The U.S. Department of Health and Human Services on Thursday announced an investigation into 13 states that require health insurance plans to cover abortion care. 

In a news release, the agency said the investigation is based on allegations that the states are coercing health care entities to provide coverage of abortion “contrary to conscience” and in violation of a federal law known as the Weldon Amendment. 

“OCR launches these investigations to address certain states’ alleged disregard of, or confusion about, compliance with the Weldon Amendment,” said Paula Stannard, director of the HHS Office for Civil Rights in a statement. “Under the Weldon Amendment, health care entities, such as health insurance issuers and health plans, are protected from state discrimination for not paying for, or providing coverage of, abortion contrary to conscience. Period.”

But reproductive rights advocates say it is a tactic to make abortion harder to access in states that have fortified protections. 

“At a time when abortion care is getting harder and harder to access, we are deeply concerned that the few states that have taken steps to protect access are now under attack,” said Katie O’Connor, senior director of federal abortion policy at the National Women’s Law Center, in a written statement. “These investigations also follow a familiar pattern from the administration: attacking states that the president views as political threats.”

Earlier this year, HHS’ Office for Civil Rights clarified the Trump administration would interpret the Weldon Amendment to allow employers and insurance plan sponsors to opt out of covering or paying for abortions because of their personal beliefs, contradicting the Biden administration’s interpretation. The agency sent a letter to top officials in Illinois in January, alleging violations of the Weldon Amendment and the Coats-Snowe Amendment. The latter prohibits governments from discriminating against health care entities as it relates to abortion training or participation.  

The agency did not specify the states being investigated, but the Washington Post reports that states with abortion-related coverage requirements are: California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont and Washington, which all have Democratic governors except for Vermont. 

States defended their laws and criticized the probe as political, following the announcement.

“Donald Trump’s latest ‘investigation’ is nothing but a fishing expedition wasting taxpayers’ money,” said New Jersey Gov. Mikie Sherrill, the New Jersey Monitor reported. 

The Vermont Department of Financial Regulation said it is reviewing the federal government’s notice and working with other state agencies to prepare a response. 

“DFR does not believe that it has unlawfully coerced or discriminated against any insurer related to the coverage of abortions as outlined in the (federal government’s) request,” Commissioner Kaj Samsom told the VT Digger. “We stand firmly behind the law in question and the protections and choice it provides Vermonters.”

The Heritage Foundation floated the proposal to withhold Medicaid funding for states in violation of the Weldon Amendment in its controversial presidential administration blueprint Project 2025, which President Donald Trump disavowed during his campaign. 

Some Republican lawmakers have routinely proposed criminally prosecuting women for getting abortions since the U.S. Supreme Court overturned Roe v. Wade, despite bipartisan condemnation and criticism from national anti-abortion organizations. 

These bills never made it to the finish line, but they keep circulating in legislatures across the country. So-called “abortion abolitionists” who believe that abortion should be classified as homicide, and that fetuses, embryos and zygotes should have the same legal protections as people are often behind these measures, States Newsroom reported. 

This year, the Foundation to Abolish Abortion praised Republican lawmakers in Illinois, Kentucky and Tennessee who introduced bills that would punish people who get abortions. 

In Illinois, Republican Sen. Neil Anderson filed a bill that would have banned abortion from the moment of fertilization and classified abortion as homicide in the Democratic-led state. Anderson’s bill did not move past introduction, and he lost a leadership position in the chamber this month, Capitol News Illinois reported. 

In Tennessee, legislation concerning an anti-abortion monument was amended to criminalize abortion, potentially allowing women who seek abortion to be charged with murder. Sen. Mark Pody, the bill’s GOP sponsor, said he doesn’t have the votes in the Senate to pass the bill with the criminalization amendment, Tennessee Lookout reported. 

Elsewhere, proposals to crackdown on the availability of abortion medication — the most common way to terminate a pregnancy — are advancing in several Republican-led legislatures, while Democratic lawmakers are moving to fortify shield laws. 

Our reproductive rights reporting team will be tracking related bills through biweekly roundups as sessions continue this winter and into the spring. Depending on the partisan makeup of a state’s legislature and other state government officials, some bills have a better chance of passing and becoming law than others.

GOP legislators still introducing bills classifying abortion as homicide

Kentucky   

House Bill 714: Abortion is already illegal in Kentucky with no exceptions for victims of rape and incest. This bill, called the “Prenatal Equal Protection Act,” would go further by classifying abortion as homicide unless it’s needed to treat miscarriages or save a pregnant woman’s life. The penalties would be the same as those for killing a person, so violators could face anywhere from one year to life in prison. 

GOP Rep. Richard White introduced a similar bill last year that didn’t go anywhere. The Foundation to Abolish Abortion praised the new measure in a Tuesday news release. The organization criticized a Kentucky prosecutor’s decision last month to drop a fetal homicide charge against a woman who was accused of taking abortion medication.  

Status: Introduced in the House on Tuesday, Feb. 24, and sent to the Committee on Committees 

Sponsors: Republican Reps. Josh Calloway and Richard White  

South Carolina 

House Bill 3537: Legislation introduced by GOP Rep. Rob Harris would ban abortion from the moment of fertilization. Harris’ bill would also allow the prosecution of people who get abortions unless it’s necessary to manage miscarriages or save a pregnant person’s life. 

Harris filed this bill in previous legislative sessions, but it hasn’t gained traction, SC Daily Gazette reported. “Bills like these do nothing but terrify women out of wanting to get pregnant,” Tori Nardone, a woman who had to leave South Carolina to get an abortion for a fatal fetal anomaly, told lawmakers last month. “Please don’t make it worse than it already is.”

Status: Stalled in the House Judiciary Committee 

Sponsor: Republican Rep. Rob Harris 

South Dakota   

House Bill 1212: South Dakota bans abortion in most cases, but this bill would have codified abortion as fetal homicide in state law and defined abortion as a Class B felony, which carries punishment of up to life in prison and a fine of up to $50,000. The proposal included exceptions for miscarriage treatment or when a pregnant patient’s life is in danger.

The bill was deferred to the last day of the legislation session by the House Health and Human Services Committee, essentially preventing it from advancing.  

Status: Sidelined 

Sponsors: Rep. Tony Randolph and Sen. John Carley, Republicans 

Republican-led states push bills to crack down on abortion pills

Mississippi   

House Bill 1613: This legislation would make it illegal to sell, manufacture, distribute or dispense abortion-inducing drugs in the state, which bans all abortions unless the mother’s life or health is at risk, and if rape or incest is reported to law enforcement. 

Violators could face between one and 10 years in prison, and the state attorney general could enforce civil penalties against the person, too, Mississippi Free Press reported. The House passed the bill on Wednesday, Feb. 11. If the bill becomes law, it would take effect in July. 

Status: Referred to Senate Judiciary Committee last week 

Sponsors: Republican Reps. Kevin Horan and William Tracy Arnold 

South Dakota  

House Bill 1274: The state House passed a bill this week that would make dispensing, distributing, selling or advertising abortion pills and any other abortion-related “instrument” or “article” illegal, South Dakota Searchlight reported. 

Under the measure, the attorney general could seek penalties of up to $10,000 for each violation, and the money would go in a fund used to pursue anti-abortion litigation, according to Searchlight. South Dakota’s AG is already involved in a legal battle with a New York-based nonprofit over abortion medication ads it ran at gas stations across the state last year. 

Status: Approved in the House on Tuesday, Feb 24; in the Senate State Affairs committee 

Sponsors: Republican Reps. John Hughes and Greg Blanc 

Democratic lawmakers move to strengthen abortion-rights protections 

New Hampshire   

Senate Bill 551: New Hampshire, which has a Republican trifecta in government, is the only state in New England without a law that protects abortion providers and patients from out-of-state investigations into reproductive health care. Legislation introduced by Democratic Sen. Debra Altschiller in February would secure the right to reproductive health care and prohibit law enforcement from cooperating with investigations into related health care, New Hampshire Bulletin reported. 

The bill would make it illegal for the governor to comply with extradition requests for abortion providers and patients. It would also ban insurers from penalizing reproductive health care providers and let residents sue people or agencies that attempt to interfere with their reproductive rights, the Bulletin reported. 

Status: The Senate Judiciary Committee voted 3-2 on Tuesday, Feb. 17, that the bill was “inexpedient to legislate.” 

Sponsor: Democratic Sen. Debra Altschiller

Oregon   

House Bill 4088: An Oregon law approved in July 2023 protects providers who offer reproductive health care from losing their licenses, and shields patients and providers from related out-of-state investigations. Legislation introduced this year would beef up those safeguards. 

This bill would bar the governor from accepting extradition requests from other states against providers who offer legally protected reproductive health care and prohibit law enforcement from cooperating with interstate investigations into related care, Oregon Capital Chronicle reported. It would also block state officials from revoking midwifery licenses for people who face prosecution for reproductive health care in other states. 

Status: Approved by the House on Monday, Feb. 16; approved by the Senate Judiciary Committee Wednesday, Feb. 25

Sponsors: Rep. Lisa Fragala and Sen. Lisa Reynolds, Democrats 

There is a content warning on page 7 of a friend-of-the-court brief recently submitted in a high-stakes abortion medication case by women who say they were injured or traumatized from taking the pills. 

“Warning: these accounts are raw, graphic and real.”

About 30 mostly anonymous people recount their medication abortions, saying they were uninformed about what they would experience mentally and physically. The graphic accounts and bloody portraits are meant to bolster the argument that the practice is a barbaric and gruesome one that states have the authority to ban. The brief argues the problem is perpetuated by telehealth abortion. 

“We call it a particularly gruesome and barbaric procedure, the pill, because Dobbs allowed particularly gruesome and barbaric procedures to be prohibited by the states,” said attorney Allan Parker of the Justice Foundation.

It’s one of many arguments made in the main complaint, though not the focus of Tuesday’s oral arguments over a preliminary injunction that could, if granted, halt access to telehealth abortion throughout the country. But it’s one with a winning history for the anti-abortion movement, whose leaders are frustrated with rising abortion rates and the Trump administration’s failure to restrict the pills. 

But reproductive legal experts who support abortion rights say the gruesome or barbaric argument mischaracterizes the realities of medication abortion, which is approved to induce a miscarriage within the first 10 weeks of pregnancy. 

Abortion opponents are focused on disrupting national access built largely on shield laws and a Biden-era policy that has allowed women to have first-trimester abortions via medication at home with a remote physician consultation, even in states with bans. 

The Justice Foundation, which co-authored the brief alongside the National Association of Christian Lawmakers, recruits women who regret their abortions to testify in court and before legislatures and has collected nearly 5,000 legally admissible affidavits, according to the brief. 

The lawsuit was originally filed last year by Louisiana Attorney General Liz Murrill and co-plaintiff Rosalie Markezich, who said her partner ordered pills without her consent and then coerced her to take them.

The complaint cited the 2007 U.S. Supreme Court decision in Gonzales v. Carhart that upheld a federal ban on an abortion procedure called intact dilation and extraction, which at the time some doctors said was a preferable method for ending certain pregnancies, typically in the second trimester, without damaging the woman’s cervix. The anti-abortion movement effectively rebranded the method “partial-birth abortion.” In upholding the ban on this method, the Supreme Court opinion, which was referenced in the 2022 Dobbs decision overturning federal abortion protections, included a reference to it as “gruesome and inhumane.” 

While the intact dilation and extraction method was used later in pregnancy and in a minority of terminations, telehealth abortions early in pregnancy made up 27% of abortions in the U.S. in the first half of December, according to the Society of Family Planning.  

“What it feels like is happening with some of these briefs is that they’re going back to the last argument that worked in shaping popular opinion,” historian and law professor Mary Ziegler said. “Because while they managed to overturn Roe, that was not a success from a popular opinion standpoint.”

The argument that abortion is barbaric and gruesome is not likely to touch public opinion the same way it did two decades ago, she said, because unlike with intact dilation and extraction abortion, most women have experienced a medication abortion or a miscarriage and know what it’s like.  

“It would be hard, I think, to convince people that a procedure that’s happening in week seven, is equally barbaric,” Ziegler said. “The whole success of partial-birth abortion as a strategy is in the name, right? The argument was, This is happening late enough in pregnancy and close enough to birth that it resembles infanticide. And with abortion pills, for many people, it’s going to much more closely resemble a very early miscarriage.”

The potential to unleash chaos

Attorneys on either side of the abortion rights divide agree that the stakes are high in the Louisiana case, because a ruling would likely apply nationally and once again shake up the abortion access landscape in the U.S. If the court grants Louisiana’s request to force the U.S. Food and Drug Administration to reinstate old restrictions while litigation continues, the action could effectively ban telehealth abortion appointments, medication dispensation at retail pharmacies, and the mailing of abortion pills even in states where abortion remains legal.

Katie Keith, founding director of the Center for Health Policy and the Law at the O’Neill Institute at Georgetown University, said a ruling in plaintiffs’ favor could “unleash chaos and confusion in the market.”

“What would happen to medication that’s already on the shelves?” she asked. “And how quickly could folks move from telehealth to in-person dispensing again? And what guidance would FDA give? And how quickly would all this get appealed?” 

It would be extremely disruptive in a year when abortion providers have already seen a lot of chaos, she said. 

Dr. Angel Foster is the co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortion to all 50 states. She said plaintiffs’ claims do not match up with national and international data on medication and telehealth abortion or with her experience as a provider. 

“Louisiana has taken things that are exceptional and presented them as common, has tried to put the ugliest face on the abortion process as possible, and has mischaracterized the kind of care that telemedicine medication abortion providers are offering,” Foster said. 

Her organization has served more than 40,000 patients seeking abortion care since 2023, she said, 95% in states with abortion bans. Patients are counseled on what to expect in terms of pain and what they might see, and are screened for potential coercion and other issues. 

For example, if a patient lists her husband’s email address, Foster said she would call the patient directly to confirm the abortion is her choice. She said a bad actor could try to bypass their screening and force someone to take abortion pills without consent, which is already a criminal offense under existing law. 

“I don’t think that the remedy is to say that nobody should be able to get abortion pills by mail,” Foster said.  

National domestic violence awareness groups have filed a friend-of-the-court brief in the Louisiana case asking the court to deny plaintiffs’ request for an injunction. They note that reproductive coercion is not limited to abortion pressure but can also include a partner barring access to birth control or other health care. 

Beyond the federal courts, states continue to try to pass laws to ban or further restrict medication abortion. Attorneys general in Louisiana and Texas have led the charge in suing shield law providers in states without abortion bans. Texas’ attorney general filed a new lawsuit on Tuesday against California physician Rémy Coeytaux, telehealth abortion nonprofit Aid Access and its founder Dr. Rebecca Gomperts. 

Foster said she has not yet been sued but that her attorneys have been in close communication with Massachusetts’ attorney general over whether the state’s shield law would protect their practice depending on how the judge rules. 

“Our intent is to continue to provide medication abortion care with mifepristone and misoprostol for as long as we can legally do so,” she said. 

Will a federal judge let the Trump administration delay?

For now, Louisiana v. FDA is in limbo. After Louisiana filed its preliminary injunction request, the Trump administration asked the court to delay while it continues to review abortion pill safety — a review that was prompted by pressure and controversial research from the anti-abortion movement. 

Trump-appointed district Judge David Joseph on Tuesday did not indicate when he might rule on Louisiana’s request for an injunction but gave the federal government’s attorneys seven days to file a brief explaining how the FDA would take emergency action if the agency discovered mifepristone presents a public health risk during its review.

Anti-abortion activists have been frustrated with the administration’s efforts to delay the Louisiana case. 

“We are disappointed that the Trump administration is asking the court to pause our case and deny our clients immediate relief while the FDA takes another year to study the known harms of abortion drugs,” said Erik Baptist, senior counsel at Alliance Defending Freedom, which is representing Markezich, in a written statement.

With the approaching midterm elections, Ziegler said she’s curious what the administration will finally say about its position on abortion pills. 

“It’s our first look at what the Trump administration will do if the court doesn’t respond by just giving them more time,” Ziegler said. “Because so far, they’ve been essentially just avoiding it, by saying they’re thinking about it, and they need more time, and they’re studying the matter, and, you know, not really taking a side.”