Idaho, Kansas and Missouri want a federal judge to let them intervene in a case that’s already been to the U.S. Supreme Court, so they can argue the FDA erred when it updated prescribing guidelines for abortion medication, shown in photo, in 2016.  (Photo by Peter Dazeley/Getty Images)

WASHINGTON — The Department of Justice wrote in a legal filing released Monday that three GOP-led states attempting to overturn federal prescribing guidelines for medication abortion have sought to keep a case going in the wrong place at the wrong time.

The filing is significant since it appears to indicate the Trump administration will defend the U.S. Food and Drug Administration’s decision nine years ago to broaden access to mifepristone. The Biden administration also sought to keep the newer prescribing guidelines intact.

Idaho, Kansas and Missouri want a federal judge to let them intervene in a case that’s already been to the U.S. Supreme Court, so they can argue the FDA erred when it updated prescribing guidelines for mifepristone in 2016.

The goal is to get those changes thrown out so use of mifepristone, one of two pharmaceuticals used in medication abortion, reverts to what was in place between 2000 and 2016.

That would cap medication abortion at seven weeks gestation instead of the current 10 weeks and patients seeking medication abortions would need to attend three, in-person doctor appointments. Medication abortion would no longer be available via telehealth and it could no longer be legally mailed to patients.

The Trump administration wrote in a 15-page brief filed with the U.S. District Court for Northern District of Texas that the three states “cannot keep alive a lawsuit in which the original plaintiffs were held to lack standing, those plaintiffs have now voluntarily dismissed their claims, and the States’ own claims have no connection to this District.”

“The States are free to pursue their claims in a District where venue is proper … but the States’ claims before this Court must be dismissed or transferred pursuant to the venue statute’s mandatory command,” the brief adds.

The Department of Justice also wrote that at “a minimum, the States’ challenge to FDA’s 2016 actions is time-barred because the States sought to intervene more than six years after FDA finalized those actions.”

Original suit began in 2022

The original case challenging the federal government’s 2000 approval and current prescribing guidelines for medication abortion began in November 2022 when anti-abortion groups filed their lawsuit in the U.S. District Court for Northern District of Texas.

That case worked its way up to the U.S. Supreme Court, which ruled in June 2024 that the anti-abortion organizations lacked standing to bring the case.

But Idaho, Kansas and Missouri state officials sought to intervene in the case before it reached the high court and have tried to keep the challenge to the 2016 prescribing guidelines moving forward.

The Department of Justice wrote in its brief that there were several reasons the case shouldn’t continue in the Northern District of Texas.

Among those is that the three states “fail to identify any actual or imminent controversy over whether any of their laws are preempted” and that they lack Article III standing since “they failed to exhaust their claims; and their challenge to FDA’s 2016 actions is outside the six-year statute of limitations.”

The case is assigned to Judge Matthew Joseph Kacsmaryk, who overturned the FDA’s original 2000 approval of mifepristone in April 2023 in the original lawsuit.

That ruling never took effect as the original lawsuit worked its way through the 5th Circuit Court of Appeals and up to the Supreme Court. 

Four of the Wisconsin 14 – from (l to r) Jeff Davis, Kai Gardner Mishlove, Pat McFarland and Thomas Lang – urged state lawmakers to extend postpartum Medicaid on March 18, 2025. (Courtesy of Builders)

Thomas Lang and Jeff Davis — conservative Catholics from Wisconsin — did the unexpected on a recent Tuesday: They asked some of their conservative legislators to extend a social safety net for pregnant women.

Both men support local crisis pregnancy centers and groups opposed to abortion, and they typically oppose expanding public services. Davis said he’s always been a conservative spender, having grown up with a Depression-era father.

But after participating in a civic engagement program about abortion a year ago, both said their empathy for pregnant women is better informed.

“My wife was a great sounding board for me being more empathetic towards women, because she was a very empathetic woman, and I kind of lost a little bit of that when she passed away,” Davis said, noting it’s been two years. “I didn’t have her level of compassion, and this helped me, seriously, to be more compassionate, and not just to women who are having an abortion, but just people in general.”

One year ago, 14 people around Wisconsin, dubbed the Wisconsin 14, were recruited by the civic engagement nonprofit Builders (formerly known as Starts With Us) to try to find common ground on reproductive health policy despite their deep divisions on abortion. For most of the participants, as the emotionally grueling Citizen Solutions sessions would reveal, their beliefs are rooted in personal trauma.

A year later, several of the participants who had severe disagreements have come back together to fight for their first consensus solution: extending postpartum Medicaid.

While the Wisconsin 14 ultimately could not agree on a single abortion-related policy, they were united on five policy proposals to make it easier and safer to give birth. Several of the participants returned to the Capitol in Madison last month to lobby their state legislators to pass Assembly Bill 97/Senate Bill 23, which like one of their proposals, would extend Medicaid coverage for women from 60 days to 12 months after giving birth if they do not already qualify for the state’s Medicaid program. Under current law, pregnant individuals in Wisconsin are eligible for Medicaid at a higher income threshold than those who are not pregnant: 306% instead of 100% of the federal poverty level. But they can lose that coverage 60 days after giving birth if their income increases beyond the non-pregnant eligibility threshold.

Reproductive health experts have identified postpartum Medicaid extension as the first step to maternal health equity, as States Newsroom has reported. According to a new study in the Journal of the American Medical Association, more than 80% of pregnancy-related deaths nationwide are preventable, and almost one-third of pregnancy-related deaths occurred after delivery.

Wisconsin and Arkansas are currently the only states cutting off postpartum Medicaid after 60 days, despite these being largely popular policies.

“Last spring, 20,000 Wisconsinites from 70 counties across the state weighed in on the proposals during a public feedback period,” said Builders communications director Tori Larned in an email. “Nearly three-quarters (73%) of people favored extending Medicaid postpartum.”

This is the second year the proposal has been introduced in the legislature, and like last year it has received bipartisan support but severe opposition from House Speaker Robin Vos. The Republican has described the bill as an expansion of “welfare,” including last week, when the bill passed the Senate 32-1.

“My position has been fairly clear from the very beginning: I’ve never supported an expansion of welfare. I can’t imagine that I would ever support one,” Vos said at a press conference after the April 22 vote, according to the Wisconsin Examiner. “But we have to talk about it as a caucus.”

Vos’ office did not reply to a request for comment for this story.

In the past month, several among the Wisconsin 14 have lobbied their legislators in person, talked about the bill in public, and a few have or are currently writing op-eds. Larned told States Newsroom nearly every participant has called Vos’ office urging him to extend postpartum Medicaid to a full year. 

“[S]tagnation on this issue does not reflect the public will,” wrote Kateri Klingele Pinell and Kai Gardner Mishlove, two of the Wisconsin 14, who fundamentally disagreed on when abortion should be legal and accessible, in a recent Milwaukee Journal Sentinel op-ed. “Extended Medicaid coverage is crucial for the physical, emotional, and mental well-being of mothers and their children. Sixty days is insufficient to address the vast array of medical needs that arise during the postpartum period.”

They cited a 2024 Wisconsin Maternal Mortality Review Team report showing that between 2019 and 2020 the majority of pregnancy-related deaths were caused by cardiovascular conditions or hypertensive disorders or due to mental health conditions, including drug overdoses. They also noted that Black women and women from low-income households suffer worse maternal health outcomes. They cited an American Hospital Association report to argue that prolonging postpartum coverage would generate cost savings.

They ended the op-ed addressing Vos directly.

“We have faith that Speaker Vos and his colleagues in the Assembly will answer our call,” they wrote. “Vos has already expressed his desire to, ‘protect life while ensuring women receive necessary medical care.’ The passage of this bill offers him the opportunity to properly represent his constituents.”

Klingele Pinell is a clinical mental health professional who opposes abortion, but believes in expanding public health services, especially as someone who says she has relied on them as a young single mom. Gardner Mishlove is a grief doula and the executive directive of Jewish Social Services in Madison, which she said provides short- and long-term case-management and advocacy to vulnerable populations.

“We need to reassure moms and families that they will not lose coverage during this crucial time,” Gardner Mishlove told States Newsroom. “Can you imagine deciding to maintain a pregnancy and then realizing that you’re going to lose your health insurance 60 days after? Being a new mom, there’s a lot to deal with, a lot to juggle, and if that’s one less thing for you to juggle so that you can make sure that you maintain connection to your healthcare provider, to your behavioral health provider, for the health and wellness not only of yourself but your family, then that’s a huge burden that’s lifted from that mother, from the family, from the health care system.”

Bridging the divide 

In mid-March, four of the Wisconsin 14 joined a lobbying event co-sponsored by Main Street Alliance, where they urged state lawmakers to pass the postpartum Medicaid extension, focusing on more reluctant Assembly and Senate Republicans.

Davis, the 77-year-old widower, said it felt out of his comfort zone just to drive from his farm to the Capitol and navigate traffic and parking, but he felt it was important to do.

“I just kind of thought that maybe my input, because of being pro-life and being for the bill, would carry some weight,” Davis told States Newsroom.

Davis and Lang said they didn’t initially appreciate how difficult it would be to move the needle with some of the Republican legislators, especially after learning how much extending postpartum Medicaid is likely to cost the state.

The state has projected that an additional 5,020 women would have coverage per month under the bill, costing an estimated $18.5 million, including $7.3 million in state general purpose revenue with the rest coming from the federal government. As the Wisconsin Examiner has reported, if Wisconsin joined other states that have accepted the full federal Medicaid expansion, the cost for the postpartum coverage would be reduced to $15.1 million in all funds including $5.2 million in general purpose revenue. However, under the Trump administration, the federal Medicaid program as a whole is under threat. 

“We’re talking a drop in the bucket,” Lang said. “We’re talking about a small annual average number of pregnant women in Wisconsin, so the fiscal hawks really don’t have much to worry about, and more importantly we’re talking about getting women out of a corner. … Everybody agrees that no woman gets pregnant to have an abortion. It’s always something of a compulsion. So let’s get her out of the corner if we want her to have choice, right?”

Gardner Mishlove and Patricia McFarland — whose politics and abortion views veer widely left from Davis’ and Lang’s — said they tried to find common ground with more conservative legislators. 

“[We’re] trying to end the divide, to find ways to talk to each other about basic human issues, so that you are not just pro-birth, but if you’re pro life, you really want the family to thrive,” said McFarland, who had a traumatic illegal abortion before Roe v. Wade enshrined federal abortion rights in 1973 and is now an abortion-rights activist. “You want that baby to be born and to have all the care they deserve.”

The fate of the bill remains uncertain, but the Wisconsin 14 have not given up on it.

Jacob VandenPlas, a dad, farmer, agricultural educator and veteran from Door County, has some of the most nuanced politics and abortion views among the 14.

VandenPlas ran for Congress as a Libertarian in 2022 and is considering a future run for governor as an independent or for Wisconsin state Senate as a Republican. He said he believes abortion should be broadly legal through the first trimester and then restricted with exceptions for health and rape. VandenPlas said he’s been calling different legislators about the postpartum Medicaid bill; lobbying his representative, Republican Rep. Joel Kitchens, at the gym; and is currently working on an op-ed. He pitches it from a Libertarian angle.

“This is our future generation, and the constriction on the pocketbooks of the American people and how much the government has robbed from us makes it very difficult to start families,” VandenPlas said. “We’re talking the cost of housing and everything else. It’s very, very important to be able to help the future mothers and future families of our state.”

“Most importantly,” he continued. “This is one of the single best ways that we can address abortion. If you want to start limiting those numbers, we have to start addressing the reasons why women are choosing abortion, and this is one of them. We can save babies’ lives by extending postpartum care, and we can save the lives of mothers.”

Builders head of programs Ashley Phillips said the organization has not given up on trying to pursue abortion consensus solutions in other states, as abortion restrictions continue to broadly impact reproductive health care, including for those who want to have babies but have a shortage of health care options. She said Builders is conducting listening sessions in Texas, the next likely state for their third Citizens Solutions initiative. But this time participants will determine the policy area, she said.

“One thing I have learned is that this work is messy, it’s complicated, it’s hard, and in the moment, it often doesn’t feel great,” Phillips said. “And then I saw a subset of those people this weekend in Wisconsin, and the joy was back, and the belief that they could do something despite having a lot of discomfort around that issue of abortion.”

In the village of Noatak in Alaska’s Northwest Arctic region, Pregnancy Risk Assessment Monitoring System (PRAMS) data showed the community had lower breastfeeding initiation and six-week breastfeeding rates than the statewide average. This data supported funding to offer culturally-adapted peer breastfeeding services in the region. (Courtesy of Laura Norton-Cruz)

In the remote villages of Alaska where social worker Laura Norton-Cruz works to improve maternal and infant health, there are no hospitals.

Pregnant patients, almost all of whom are Alaska Native, often fly on small 10-seat planes to the region’s larger hub community of Kotzebue. While some give birth there, many more then take a jet out of the Northwest Arctic region to Anchorage, the state’s largest city. By the time they fly back to Kotzebue for their six-week checkup, a high percentage have stopped breastfeeding because of a lack of ongoing supports. 

Norton-Cruz knows that because of data collected by Alaska’s Pregnancy Risk Assessment Monitoring System (PRAMS)— a grantee of the U.S. Centers for Disease Control and Prevention’s PRAMS program, started in 1987 in an effort to reduce infant morbidity and mortality.

But earlier this month, the Trump administration cut the federal program, its 17-member team and more workers in the Division of Reproductive Health as part of sweeping layoffs within the U.S. Department of Health and Human Services.

Rita Hamad, associate professor at Harvard School of Public Health, said PRAMS helps researchers understand what kinds of state policies are improving or harming child health.

“I can’t overemphasize what an important dataset this is and how unique it is to really show national trends and help us try to understand how to optimize the health of moms and young kids,” Hamad said.

PRAMS does not ask abortion-related questions, but some anti-abortion groups still try to make a connection.

“The cuts seem appropriate given all the bias in choosing topics and analyzing data, but if Pregnancy Risk Assessment Monitoring System wishes to justify their reporting, point to the study that has most helped women and their children, born and preborn, survive and thrive,’’ Kristi Hamrick, vice president of media and policy at Students for Life of America, told States Newsroom in an email.

Over the past two years, Norton-Cruz used Alaska’s PRAMS data to identify low breastfeeding rates in the region, connect with people in the villages and interview them about what would help them continue to breastfeed. What they wanted, she said, was a peer in the community who understood the culture — so that’s what she’s been working to set up through federal programs and funding that is now uncertain.

Norton-Cruz also uses responses from PRAMS surveys to identify risk factors and interventions that can help prevent domestic and sexual violence and childhood trauma, particularly in rural communities, where the rates of domestic violence and maternal death are high.

“PRAMS data not being available, I believe, is going to kill mothers and babies,” she said. “And it’s going to result in worse health for infants.”

New York City grant is renewed, but data collection is paused

Individual states collect and report their own data, and the CDC team was responsible for aggregating it into one national picture. Some localities, such as New York City, maintain a full dashboard of data that can be explored by year and survey question. The most recent fully published data is from 2022 and shows responses by region, marital status, Medicaid status and more.

For instance, 2022 data showed women on Medicaid experienced depressive symptoms at a higher rate after giving birth than those not on Medicaid. It also showed that a much higher percentage of women not on Medicaid reported putting their babies on their backs to sleep, the recommended method for safe sleep — 63% of women on Medicaid reported following that method, versus 85% not on Medicaid.

Hamad said PRAMS is the only national survey dataset dedicated to pregnancy and the postpartum period. Her team has studied the outcomes of the Women, Infants, and Children food assistance program, and how state paid family leave policies have affected rates of postpartum depression.

“This survey has been going on for decades and recruits people from almost all states,’’ she said. “There’s really no other dataset that we can use to look at the effects of state and federal policies on infant health and postpartum women.”

Under Secretary Robert F. Kennedy Jr., Health and Human Services laid off about 10,000 employees as part of a restructuring effort in early April. The overhaul is part of the “Make America Healthy Again” initiative, and the agency said it focused cuts on redundant or unnecessary administrative positions. It rescinded some of the firings in the weeks since, with Kennedy telling reporters that some were “mistakes.” It’s unclear if any of those hired back were PRAMS employees.

The cuts, Hamad said, also run counter to the administration’s stated goals of wanting to protect women, children and families.

“The government needs this data to accomplish what it says it wants to do, and it’s not going to be able to do that now,” she said.

The funding for local PRAMS programs seems to be unaffected for now. Spokespersons for health department teams in Alaska, New Mexico, Oklahoma and Kansas told States Newsroom they have not had any layoffs or changes to their grants, but the funding for this fiscal year ends on April 30. Forty-six states, along with D.C., New York City and two U.S. territories, participate in the program. According to the CDC, those jurisdictions represent 81% of all live births in the United States.

New York State Department of Health spokesperson Danielle De Souza told States Newsroom in an email their program has received another year of funding that begins May 1 and supports one full-time and two part-time staffers. But without the assistance of the national CDC team to compile, clean, and prepare the data, maintain the data collection platform and establish standards, De Souza said their state-level operations are on pause.

“We remain hopeful that the data collection platform will be fully reactivated, and that CDC coordination of PRAMS will resume,” De Souza said. “The department is assessing the challenges and feasibility of continuing operations if that does not occur.”

Hamad said some states might be willing to allocate state dollars to the programs to keep them running, but the states that have some of the worst maternal and infant health outcomes — such as Arkansas, Mississippi and Alabama — are the least likely to have the political will to do that. And it would still make the data less robust and valuable than it was before.

“If one state is asking about how often you breastfed in the last week, and another one is asking about the last month, then we won’t have comparable data across states,” she said.

Project 2025, anti-abortion groups have criticized CDC data collection

Jacqueline Wolf, professor emeritus of social medicine at Ohio University, has studied the history of breastfeeding and childbirth practices and said the rates of maternal and infant death were high in the late 19th and early 20th centuries. For every breastfed baby, 15 raw milk-fed babies died. Wolf said 13% of babies didn’t live to their 1st birthday, and more than half were dying from diarrhea.

To help determine what was causing those deaths and prevent it, public health specialists created detailed forms and collected information from families about a mother’s age, the parents’ occupations, race, income level, household conditions, and how the babies were fed.

Researchers at that time were able to determine that babies who weren’t breastfed were getting sick from unpasteurized milk and tainted water supply, and more than half were dying from diarrhea. Through public health reforms, like requiring cow’s milk to be pasteurized, sold in individual sterile bottles and kept cold during shipping, infant death rates dropped, Wolf said.

Health officials also increased education campaigns around the issue. Today, PRAMS uses survey data the same way.

“These were detectives,” Wolf said. “That’s what public health really is, detective work, which is why this data is so important.”

Project 2025, the blueprint document of directives for the next Republican presidential administration crafted by conservative group Heritage Foundation in 2024 and closely followed by President Donald Trump and his cabinet, details plans for the CDC’s data collection efforts. Page 453 of the 900-page document, written by Heritage Foundation executive Roger Severino says it’s proper for the CDC to collect and publish data related to disease and injury, but the agency should not make public health recommendations and policies based on that data because it is “an inescapably political function.”

The agency should be separated into two, Severino wrote, with one agency responsible for public health with a “severely confined ability to make policy recommendations.”

“The CDC can and should make assessments as to the health costs and benefits of health interventions, but it has limited to no capacity to measure the social costs or benefits they may entail,” the document says.

On page 455, Severino says the CDC should also eliminate programs and projects that “do not respect human life” and undermine family formation. It does not name PRAMS as a program that does this, but says the agency should ensure it is not promoting abortion as health care.

Hamrick, of Students for Life of America, told States Newsroom in an email that because there is no national abortion reporting act that tracks outcomes for women who end a pregnancy, assumptions in current reports “taint the outcomes.” Hamrick said the CDC has done a poor job of getting a complete picture of pregnancy risks, including the risk of preterm birth after having an abortion.

“Taxpayers don’t have money to waste on purely political messaging,” Hamrick said.

Without data, researcher worries policy recommendations will be easier to dismiss

If researchers like Laura Norton-Cruz don’t have PRAMS data moving forward, she said they will be operating in the dark in many ways, using anecdotal and clinical data that is not as reliable and accurate as the anonymous surveying. That can make it more difficult to push for funding and program changes from lawmakers as well.

“Moms need safe housing and domestic violence resources, moms need health care and breastfeeding support, and if we can’t show that, then they can justify not providing those things, knowing that those most affected by not having those things will be groups who are already marginalized,” Norton-Cruz said.

While HHS did not cite the administration’s ongoing efforts to remove any content from the federal government that acknowledges disparities in race or gender as its motivation for cutting the PRAMS team, researchers who spoke with States Newsroom think that could be the underlying reason. 

Wolf said race matters in data collection just as much as household economics or class, and it is just as relevant today as it was when PRAMS was established, as maternal death rates for Black women and other women of color are disproportionately high in a number of states. Those states are also often the poorest and have higher infant mortality rates.

Wolf recalled that during Trump’s first term in 2020, the first year of COVID, the administration ordered the CDC to stop publishing public data about the pandemic. She sees a parallel to today.

“I fear that is exactly what’s going on with PRAMS,” she said. “To pretend like you don’t have the data, so the problem doesn’t exist, is just about the worst response you can think of, because more and more mothers and babies are going to get hurt.”

States Newsroom state outlet reporters Anna Kaminski, Danielle Prokop and Emma Murphy contributed to this report.