In the early months of 2022, Democrats in Congress came close to passing an appropriations bill that did not include a provision barring federal funding for abortions — maybe the closest it had ever come in more than 40 years.

But those who wanted the Hyde Amendment included won the battle in the end. Three months later, the U.S. Supreme Court made its decision in Dobbs v. Jackson Women’s Health to allow states to regulate abortion access. That year, the 50-year precedent of a constitutional right to abortion ended, and the 50-year precedent of no federal tax funding to pay for abortions endures.

The Hyde Amendment was first passed Sept. 30, 1976, three years after the Roe decision. The clause — which isn’t a constitutional amendment — is named for Republican U.S. Rep. Henry Hyde of Illinois. It marked one of the first legislative victories for anti-abortion groups after Roe v. Wade guaranteed abortion access up to fetal viability. 

In the decades since, it has been added to every appropriations bill passed by Congress, restricting federal Medicaid dollars from paying for abortion care except in limited cases of rape, incest and to prevent a pregnant patient’s death. The result has left countless people without a way to pay for the procedure, which advocates for abortion access say causes more abortions to happen later in pregnancy and unnecessarily endangers patients’ health.

Abortion opponents say the Hyde Amendment has prevented 2.7 million abortions. An estimated 300,000 abortions per year were covered by federal dollars prior to the Hyde Amendment. While there aren’t any major organizations that have published how much the federal government has saved by not funding abortion care, advocates say it costs the government more not to fund it because of the extra costs added to medical care and public assistance programs.

As more polls and strategists indicate Democrats could take over congressional majorities in the U.S. House of Representatives and the U.S. Senate in January, some anti-abortion advocates fear such a change could be the most serious threat to Hyde’s future since the party nearly repealed the amendment in 2022. 

“If there becomes a pro-abortion majority in Congress, then Hyde is going to be one of the first things to go, probably, especially because it’s been in the spotlight more recently,” said Gavin Oxley, spokesperson for Americans United for Life, a national anti-abortion organization.

Advocates from each side of the issue have pushed for Congress to either codify Hyde into law or codify its repeal, but neither side has been successful. Because of filibuster rules that are usually used in the U.S. Senate on controversial pieces of legislation, legislation would likely need 60 votes to pass, a tall order in a highly polarized environment.

Oxley said anti-abortion advocates aren’t worried just about Democrats, though. During negotiations over legislation that would have extended subsidies for premiums under the Affordable Care Act, President Donald Trump told congressional Republicans in January that they needed to be “a little flexible” on including the Hyde Amendment. The bill never came to fruition and the subsidies expired, but the incident worried anti-abortion groups such as Oxley’s.

“If we get a pro-abortion majority (in Congress), then I would be concerned,” Oxley said. “There are some Republicans who may not be as committed to protecting Hyde.”

Anti-abortion groups tout polls showing strong support for keeping federal dollars from funding abortion care, but few nonpartisan polls have been conducted on the issue, and no major nonpartisan polls have surfaced in the years since 2022, when 13 states implemented near-total abortion bans. A 2016 Politico poll conducted by the Harvard T.H. Chan School of Public Health found 58% of likely voters opposed using Medicaid to fund abortions. 

When other polls commissioned by pro-abortion rights organizations have framed the question with language specific to how Hyde works, which is that a pregnant patient covered by Medicaid can have pregnancy care and childbirth covered but not the cost of an abortion, support for repealing the Hyde amendment goes up. A 2015 poll found that 62% of voters said Medicaid should cover abortion services.

Effects extend beyond abortion procedures 

Amanda Jean Stevenson, associate professor of sociology and director of population at the University of Colorado, Boulder, said many scholars have tracked the fallout of the Hyde Amendment since its inception, but it’s difficult to trace pregnancy complications or deaths back to Hyde.

Many abortion rights advocates point to the case of Rosie Jimenez, a 27-year-old Texas woman who was denied care at a clinic in 1977 because of her Medicaid status and instead sought care from an unlicensed midwife. She died from an infection after spending a week in intensive care. Her daughter, Monique, was 4 years old at the time and now advocates for policy change.

“It’s very easy for some people to say (Rosie Jimenez’s death) was caused by the Hyde Amendment,” Stevenson said. Had Medicaid benefits covered the abortion, “she probably would’ve had that option for safer care.”

Jimenez’s case happened a few months after Hyde was first included in an appropriations bill, but it didn’t change its inclusion in future bills. Many scholars have documented the effects of low-income patients being denied coverage for abortions, but it hasn’t resulted in policy change, Stevenson said.

“People set out to find out about the impact of it, they find that it has a big adverse impact, and that doesn’t matter. It doesn’t change the policy or people’s opinion of it, it doesn’t change anything, really,” she said. “Evidence continues to be generated, and it continues to be ignored.”

Marlene Gerber Fried, co-founder and the former president of the National Network of Abortion Funds, said it would be nice to think that a change in Congress would bring about the end of Hyde, but she’s heard optimism of that kind before. When former Democratic President Bill Clinton took office in 1993, abortion-rights advocates also expected change.

In the years since, Fried said, the Hyde Amendment has been a “fault line” in the abortion rights space, even as some abortion rights advocates think they are gaining ground with public opinion.

“It’s not that they were against public funding, they just thought it wasn’t going to get to a win,” Fried said.

Researchers say Hyde doesn’t just affect the direct costs of abortion procedures. River Robbins, a doctoral candidate in applied medical anthropology and adjunct instructor at the University of South Florida, said his dissertation research has shown not having access to federal funding affects other services available at individual clinics. Independent clinics provide 58% of all abortions nationwide, according to data from the Abortion Care Network.

Many clinics serve low-income communities and people of color, including patients who need interpreters or other language or disability services. While hospital networks have access to funding that helps them provide those services, such money is not available to clinics that primarily exist to provide abortion care. 

Hyde won’t be the end of funding challenges, advocates say 

Now that access to abortion is extremely limited in more than a dozen states, even fewer people can rely on Medicaid to cover abortion costs. Those who can’t access abortion care at home often must travel to another state, where their local Medicaid program dollars won’t apply. That has put extra burdens on local and regional abortion funds and other philanthropic organizations to fill the funding gaps. Sometimes health clinics just take a loss rather than denying someone an abortion.

“We know that our providers don’t turn folks away, and sometimes that comes at great cost to their clinics and their ability to operate,” said Kelsey Ryland, policy counsel for the National Abortion Federation.

Chelsea Souder, co-owner of Hope Clinic in Illinois, said she hopes the Hyde Amendment will be permanently repealed in the near future, but that even if it is, there will still be many gaps in funding for abortion care. 

Even in states with access, including some of the most accessible states in the country like Illinois, state Medicaid coverage is often inadequate to cover costs by itself, especially for those who need care later in pregnancy. Souder said 85% of her clinic’s revenue does not come from patients who pay out of pocket or with Medicaid — it comes from abortion funds or donors, which she said is not sustainable.

“Making abortion actually accessible and affordable is where the focus has to be,” Souder said.

According to health policy institute KFF, 21 states allow their state Medicaid program to cover abortion costs, and some have expanded those policies since Roe fell. But reimbursement rates for providers continue to be low, regardless of where the clinic is located, and they are exceedingly low for abortions later in a pregnancy.

Dr. Diane Horvath, chief medical officer at Partners in Abortion Care in Maryland, said the clinic ran an experiment of accepting all state Medicaid patients for a year and a half, starting in 2024. Despite strong state support for abortion access at any stage in pregnancy, the low reimbursement rates for care beyond the second trimester resulted in a loss to the clinic of $1.2 million during that time. That includes cost increases for supplies and labor, since the clinic hasn’t increased prices for patients.

“For most of these patients, we lose at least $4,000 a patient,” Horvath said. “A hospital might be able to recover more and spread loss over different departments, but I don’t have another clinic, I don’t have another place I can draw funds from.”

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

As physicians continue to navigate care for patients with complex pregnancies in states with abortion bans, a group of maternal-fetal medicine specialists has developed new guidelines to help providers in those states navigate legal risks for themselves and medical challenges for their high-risk patients. 

Maternal-fetal medicine specialists handle some of the most high-risk pregnancies, including patients with high blood pressure, diabetes, cancer, fetal anomalies or other complications. In states with abortion bans, those conditions can become even more dangerous for a patient if a doctor is unsure when they can terminate a pregnancy without potentially jeopardizing their medical license or facing criminal penalties that can include jail time.

“Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care,” the Society for Maternal-Fetal Medicine wrote in a special statement published this month. 

Ten states plus the District of Columbia allow abortion access without gestational restrictions, while 13 states ban abortion at all stages. Following the implementation of those bans since 2022, many hospital systems and clinics have offered different interpretations of how to avoid legal jeopardy under the bans and what qualifies under exceptions, leading to confusion and delays in care that have been documented in many states nationwide. 

To mitigate those problems, the guidelines encourage providers and administrators to set up referral networks across state lines, work to find agreement on what is permissible under state law and counsel patients on their options even in states with restrictions to deliver the highest-quality care. 

“We are uniquely positioned as high-risk pregnancy experts to make that case to our leaders,” said Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio who chaired the committee that developed the statement. “And a statement like this would give providers and our colleagues some confidence to be leaders in this space.”

The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists agree that access to abortion and counseling about options is the standard of care for obstetric patients, but there are conscientious exceptions for doctors who do not want to provide abortion care. 

Some doctors choose to affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, and offer their own guidance about approaching complications, which still includes termination in some situations. The group is officially a partner of the Alliance Defending Freedom and several anti-abortion groups, as well as the Alliance for Hippocratic Medicine, which is the group that sued to revoke federal approval of one of two drugs used to terminate a pregnancy or treat miscarriages.

A representative from the American Association of Pro-Life Obstetricians and Gynecologists could not be reached for comment before publication.

Worse outcomes for high-risk patients

Nationwide, women in states with bans have reported difficulties receiving care when experiencing pregnancy complications. 

One of the most common emergencies occurs when a patient’s amniotic sac breaks before a fetus is viable. If left untreated, it can quickly turn into a deadly infection. The statement noted that after Texas passed Senate Bill 8 in 2021 banning abortion at an early gestation, waiting to treat patients in those medical situations dramatically increased negative health outcomes. According to research cited in the statement, complications such as blood transfusion, intensive care admission and serious infection resulted in 57% of cases, versus comparable research in states without restrictions that showed a complication rate of 33%. In all of the cases, the fetus did not survive.

Federal judge’s order allowing an Idaho doctor to perform certain abortions is put on hold

The guidance states hospitals and clinics should expand their abortion care to the extent allowed by law, and recognize maternal-fetal medicine specialists as sources of best care practices. It also instructs providers to work with legal teams in their networks to understand the federal Emergency Medical Treatment and Labor Act and when it may require abortion care, as well as encouraging training for basic termination procedures. 

Dr. David Hackney, a maternal-fetal medicine specialist in Ohio who published a book in August about navigating high-risk pregnancy care under Dobbs, said the statement will be useful for many providers nationwide.

“We don’t always focus enough on hospital administration, care and systems, but there’s always so much that can be done in those regions that is almost — if not more — important,” Hackney said.

After the Dobbs decision in June 2022, Hackney said, many individual healthcare systems didn’t know what to do when faced with certain situations where termination might be needed, and set a patchwork of policies that increased confusion for providers. But in the years since, providers and administrators in some healthcare systems have come together to reach informal agreements about what they are comfortable doing within the confines of an abortion ban.

“You have some defense if everyone has agreed to do the same thing,” he said.

When laws are unclear, he said, people will most often lean toward over-complying, which can create worse outcomes for the patient. 

“Even outside of abortion, medical care tends to work better when you have consensus and you have common best practices, even if it’s on a regional level,” he said. 

‘When they need me, they call me’

Many specialists’ cases aren’t emergencies, but rather pregnancies that put a patient at risk because of underlying health conditions, whether they existed before a pregnancy or developed during pregnancy, or late-term diagnoses of fetal anomalies that upend a wanted pregnancy. 

In those cases, the maternal-fetal organization says, patients should be told that their options include termination, even if that can’t happen in their home state.

Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who co-authored the special statement, moved to Colorado from Tennessee in 2023 after that state enacted a near-total abortion ban.

She said she saw firsthand how difficult it was in Tennessee to try to take care of patients without clarity around the law and without leadership that was willing or able to try to provide support. One goal of the statement is to help provide that kind of support to physicians, she said.

“We know you’re in a tough situation, we’re not blind to that. No one is blaming you for what you can and cannot do,” Zahedi-Spung said.

The society’s statement suggests that providers establish relationships with leaders within their clinical settings as well as in the community, region and state to agree on legal interpretations of abortion restrictions, particularly those who might hold leadership positions themselves. It also encourages doctors to establish referral networks locally and between states to ensure patient access.

“I have lots of people from Texas who have my phone number, and when they need me, they call me,” Zahedi-Spung said. “That is a system that works. And then those patients go back to safe providers who can take care of them.”  

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

The U.S. Food and Drug Administration says it’s helping manufacturers increase the supply of estrogen-based hormonal patches and acknowledged a current nationwide shortage as more women seek hormonal therapies for symptoms related to menopause.

In a release earlier this month, the FDA said it is expediting actions to increase supply, and said all six manufacturers are working to expand capacity and prioritize production of the patches.

“The FDA views increased interest in menopause treatment as an important development for women’s health and is working closely with manufacturers to help ensure that the supply of estradiol patches keeps pace with demand,” the release said.

Menopause typically occurs between the ages of 45 and 55, according to the National Institute on Aging, when a woman stops having menstrual periods. That hormonal change can cause symptoms such as hot flashes, night sweats, bone density loss, insomnia and more. Estradiol transdermal patches worn on the skin can replace estrogen lost through menopause and reduce those symptoms for some women.

Stateline reported in May that more awareness of menopause and its effects was leading to more states introducing legislation around the topic to mandate more insurance coverage for treatment and to create more workplace accommodations. At that time, the FDA did not list the patches in its list of shortages — this month marks the first time the agency has acknowledged a shortage. The American Society of Health-System Pharmacists first noted a shortage in January, two months after the FDA removed the treatment from its longtime “black box” warning status.

As of May, the National Menopause Foundation said more than 60 pieces of legislation related to menopause had been introduced nationwide this year. Twenty-six, and 26 states have enacted menopause-related laws since 2019, and more bills are expected to be introduced in the upcoming 2027 legislative sessions.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

A federal judge in Texas on Sunday paused a lawsuit seeking to revoke nationwide approval of the abortion drug mifepristone, saying the case won’t be heard until at least Dec. 1 and granting the U.S. Food and Drug Administration’s request for a stay to continue its safety review of the drug.

The Republican attorneys general of Florida and Texas filed a lawsuit against the FDA last December seeking to permanently revoke the agency’s initial approval of mifepristone from 2000, along with subsequent decisions over the years that eased access for patients. Florida and Texas had agreed to the FDA’s request for a stay. 

If a judge were to rule in favor of Florida and Texas, the medication would become unavailable in all states, regardless of abortion laws.

In the same ruling, U.S. Chief District Judge Reed O’Connor, an appointee of former President George W. Bush, denied a motion to dismiss the case from distributor Danco Laboratories and GenBioPro, one of the drug’s main manufacturers. The company’s attorneys intervened as defendants in April. O’Connor’s ruling will delay any action in the case until after the midterm elections.  

“We expect the FDA’s review of mifepristone to not contradict the decision they made in 2023 that reaffirmed our product is safe and effective,” GenBioPro CEO Evan Masingill said in a statement Monday. “GenBioPro will continue to use all legal and regulatory tools available to ensure Americans’ access to reproductive care.”

The lawsuit by Florida and Texas is one of three suits pending in federal courts that would change nationwide access to mifepristone, and it’s the most sweeping in its goals. 

Florida and Texas’s lawsuit cites in part the federal Comstock Act, a 150-year-old anti-obscenity law that made it illegal to send any materials that could induce an abortion through the mail. That law has not been enforced for many decades. Anti-abortion groups recently called for new U.S. Attorney General Todd Blanche to revisit the Comstock Act’s prohibition. 

Mifepristone, one of two drugs most commonly used to terminate a pregnancy before 10 weeks’ gestation and to treat miscarriages, has repeatedly shown in scientific studies to be safe and effective, but the FDA began another safety study in June and announced it would take about six months to complete. 

The 5th U.S. Circuit Court of Appeals will hear oral arguments Sept. 9 in a case from Louisiana seeking to remove a rule allowing the medication to be dispensed without an in-person visit to a provider, and the attorneys general in Missouri, Idaho and Kansas have asked a federal judge in Missouri to roll back the rules to what they were before 2016. Prior to that year, the drug was only approved for use before seven weeks’ gestation and required three in-person office visits.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

BOISE, Idaho — The group leading the effort to restore abortion access by ballot initiative in Idaho has filed a lawsuit against state officials over proposed language that will appear on the ballot and in a state-issued voter pamphlet.

Idahoans United for Women and Families, the nonprofit organization that drafted the initiative — now called Proposition 1 — says the “yes” and “no” statements as prepared by Idaho officials violate the law guiding the initiative process and are confusing and misleading. Attorneys filed the lawsuit to the Idaho Supreme Court late Wednesday night.

Idaho Secretary of State Phil McGrane stressed that the issue needs to be quickly resolved to meet upcoming ballot deadlines. The voter pamphlet must be printed by September 25, according to the law, and ballots need to be mailed to military and overseas voters about a week before that. McGrane said the state has paused production amid the litigation on the 850,000 copies of the voter pamphlet that need to be printed and mailed.

“There was a good-faith effort to try and reflect each of the sides of the pro and con statements that were submitted to us,” McGrane told Stateline by phone on Thursday. “I think one of the biggest challenges that we’re going to see with Proposition 1 is that it’s a very complicated issue with a lot of nuance … and this isn’t a simple issue to consolidate down into a short, one-sentence statement.”

Following the law, McGrane developed the language for the statements with Idaho Attorney General Raúl Labrador, who has been outspoken in his anti-abortion views for many years and recently appealed a federal judge’s decision that would protect abortion access in cases of threats to a pregnant patient’s physical and mental health.

Labrador told Stateline in an emailed statement that his duty alongside the secretary was to clearly and concisely explain the effects of a “yes” or “no” vote and to fully inform Idaho voters, and said they applied the same legal standard to every measure that has been on the ballot.

“Idaho voters deserve a straightforward explanation of what their vote will do,” Labrador said.

Idaho Supreme Court orders officials to revise abortion ballot initiative language, impact statement

There have been similar legal fights over abortion ballot language in other states. Activists on both sides of the issue in Missouri, for example, have spent years arguing over ballot language, both on the 2024 citizen-led amendment that restored legal access to abortion, and on the 2026 amendment referred by the legislature that would reinstate the ban.

Similar battles between Republican state officials and initiative organizers played out in Ohio, Arizona and Montana between 2023 and 2024. Voters in all three of those states ultimately approved amendments to protect abortion rights.

It’s also not the first time Idahoans United for Women and Families has sued the state over ballot language. In April 2025, the Idaho Supreme Court heard arguments in the lawsuit, including whether the short ballot title and fiscal impact statement should be revised, and unanimously sided with Idahoans United on those two elements.

Under Idaho law, the ballot must include a clear and concise statement about the effect of a “yes” or “no” vote, and the voter pamphlet must include a complete copy of the initiative text, its fiscal impact, and arguments for or against the measure with rebuttals.

But the ballot won’t include the full text of the initiative or the arguments for and against — just the long and short titles of the initiative, statements about fiscal impacts and the “yes” or “no” statements.

“In the two decades we’ve had a yes/no statement on the ballot, they’ve never looked like this,” said Melanie Folwell, lead organizer for Idahoans United, in a statement. “And it’s not because our initiative is longer or more complex than past initiatives.”

According to a copy of the voter pamphlet pages drafted by the Idaho state officials, a “no” vote “would make no change to Idaho’s current law, which protects the life of the unborn while allowing abortion in reported cases of rape or incest, or when necessary to protect the life of the mother.”

The “yes” side said it would “create reproductive rights, including a right to abortion before a fetus’ ability to survive and after a fetus’ ability to survive in cases of medical emergency, and provide liability protections for healthcare providers.”

The complaint says the “no” statement is not “clear and concise,” and said the “yes” statement is similarly inadequate because it describes viability in a different way than the other parts of the ballot language.

Missouri appeals court rewrites ballot proposal to clarify a ‘yes’ would end right to abortion

They also argue the “no” statement does not adequately describe Idaho’s abortion law, which is a criminal statute that carries felony punishment for providers, and they said it does not accurately describe the exceptions.

The group is asking the court to order that the statements be simplified to say that a “yes” vote means the proposition will become state law, and a “no” vote means state law regarding abortion will remain unchanged.

Attorneys asked the court to make a decision by September 11.

This story has been updated to more accurately reflect the outcome of the Idaho Supreme Court ruling in the first lawsuit over the initiative ballot language in 2025. Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

A federal court ruling out of Idaho has potential implications for exceptions in abortion bans nationwide and could eventually end up before the U.S. Supreme Court to decide.

U.S. District Judge B. Lynn Winmill ruled earlier this month that the 14th Amendment of the U.S. Constitution provides a narrow right for a pregnant patient to obtain an abortion if the pregnancy could be a risk to their health, including their mental health. It’s the first ruling since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health in 2022 to find that the U.S. Constitution includes a right to abortion access in certain situations.  

Mary Ziegler, a legal historian and law professor at the University of California, Davis School of Law, said Winmill’s ruling could be the beginning of a “slow erosion” of the Dobbs decision, similar to the way that anti-abortion advocates used lawsuits and legislation to chip away at the law established by Roe v. Wade after it was decided in 1973.

Supreme Court justices appear split over whether to protect abortion care during emergencies

“They kind of worked over the course of decades to do a death by a thousand cuts, chipping away at its breadth,” Ziegler said. “This may be kind of a funhouse mirror version of that.”

For years, anti-abortion state officials and advocacy groups used various legal tactics to diminish access to abortion nationwide after Roe v. Wade determined that the procedure was a constitutional right. Over time, state legislatures passed procedural laws that made it more difficult for providers to offer abortion services, as well as so-called “fetal pain” laws, and worked up to passing the six-week and 15-week abortion bans that eventually led to Dobbs. 

Two years ago, U.S. Supreme Court justices were asked to consider whether Idaho could set aside federal law mandating stabilizing care in an emergency if that stabilizing care, in a doctor’s opinion, was to terminate a pregnancy. Now the question could be whether any pregnancy scenario where a patient’s physical or mental health is threatened is something that all states can regulate under Dobbs.

Health exceptions

Out of the 13 states that have near-total abortion bans, five have no exception for preserving a pregnant patient’s health, including Idaho, Arkansas, Mississippi, Oklahoma and South Dakota. 

All 13 have an exception to save a pregnant woman’s life, but doctors say there most often is no clear moment when they can easily say a person will die without an immediate abortion. Instead, doctors are left to guess whether terminating a pregnancy to save a patient would cost them their license to practice or land them in prison.

Even in states with health exceptions, some doctors hesitate to act because of the ban,  opting for delays that can cause medical complications such as organ damage or fertility loss. An Arkansas woman said she was denied an abortion during a miscarriage in 2024, resulting in a days-long ordeal that eventually led to her being transferred out of state to Kansas, where abortion is legal.

Winmill’s legal decision blocks enforcement of Idaho’s near-total abortion ban when a pregnancy is terminated under those circumstances. Idaho Attorney General Raúl Labrador, a Republican, appealed the decision to the 9th U.S. Circuit Court of Appeals on Wednesday, and also asked Winmill to pause that injunction while the decision is appealed.

“The state’s interest in protecting unborn children from unjustified abortion is irreparably harmed by the order, and public interest and equity support a stay for that same reason,” Idaho Assistant Solicitor General Aaron Green wrote in the request for a stay.

The attorney general and leadership at the Idaho Family Policy Center, a religious organization that helped craft the legislation that established the state’s ban, have expressed confidence that Winmill’s decision will be reversed quickly.

“The Fourteenth Amendment protects the basic rights that are part of the historical fabric of our nation, not a right to take the life of an innocent child in the womb, an act that was a crime at the time that the Fourteenth Amendment was ratified,” said Caleb Pirc, general counsel for the Idaho Family Policy Center, in a statement. “We fully expect Judge Winmill’s attempt to shoehorn a right to abortion into the Constitution to be swiftly rejected on appeal.” 

Supreme Court watch

Dr. Stacy Seyb, a maternal-fetal medicine specialist  for Idaho’s largest health system, St. Luke’s, sued state officials and the Idaho Board of Medicine in 2024, arguing that the state’s near-total ban prevented him from providing appropriate care to all of his patients. Maternal-fetal medicine specialists handle the most high-risk pregnancies, including patients carrying multiples and those with conditions such as high blood pressure and gestational diabetes.  

In his ruling, Winmill wrote that although Dobbs allowed states to regulate abortion access, that case was about elective abortions, and that his ruling was about a pregnant woman’s ability to seek care under “the most difficult and tragic circumstances,” almost always when the woman wanted the pregnancy.

U.S. Supreme Court ruling reinstates ability to perform emergency abortions in Idaho under ban

“By banning health-preserving abortion, Idaho attempts to deny this fundamental right on the basis that the threat of harm comes from a fetus, which depends on the woman for survival,” Winmill wrote. “But a pregnant woman’s health is not a state resource to be allocated at the legislature’s whim. The Fourteenth Amendment exists precisely to prevent subjugation like this.”

Winmill discussed the history of abortion bans in his opinion, writing that when the 14th Amendment was ratified in 1868, the states and territories that restricted abortion also included exceptions for therapeutic purposes when a doctor was acting in good faith.

But Winmill went further than many judges have gone by including a pregnancy’s threats to mental health, something that only Alabama has recognized as an explicit healthcare exception for abortions among states with bans, according to KFF. There, a psychiatrist is required to diagnose a pregnant patient with a serious mental illness that could result in their death or the death of the fetus in order to qualify for that exception.

“The brain is an organ of the body, and healthcare providers use empirical tools to reliably assess the risk of suicidality and the most effective treatments,” Winmill wrote. “It is an affront to human dignity to bar pregnant women from receiving life-saving care on the basis that the threat comes from a mental health condition rather than a physical health condition.”

Idaho’s role

Idaho has been at the center of the national debate about when health conditions take priority over an abortion ban since the first year after the Dobbs decision. 

The U.S. Department of Justice under former President Joe Biden sued Idaho to require that it acknowledge a federal law known as the Emergency Medical Treatment and Active Labor Act — better known as EMTALA — in the context of patients who come to the emergency room with pregnancies that may need to be terminated to prevent infection or other adverse health outcomes.

The U.S. Supreme Court heard that case in late April 2024, but sent it back to the lower appellate court in June, saying it was too early in the process for justices to have considered ruling on it. The case was later dropped by the DOJ under President Donald Trump, but St. Luke’s filed its own lawsuit against the state that is still ongoing. That case is also before Winmill in federal court.

At the time of the EMTALA arguments, Idaho officials had argued that if it allowed women to get a legal abortion in an emergency room, anyone could come to a hospital’s emergency department  and threaten to harm themselves.  

Tanya Pellegrini, co-director of litigation at The Lawyering Project and one of the attorneys who represented Seyb in this month’s case, said that wasn’t true under EMTALA, and it won’t be true following Winmill’s ruling. 

“I think the order really speaks for itself in terms of why mental health should not be treated differently from physical health,” Pellegrini said.

Ziegler said she won’t be surprised if Seyb’s case ends up before the Supreme Court in the near future, because it strikes at the heart of questions about the Dobbs decision that have yet to be fully resolved.

“It’s a really important question that they’ll have to address sooner or later,” Ziegler said. 

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

A federal judge in the District of Columbia issued an order Wednesday blocking U.S. Health and Human Services from implementing sweeping changes to grants under the Teen Pregnancy Prevention Program while a lawsuit proceeds, but dozens of existing grants that were canceled this summer will remain so for now, unless the administration chooses to reinstate the funds.  

The agency canceled 53 out of 67 grants under the program at the end of June, affecting grantees in more than two dozen states, including Louisiana, New York, Oklahoma and Texas. Grantees were given no advance notice and were told their programs did not align with agency priorities — most were told their programs normalized or promoted sexual activity for minors. The grants were canceled two years before their expiration dates.

Following the cancellations, three affected grantees and sex education advocacy group SIECUS: Sex Ed for Social Change filed a lawsuit in the District of Columbia federal court district on July 14. U.S. District Judge Christopher Cooper, an appointee of former President Barack Obama, said the plaintiffs are likely to succeed in the case, warranting his decision to block the Trump administration’s actions. 

But Cooper said it’s unclear whether he can order the restoration of nearly $70 million in canceled funds, and that other court cases need to be resolved before he can move forward with that kind of action.

Congress established the Teen Pregnancy Prevention Program in 2010 as a national, evidence-based grant program that would fund diverse programs working to prevent teen pregnancy using methods that have repeatedly shown to be effective. Grant recipients typically offer educational programs about preventing pregnancy or identifying healthy relationships, and provide referrals for community and healthcare resources as needed. 

Since then, teen pregnancy rates have fallen about 72%, which researchers say is the biggest contributor to the overall drop in national birth rates.

To replace the canceled grants, HHS published two notices for new programs that focused less on preventing pregnancy and more on fertility tracking, “body literacy” goals and “reproductive goals counseling.”

“HHS is perfectly entitled to formulate its own views about how to stem teen pregnancy — or even whether it is worth preventing at all — and to pursue policy initiatives consistent with its viewpoint,” Cooper wrote in his ruling. “But it is not at liberty … to impose conditions on grant recipients that Congress did not intend or that are unreasonable or unexplained. The preliminary record suggests that HHS has done just that.”

Cooper said HHS could choose to reissue the grant funding opportunities under the previous guidelines, but it can’t move forward with the new ones while the lawsuit proceeds.

The judge also noted that in July 2025, HHS issued a notice telling grantees to revise their programs to align with current executive orders, including by deleting any references to health equity and inclusivity, and offered guidance about what it considered medically accurate and age appropriate content. 

Three grantees sued over the notice, saying it was contrary to the statute guiding the program as established by Congress, and another D.C. judge agreed, vacating the guidance and blocking its implementation. 

“As the saying goes, ‘When at first you don’t succeed, try, try again.’ HHS has taken this adage to heart,” Cooper wrote this week, citing the 2025 court case. “Unfazed by the adverse ruling, HHS issued new (grant funding notices)  that repackaged the vacated policy changes and imposed additional grant parameters.”

The administration could appeal the decision in the coming weeks. Stateline has requested comment from HHS officials.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.