Medina Court Case and Spending Bill Carry Consequences for Reproductive Health Care

Recent federal decisions could have significant implications for people’s access to reproductive health care in the United States—especially people in the lowest income brackets. Trump’s spending and tax bill includes a provision that bans organizations that provide abortion services from receiving Medicaid payments for one year if they received over $800,000 in Medicaid payments in 2023.

This directly impacts Planned Parenthood and other providers who provide a range of reproductive health care services across the nation. These groups rely heavily on Medicaid payments for meeting their patients’ broad health needs (though Medicaid payments typically do NOT cover abortion care).

The recent Supreme Court decision on Medina v. Planned Parenthood South Atlantic has additional implications for reproductive health. It says patients cannot use Medicaid to pay for services from an organization that also offers abortions. This allows states to restrict organizations, like Planned Parenthood, from receiving Medicaid, even if they provide services outside of abortion care, such as prescribe birth control or testing and treatment for sexually transmitted diseases.

On Monday, U.S. District Judge Indira Talwani, delivered a temporary court order that blocks the federal government from denying Medicaid payments to Planned Parenthood locations that don’t offer abortions or that received less than $800,000 in a single year from Medicaid.

While this is a positive development for the organization, it is temporary. It also does not solve the larger health care dilemma that could occur if Planned Parenthood is defunded. For context, the organization saw more than 2 million patients in 2024 and provided more than 5 million sexually transmitted infection (STI) tests or services and half a million cancer screenings and preventive services during that time.

Medicaid cuts outlined in the spending and tax bill could also affect smaller independent clinics and rural hospitals. Medicaid doesn't cover abortion care, but it does cover family planning.

“There will be clinics in Georgia that are going to be affected by essentially being excluded from the Medicaid provider pool,” says Anna Newton-Levinson, PhD, assistant professor of behavioral, social, and health education sciences at the Rollins School of Public Health.  

The Bigger Picture

The vast majority of what Planned Parenthood provides is not abortion care. It’s family planning care inclusive of contraceptives and well-person care.

“Over half of their services are STI [sexually transmitted infections] testing and treatment, contraceptive services, and preventive cancer screenings,” says Sara Redd, PhD, assistant professor of behavioral, social, and health education sciences at Rollins.

“So, it's so much more than just abortion care, which is a critical health care service. There are so many other health care services that are so critical to the health and well-being of people and their reproductive lives that are also going to be targeted by these bills and or decisions.”

According to the 2023-2024 Planned Parenthood Annual Report: 
●    Abortions make up 4% of the services they provided in 2023
●    54% were for STI testing and treatment
●    24% were contraceptive services
●    11% were other reproductive health care, which includes pregnancy tests

A Rollins-led study found that in two states that have passed bills to cut Planned Parenthood out of Medicaid (Kentucky and Louisiana), more than 64% of the patients surveyed didn't have a regular source of care.

“They were often going for primary care services like pap smears, cervical and breast cancer screenings, or well women exams,” says Newton-Levinson. “Those who didn't have a regular source of care besides Planned Parenthood were frequently going more for those services. Cutting them out of the system isn't just cutting out abortions, it's cutting out critical contraceptive access and well-woman visits for people who don't have a regular source of care otherwise.”

Changes May Worsen Health Gaps, Lead to Hospital Closures

Another new aspect of the spending and tax bill involves updated work requirements for Medicaid enrollees.

“I am really worried about folks who are on Medicaid having access to critical reproductive health care and what it's going to mean for people having to have work requirements when they're already taking care of their children,” says Newton-Levinson. “It’s going to mean that fewer and fewer people will be able to access affordable reproductive health care that they need.”

Medicaid changes folded into the tax and budget bill will also impact rural hospital closures and maternal mortality rates in the U.S. As Redd points out, any bill that limits the pool of providers and deepens Medicaid cuts will make it harder for hospitals to stay open.

“In a state like Georgia, where there's such a strained maternal health care delivery system, we don't have a lot of OBGYNS,” says Redd. ‘We don't have a lot of physicians in some of these counties. So, we have not only these maternal health care deserts, but also just general provider health care deserts.

“Obviously that shows up through maternal, infant, and child health outcomes. It’s a concerning situation.”

As of 2024, more than half of Georgia’s rural hospitals are struggling financially. Nine of Georgia’s rural hospitals have closed, and 18 are at risk of closure. Since the mid-’90s more than 40 labor and delivery units have closed in Georgia.

“The highest percentage of Medicaid covered patients are often in rural areas,” says Newton-Levinson. “They have lower reimbursements for Medicaid services. There's a lot more uninsured folks who they're serving. If they're expecting this level of cuts to Medicaid, it means they may expect to close.

Newton-Levinson continues, “Despite the fact that Congress passed the $50 billion Rural Health Fund, it’s estimated to only cover a third of the funding that rural communities are expected to lose in Medicaid cuts. It’s like using a band-aid to stop a dam. All of this means less access to critical reproductive health care, which means less ability to prevent poorer maternal health, STIs, and cancer.”