial threat to essential health providers, raising legal and constitutional challenges to Medicaid’s core protections. To gain a comprehensive understanding of the issue, we must examine details of the provision, legal ramifications, and public health concerns.

Statutory Defunding Provision

On July 4, 2025, the One Big Beautiful Bill Act was signed into law, as Public Law 119-21. Section 71113 imposes a one-year prohibition on federal Medicaid payments to certain “prohibited entities.” (6) The statute defines a prohibited entity as a 501(c)(3) essential community provider primarily engaged in family planning and reproductive health services that also provides abortions, except in cases of rape, incest, or when a physician certifies that continuing the pregnancy would endanger the woman’s life. (7) Additionally, the ban applies only to entities whose combined Federal and State Medicaid payments exceeded $800,000 in FY 2023, including payments routed through affiliates, subsidiaries, successors, clinics, or nationwide provider networks. (8)

Although it does not name Planned Parenthood, the provision functions to defund it and similar providers. The Hyde Amendment already prohibits Medicaid funding for most abortions, allowing exceptions only in cases of rape, incest, or life endangerment of the woman, making it clear that federal funds do not support abortion services. (9) Yet, section 71113 goes further by restricting Medicaid funding for all other healthcare services provided by clinics like Planned Parenthood, even when those services are unrelated to abortion and are often critical for low-income patients. (10)

Legal Response, Constitutional Objections, and Broader Concerns

Following the signing of the One Big Beautiful Bill Act on July 4, 2025, Planned Parenthood filed suit almost immediately, prompting a federal district court to issue a temporary administrative hold while it reviewed the challenge. (11) However, the pause was short-lived. Within days, the hold was lifted, allowing Section 71113 to take effect even as litigation continues. So why did the court lift the administrative hold so quickly? Understanding this requires examining three areas: the procedural response that followed the bill’s enactment, the constitutional objections raised by Planned Parenthood, and the broader legal concerns introduced by Section 71113.

The district court’s temporary hold represents a temporary standard measure used to allow time for initial review. However, emergency relief requires an exceptional demonstration of imminent and irreparable harm. Because the court concluded that Planned Parenthood had not met that threshold at this preliminary stage, Section 71113 took effect while the case proceeds.

The initial lawsuit, Planned Parenthood Federation of America v. Kennedy, argued that the defunding provision was unconstitutional on multiple grounds, including violations of the Bill of Attainder Clause, the First Amendment (for targeting speech and advocacy on abortion), and the Fifth Amendment’s Equal Protection component. (12) Planned Parenthood also argues that Section 71113 violates the unconstitutional-conditions doctrine. Although Congress may withhold funding for abortion, it may not condition access to unrelated federal benefits on a provider’s willingness to forgo lawful, privately funded services. (13) Precedent such as Planned Parenthood of Indiana & Kentucky v. Commissioner and historical bill-of-attainder cases like United States v. Lovett further reinforce the argument that a statute aimed at financially crippling a specific disfavored entity may exceed Congress’s constitutional authority. (14)

Section 71113 raises deeper legal issues that extend beyond reproductive healthcare policy, addressing foundational principles of Medicaid structure, federal spending power, and constitutional limits. Although Congress has broad authority to attach conditions to federal funding, the Supreme Court has held that such conditions must be clear, related to the program’s purpose, and not coercively punitive toward states or beneficiaries. (15) Conditioning Medicaid participation on a provider’s willingness to refrain from offering privately funded, lawful services may implicate the unconstitutional conditions doctrine. (16) Although Congress is not required to subsidize abortion, it cannot penalize the exercise of a constitutional right by withdrawing unrelated benefits. Even under post-Dobbs jurisprudence, where abortion is no longer recognized as a federally protected right, courts may scrutinize whether punishing providers for offering legal services beyond the scope of federal funding violates principles of due process, equal protection, or viewpoint neutrality in public funding schemes. (17)

Public Health Concerns and Broader Impact

In 2024, Planned Parenthood provided 9.45 million services, including STI testing and treatment, contraception, cancer screening, and childbirth services. (18) Limiting access to contraception, STI testing, and cancer screening may lower short-term government expenditures, but will likely increase long-term costs via unintended pregnancies, untreated infections, and preventable disease. Furthermore, a study of clinic closures in Texas following HB 2 found that women faced significantly longer travel distances (70 miles vs. 17 miles), greater out-of-pocket costs, delays accessing abortion care, and there was a sharp decline in long-acting reversible contraception (LARC) use. (19) These effects illustrate the broader healthcare dangers of defunding essential community providers.

Moreover, in 2024, Planned Parenthood contributed to 44 peer-reviewed publications. (20) Defunding thus harms not only access but also the research that drives policy innovation. Beyond the immediate effects on patients, the bill challenges long-standing legal protections under the Medicaid Act, particularly the Free Choice of Provider provision, by conditioning public funding on ideological compliance rather than clinical qualification. (21) It also sets a dangerous precedent for how Congress may sidestep judicial limits by targeting providers indirectly through appropriations mechanisms. The result leaves effects not only on abortion access, but on the entire spectrum of reproductive and preventive care, leaving low-income communities medically underserved and constitutionally unprotected.

Endnotes

1. Planned Parenthood Federation of America. 2022–2024 Annual Report. 2024. https://www.plannedparenthood.org/uploads/filer_public/ec/6d/ec6da0d6-98e5-4278-8d11-99a5cba8e615/2024-ppfa-annualreport-c3-digital.pdf

2. Ibid.

3. Planned Parenthood Federation of America. “History of Planned Parenthood.” Accessed November 15, 2025. https://www.plannedparenthood.org/about-us/who-we-are/our-history

4. Guttmacher Institute. “Why Protecting Medicaid Means Protecting Sexual and Reproductive Health.” 2017. Guttmacher Policy Review. March 27. https://www.guttmacher.org/gpr/2017/03/why-protecting-medicaid-means-protecting-sexual-and-reproductive-health

5. Congress.gov. H.R. 1 – “One Big Beautiful Bill Act of 2025.” 119th Congress (2025–2026), Subtitle D, Section 71113. Accessed November 15, 2025. https://www.congress.gov/bill/119th-congress/house-bill/1

6. Ibid.

7. Ibid.

8. Ibid.

9. Executive Office of the President. “Hyde Amendment.” Omnibus Appropriations Act, 2024, Pub. L. No. 118-XXX, Div. H, §§ 506–507. https://www.congress.gov/amendment/118th-congress/house-amendment/742/text

10. Ibid.

11. Planned Parenthood Federation of America v. Kennedy, Complaint, No. ___ (D.D.C. filed July 2025).

12. Ibid.

13. Ibid.

14. United States Court of Appeals for the Seventh Circuit. Planned Parenthood of Indiana and Kentucky, Inc. v. Commissioner of the Indiana State Department of Health, 894 F.3d 844 (7th Cir. 2018). https://www.supremecourt.gov/opinions/18pdf/18-483_3d9g.pdf

15. Guttmacher Institute. “Recent Funding Restrictions on the U.S. Family Planning Safety Net May Foreshadow What Is to Come.” 2016. Guttmacher Policy Review, December. https://www.guttmacher.org/gpr/2016/12/recent-funding-restrictions-us-family-planning-safety-net-may-foreshadow-what-come

16. Kathleen M. Sullivan. “Unconstitutional Conditions.” 1989. Harvard Law Review 102: 1413–1515.

17. Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization, 597 U.S. ___ (2022). https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf

18. Planned Parenthood Federation of America. 2022–2024 Annual Report. 2024.

19. Caitlin Cameron, Kari White, Amanda Stevenson, Kristine Hopkins, and Joseph E. Potter. “Impact of Clinic Closures on Women Obtaining Abortion Services After Implementation of a Restrictive Law in Texas.” 2016. American Journal of Public Health 106, no. 5 (May): 857–864. https://doi.org/10.2105/AJPH.2016.303134

20. Planned Parenthood Federation of America. 2022–2024 Annual Report. 2024.

21. Guttmacher Institute. “Recent Funding Restrictions on the U.S. Family Planning Safety Net May Foreshadow What Is to Come.” 2016. Guttmacher Policy Review, December. https://www.guttmacher.org/gpr/2016/12/recent-funding-restrictions-us-family-planning-safety-net-may-foreshadow-what-come