A Biden-era protection for reproductive and gender affirming health care information was upended by a federal judge in Texas in June. Despite several lawsuits, key privacy rules for medical records remain, but some experts say they aren’t sufficient. (Photo by Dave Whitney / Getty Images)

The four lawsuits at the center of a Republican-led effort to ensure law enforcement can access reproductive health records are now mostly resolved, after attorneys for Texas Attorney General Ken Paxton agreed last week to dismiss the last remaining suit challenging the legality of a foundational health privacy rule.

Paxton filed the lawsuit in September 2024 arguing that Democratic President Joe Biden’s administration illegally created a rule under the Health Insurance Portability and Accountability Act barring certain reproductive health care information from being disclosed if a procedure such as abortion was obtained in a state where it is legal.

The federal HIPAA law is meant to protect patient information generally, especially when that information travels between providers. It contains exceptions for information that can be disclosed to investigators, who can subpoena records from other states. 

Ashley Kurzweil, senior policy analyst for reproductive health and rights at the National Partnership for Women & Families, said the dual threat that Paxton’s lawsuit presented was alarming on a much wider scale than just reproductive health care, so it is a relief that the case is dismissed. Overturning key privacy protections from 2000 that formed the basis of the Biden-era rule could have thrown the entire health care system into chaos, she said.

“We are thrilled that the 2000 privacy rule is still in effect. It is hugely important that it is still in place,” Kurzweil said. “However, (it) provides insufficient safeguards for reproductive health care information when it comes to the broader landscape of increased criminalization risk that people are facing.”

The 2024 rule specifically relating to reproductive and gender-affirming health care information was nullified in June by U.S. District Judge Matthew Kacsmaryk. His ruling came in a Texas-based case filed by a clinician in a small town who said the rule created a conflict with her responsibility to report child abuse, because she considers abortion and gender-affirming health care to be child abuse.

Without those 2024 protections, doctors can choose whether to report patients to law enforcement, Kurzeil said, and some might also be discouraged from offering reproductive health care altogether to minimize legal risks.  

States Newsroom reported more than 400 people were charged with pregnancy-related crimes in the two years after the U.S. Supreme Court’s Dobbs decision, according to data from the nonprofit Pregnancy Justice. 

One of those people was Brittany Watts, an Ohio woman who went to the hospital with miscarriage complications and waited for hours without receiving help. After miscarrying at home and returning to the hospital, staff called the police, accusing her of abuse of a corpse. A grand jury declined to indict her, and Watts is now suing the hospital. 

In nine of the 400 cases, pregnant people were accused of researching or attempting to obtain an abortion.

Advocacy group dropped effort to appeal Texas ruling

The case before Kacsmaryk is the only one of the four that resulted in a ruling. Although it was filed in the last few months of the Biden administration, the bulk of the case was litigated under Republican President Donald Trump’s Department of Justice.

Repealing the rule was a directive in Project 2025, the conservative blueprint published by the Heritage Foundation. Several prominent anti-abortion organizations were part of the panel that drafted Project 2025, and many of the people involved in writing the 900-page document now work for the Trump administration.

Democracy Forward, a nonprofit legal organization, represented Doctors for America and the cities of Columbus, Ohio, and Madison, Wisconsin, in an attempt to intervene in the case because they did not expect the government to defend the rule. If they were allowed to intervene, they could appeal Kacsmaryk’s opinion striking down the rule regardless of the Trump administration’s decision.

Their attempts were denied by Kacsmaryk, and while the organization did initially appeal that decision, the attorneys dropped the effort in September, saying in a court filing that “the resources of the parties and the courts would be best conserved by dismissing this appeal.”

In a statement to States Newsroom, a spokesperson for Democracy Forward said they will continue to pursue every tool available to defend reproductive rights from political interference and anti-abortion extremists.

The other two cases are in Missouri and Tennessee, where Republican attorneys general also challenged the 2024 reproductive health care-specific rule. The Missouri case was dismissed in September, because Kacsmaryk’s decision had a nationwide effect, and the Tennessee attorney general asked the court to dismiss their case for the same reason. The judge in that case has not yet granted the motion.

Shield laws help, but federal backstop would address more situations

Texas and Louisiana have recently launched investigations into out-of-state doctors who, through telehealth, prescribed and mailed abortion medication to patients in their states where abortion is outlawed.

Texas officials have repeatedly investigated and attempted to prosecute people for either leaving the state to seek abortion care or for prescribing abortion medication from a different state. At the end of October, a New York judge dismissed a civil case brought by Paxton seeking $100,000 in damages from a provider the AG said prescribed abortion pills to a woman in the Dallas area, according to The Texas Tribune. Officials in Louisiana attempted to extradite the same New York doctor on criminal charges related to an abortion medication prescription for a pregnant minor. That case was also rejected.

Those attempts were some of the first that tested shield laws implemented by 18 states, including New York. Four others have executive orders from Democratic governors saying they won’t comply with extradition requests for investigations into reproductive health care.

Texas has also passed a law allowing people to seek at least $100,000 in damages if someone they impregnated or someone they’re related to received abortion pills by mail from another state. That law took effect Thursday, Dec. 4.

Kurzweil said those shield laws are a vital help to patients seeking care, but the addition of a federal protective rule would be ideal.

“The two in tandem would be much more fulsome and would address gaps that come up,” she said.

The Planned Parenthood clinic in New Orleans was open for over 40 years but stopped seeing patients at the end of September after federal Medicaid funding cuts. Abortion opponents are looking for more ways to pull funds from the organization, despite legal abortion care making up a small portion of the services affiliated health centers provide. (Photo by Greg LaRose/Louisiana Illuminator) 

Anti-abortion organizations and Republican elected officials are searching for more ways to prevent Planned Parenthood from receiving federal resources after congressional Republicans successfully cut off federal Medicaid funding until at least July 2026.

Letters written by activist organizations and Republican elected officials show stated goals of barring Planned Parenthood health centers from receiving federal money of any kind and pulling them from the 340B drug pricing program. With it, Title X-funded centers can receive significant discounts on prescription drugs, allowing the purchase of more medications and the ability to reach more patients.

Anti-abortion activists also expect proposals for further restrictions on Planned Parenthood’s access to Medicaid in health care legislation in early 2026.

In July, Republican members of the House and Senate passed a sweeping budget reconciliation bill that included a one-year provision barring clinics from receiving federal Medicaid reimbursement if they offer abortion services and billed Medicaid more than $800,000 in fiscal year 2023. The rule largely affects Planned Parenthood because of the high dollar amount, but some large independent clinics have also been affected.

Since then, more than 20 Planned Parenthood clinics nationwide have closed their doors, many of which did not provide abortion services. Others have laid off staff, including in Ohio. Maine Family Planning, the state’s largest reproductive health care provider, also offered primary care services at three of its 18 clinics but discontinued those services at the end of October because of the funding loss.

Katie Rodihan, director of state advocacy communications for Planned Parenthood Action Fund, said in a statement that those actions would make medication more expensive and take away access to birth control, testing and treatment for sexually transmitted infections, and cancer screenings.

“These anti-abortion lawmakers are so hellbent on shutting down Planned Parenthood that they’re willing to sacrifice your health care,” Rodihan said. “No matter what attack anti-abortion groups and politicians launch, Planned Parenthood Action Fund will always be ready to fight back for patients.” 

Opposition to the organization receiving federal funding is rooted in a belief that its main purpose is to provide abortion care, when in fact abortion makes up about 4% of the services Planned Parenthood clinics provide nationwide, according to the most recent annual report. But anti-abortion groups and many Republican lawmakers object to federal dollars being associated with legal abortion care in any way, even if it’s not directly paying for the procedure except in limited circumstances under the law.

In late September, Oklahoma Republican Gov. Kevin Stitt sent a letter to the administrator of the federal Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, asking that the agency revoke Planned Parenthood’s 340B drug pricing eligibility and reject any future requests for that designation. The letter is also signed by the Republican governors of Alabama, Arkansas, Indiana, Iowa, Louisiana, Ohio, Tennessee, Utah, West Virginia and Wyoming.

Several Republican-led states, including Ohio and Indiana, have also recently tried to cut Planned Parenthood off of state Medicaid funding.  

“States across the country are acting to ensure taxpayer dollars are not used to fund or promote abortions, and in turn, these clinics are seeking roundabout ways to maintain their funding,” Stitt wrote. “Even if Planned Parenthood affiliates with pro-life laws refrain from using federal funds for abortion, the organization’s national infrastructure still benefits, enabling abortion expansion in states where abortion is legal … .”  

Instead, Stitt suggested that money be allocated to community health centers and rural hospitals.

The letter was sent five days before the government shutdown started on Oct. 1, and no action has been taken by the agency so far since reopening on Nov. 12.

Argument traces back to COVID loans

Students for Life of America, an anti-abortion group with more than 2,000 student chapters nationwide, is leading the effort to pressure Republican President Donald Trump and his administration to disqualify Planned Parenthood as a vendor with the federal government. Called “debarment,” the administrative process usually applies to vendors accused of wrongdoing — such as fraud, embezzlement, failure to perform or tax evasion — and is determined by  the U.S. General Services Administration.

A vendor who is debarred cannot receive federal money of any kind for a period of three years. There is also a lesser penalty of suspension, which lasts up to 12 months.

Kristi Hamrick, Students for Life’s vice president of media and policy, told States Newsroom that members started discussing the idea toward the end of Trump’s first term, but since it involves a long administrative process, there wasn’t enough time to pursue it before Democratic President Joe Biden took office.

Students for Life sent a letter to the U.S. Small Business Administration on Oct. 22, along with a letter to the president’s office signed by more than 50 other anti-abortion groups, encouraging them to start the process of debarment. There has not been a response from the small business agency so far, Hamrick said, but employees only returned to work recently following the 43-day shutdown.  

The letter to Trump is signed by other well-known anti-abortion organizations, including Susan B. Anthony Pro-Life America, Family Policy Alliance, Americans United for Life, Family Research Council and National Right to Life.

Along with allegations of financial fraud, the letter to the Small Business Administration accuses Planned Parenthood of a host of other violations, and mentions lawsuits filed against the organization led by Republican attorneys general in states like Missouri and Texas.   

Hamrick said the letter went to the agency because Republican U.S. Sens. Rand Paul of Kentucky, and Joni Ernst of Iowa wrote a letter of their own in March about alleged fraud committed by Planned Parenthood. They wrote that many of its affiliates — which are independent nonprofit organizations — applied for and received Paycheck Protection Program loans of about $120 million during the COVID pandemic.

The two senators said Planned Parenthood was not eligible for the loans because organizations with more than 500 employees were excluded. Planned Parenthood argued the national organization and the regional affiliates are separate — the affiliates applied individually — and guidance for the loans was later updated by the Biden administration to allow them. Most of the loans were forgiven.

Other entities were also accused of abusing the intent of the Paycheck Protection Program, including Catholic Charities USA, a humanitarian aid arm of the Catholic church with more than 3,000 employees. The Associated Press reported the organization and its member agencies received about 110 loans worth up to $220 million, which were forgiven.

Hamrick said Republicans in Congress should keep up their efforts to bar Planned Parenthood from Medicaid reimbursements, but there’s more that can be done.

“We won’t have to keep voting on whether or not Planned Parenthood can be funded in any one program, such as Medicaid, if they’re not eligible to be funded at all,” Hamrick said.

States still heavily affected by cuts

Hamrick said she hopes to see Republican lawmakers extend the Medicaid cuts for 10 years or more this time around, because this first round of cuts didn’t yield any “dire consequences.”

Dr. Chelsea Daniels, a member of the Committee to Protect Health Care’s Reproductive Freedom Task Force, disagrees. She moved out of Florida two months ago, where she worked in Miami for Planned Parenthood of Florida, and where she tried to help pass an amendment that would have enshrined a right to abortion into the state constitution. Although 57% of voters approved it, 60% is required by Florida law.

That demoralizing loss on top of many days where she had to tell people she legally couldn’t help them became too much. Florida has a six-week abortion ban, with exceptions for rape, incest, fatal fetal abnormalities and human trafficking. But Daniels said she routinely saw sexual assault victims who weren’t able to get an abortion regardless of any documentation they presented.

“Florida honestly just kind of pulverized me. I felt ground up by the end of it,” Daniels said.

She moved to California, and now practices as a family planning physician at Planned Parenthood of Orange and San Bernardino Counties. In her first week of employment there, the affiliate announced it would close its primary care practice because of the Medicaid cuts, laying off 77 staffers and sending 13,000 patients across seven clinics looking elsewhere for basic care such as treatment for high blood pressure, vaccines, annual wellness exams and diabetes management. The final day of service will be Dec. 10.

Daniels wasn’t part of the layoffs, but she said that loss of care for so many patients is devastating.

“I left Florida for good reason, but the state of the country writ large is not good,” Daniels said. “And I don’t think our federal government cares. They think it’s just collateral damage and punishment for anyone who’s ever been associated with Planned Parenthood.”