Planned Parenthood has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of a provision in the massive budget bill signed by President Donald Trump last week. (Photo by McKenzie Romero/Utah News Dispatch)

Days after President Donald Trump signed a massive budget bill, attorneys for Planned Parenthood Federation of America and its state members in Massachusetts and Utah filed a lawsuit Monday challenging a provision they say will affect more than 1 million patients who use their clinics across the U.S.

Planned Parenthood says if the defund provision stands, those targeted will be patients who use Medicaid as their insurance at its centers for services including birth control and cancer screenings. The organization says it only uses federal Medicaid funding for abortion in the very narrow cases allowed, including rape, incest, and to save a pregnant person’s life.

The complaint, filed in U.S. District Court of Massachusetts against U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Medicaid and Medicare administrator Dr. Mehmet Oz, challenges a provision on page 597 of the reconciliation bill. It prohibits Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $800,000 in federal and state Medicaid funding in fiscal year 2023. That prohibition will last one year from the date the bill was signed.

While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics. The entire organization has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of the change in the law.

“This case is about making sure that patients who use Medicaid as their insurance to get birth control, cancer screenings, and STI testing and treatment can continue to do so at their local Planned Parenthood health center, and we will make that clear in court,” said Planned Parenthood Federation of America president and CEO Alexis McGill Johnson in a public statement.

The organization identified 200 of its clinics in 24 states that are at risk of closure with the cuts, and said nearly all of those clinics — 90% — are in states where abortion is legal. In 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. Because of that, some reproductive health advocates have called it a backdoor nationwide abortion ban.

The nonprofit also warned that eliminating Planned Parenthood centers from the Medicaid program would likely also impact patients who use other forms of insurance, if centers are forced to cut their services or close. 

Planned Parenthood argued this section of the bill is unconstitutional because it specifies and punishes them, saying it violates equal protection laws and qualifies as retaliation against free speech rights. 

“The Defund Provision is a naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment,” the complaint says. “It does so not only because of Planned Parenthood members’ long history of providing legal abortions to patients across the country, but also because of Planned Parenthood’s unique role in advocating for policies to protect and expand access to sexual and reproductive health care, including abortion.”

The complaint also details numerous instances when Trump said he was committed to defunding Planned Parenthood in 2016 and 2017, during his first presidential term, and it highlighted the provisions of Project 2025 that called for the defunding of Planned Parenthood. Project 2025 is the blueprint document drafted by the conservative Heritage Foundation, and the administration has followed many of its directives so far.

According to the lawsuit, Planned Parenthood members have “structural independence,” meaning no member “has control over the operations or decision-making processes of another.” It’s argued in the complaint that 10 members, including plaintiff Planned Parenthood Association of Utah, don’t meet the definition of prohibited entity under the new law, because they do not provide abortion services or did not receive over $800,000 in Medicaid funds during fiscal year 2023. They say these members are not “affiliates, subsidiaries, successors, or clinics” of any prohibited entity because they are separately incorporated and independently governed.

“But these Non-Qualifying Members can take no comfort in the plain text of the statute,” reads the lawsuit. “Defendants will willfully misinterpret the statute to disqualify them from receiving federal Medicaid funding, based solely on their association with PPFA and other Planned Parenthood Members.”

“As the Trump administration guts our public health care system, we know millions will suffer and struggle to get care. We will not tolerate these attacks,” said Shireen Ghorbani, interim president of Planned Parenthood Association of Utah, in a statement. “For over 55 years, we have proudly cared for generations of Utahns, and we will always find ways to meet the health care needs of our communities. Here in Utah, we are used to politicians trying to strip away our rights for political gain. We haven’t backed down before, and we won’t now.”

Defunding will harm general wellness, not abortion care, Arizona clinic owner says

Planned Parenthood also noted in its complaint that the harms could be especially devastating because “even where alternative providers are theoretically available, those providers, who are already stretched to capacity, often do not offer the same comprehensive sexual and reproductive health service options, have long wait times for patients, and cannot accommodate the huge influx of patients who would need to find a new provider of care.”

Some clinics that operate independently of Planned Parenthood will be affected by the law as well. George Hill, president and CEO of Maine Family Planning, said they receive nearly $2 million from Medicaid funds (MaineCare) on a yearly basis, and about half of their patients are enrolled in some form of Medicaid. Hill said they plan to sue as well, but the timing is uncertain at this point. Abortion care makes up about 15% of their overall services, while the rest is routine gynecological and preventative health care, he said.

In the meantime, Hill plans to solicit as much support as possible from individual donors to keep the doors to their 19 clinics open and serving Medicaid patients.

“Whether or how long we’ll be able to do that is another question,” Hill said.

In Arizona, Dr. DeShawn Taylor operates the independent clinic Desert Star Institute for Family Planning. About 75% of the services at Desert Star are abortion related, and while Medicaid (AHCCCS in Arizona) dollars can’t be used for the procedure, Taylor said they could often at least get the initial consultation appointment covered by Medicaid.

The cuts that are coming, Taylor said, will not stop people from obtaining an abortion somehow. But there will be other downstream effects.

“People are already economically depressed,” she said. “What we’re going to see is people are still going to do what’s necessary to get (abortion) care, but what’s going to fall off is their ability to get their preventative care, their contraception, their wellness exams, those types of things.”

Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America. 

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Closures would affect already fragile health care system, Midwest doctor says

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

‘Changes to Medicaid … only adds to the chaos’

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Program, recently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program. 

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”

Amanda Becker, reporter for The 19th, and Colleen Long, editor for NBC News, presented their post-Dobbs books at the 2025 Gaithersburg Book Festival in Gaithersburg, Maryland, May 17. Becker’s “You Must Stand Up: The Fight for Abortion Rights in Post-Dobbs America” and Long and Rebecca Little’s “I’m Sorry for My Loss: An Urgent Examination of Reproductive Care in America,” were both published in 2024. (Photo by Sofia Resnick/States Newsroom)

During the pandemic, when many people were reevaluating their life goals, Colleen Long texted her childhood best friend and fellow journalist Rebecca Little to see if, together, they could write a relatable, even funny, book about pregnancy loss.

“My friend Rebecca … she likes to say she kind of had the pu pu platter of loss,” Long said during an author panel at the 2025 Gaithersburg Book Festival in Gaithersburg, Maryland, on May 17. “She had all sorts of terrible things happen: a stillbirth; she had to end the pregnancy of twins; she had several miscarriages. And I had a stillbirth.”

They wanted to understand why it was so hard to talk about pregnancy loss in public, and thus difficult to process.

“She and I started talking about how what we would really like to do is to write a book about why we are so bad at talking about pregnancy loss,” said Long, a senior editor at NBC News. “What is it about our culture that makes it impossible to sort of discuss this, and yet, when it happens to you, then all of these people come out of the woodwork and talk about it. We’re saying it’s like ‘Fight Club,’ but maybe we should be taking fewer cues, you know, from Brad Pitt.”

Long and Little ended up speaking to about 100 people who experienced some form of pregnancy loss and continue to hear from people with experiences since their book, “I’m Sorry for My Loss: An Urgent Examination of Reproductive Care in America,” came out last year. Their book is also about how the U.S. Supreme Court’s reversal of federal abortion rights in June 2022, with the Dobbs v. Jackson Women’s Health Organization decision, has exacerbated the consequences when pregnancy doesn’t go the way it’s supposed to. In the book, Little and Long document how pregnant and miscarrying women have been denied standard medical treatments because of state abortion bans, and how many people — disproportionately people of color — have been criminalized for decisions made while pregnant, long before Dobbs.

“In some ways, reproduction in America has been stripped back to basics, but we don’t find ourselves suddenly reliving a colonial life,” they write. “We would argue it’s more perverse in some ways because the advances in medicine are available, but they’re being withheld. Like the Back to the Future timeline where Biff Tannen runs a dystopian Hill Valley, we’re going back to a place we never really were.”

Joining the panel was The 19th’s Amanda Becker, whose “You Must Stand Up: The Fight for Abortion Rights in Post-Dobbs America,” also published in 2024, tells the story of the first year after Roe v. Wade was overturned, from the perspective of abortion providers and reproductive rights activists.

“I truly think a lot of the people I feature in my book are heroes,” Becker said. “Being around them was just so incredibly inspiring, and how hard they’re working to help people and take care of people and preserve the ability to access care where people can still get it, and fighting to get it back where they can’t.”

States Newsroom reporter Sofia Resnick moderated the Q&A with the authors. The version below has been edited for brevity and clarity. The full conversation is scheduled to be broadcast on C-SPAN 2 Book TV on June 8.

States Newsroom: You both were working on these books before the Dobbs decision and you’ve been both covering major national stories. Why did you both decide to dedicate so much time to this particular story?

Colleen Long: When Roe fell, it really sort of informed our reporting in a different way, because a lot of the procedures that are used to treat pregnancy loss are used to treat abortion. So, our book was focused more on pregnancy loss. But really, our sort of principle for the book is, what has happened in the past 50 years — since Roe has been codified and now fallen — is that we sort of hold out everything that isn’t a perfect pregnancy or the end of an unwanted pregnancy. But there’s this vast middle ground that a lot of people tend to experience. … When Roe fell, everybody was like, “Oh, this is not going to affect miscarriage care. This could possibly not affect a woman who is wanting a pregnancy and is unable to continue her pregnancy.” And so what we’ve seen, obviously, since the fall of Roe, is that actually these things are all very much intertwined. So our idea was to better inform everyone.

Amanda Becker: My background is as a political reporter, not a health care reporter. So I was more interested in how reproductive rights, and abortion specifically, have really reordered our politics. It’s the biggest political story of my lifetime, and because I’m a person that was capable of giving birth, I also thought it was the most important story overall that affects more than half of this country directly. And I would argue that it affects everyone indirectly in some way.

I just knew it was going to be a very big year, and that’s why I decided to structure the book — it literally starts with the decision in June, and it ends the next June — because it was just such a sprawling story that I knew would affect every single state in a different way, and the residents in those states in different ways.

SN: What were the parts of your books that were hardest to write?

Long: Rebecca trained at [the famed Chicago improv theater] Second City, so she’s funny, she will be the first to tell you. We wanted to make this book readable … so we worked on the tone a lot. That said, the hardest part about writing this book was interviewing the people. We interviewed 100 different people, and they ran the gamut. Some experienced a miscarriage, some had a stillbirth, some had multiple stillbirths. Some had to end their pregnancies because of a host of reasons. We interviewed people from every religion, conservative people, liberal people, all kinds of different people, and it was hard. As a journalist, you are used to listening to people and hearing stories that are upsetting, but I think the thing that was most upsetting for us was how common a lot of their stories were in that they all felt, like, alone, unsure, didn’t know where to go.

Becker: I was trying to write a book that was ultimately hopeful. … I would say the most difficult points were just, like, the overwhelmingness of what was happening that year. And because my book is kind of looking at the loss of abortion rights as happening in tandem with the erosion of our democracy, which is something I care a lot about, it just would start to feel overwhelming sometimes. Like, how are we going to fix these things that have been happening over the last 100 years, you know? How can we get reproductive rights back unless we fix gerrymandering?

SN: In your respective historical research, what were some things that surprised you?

Becker: I was floored when I found out that the American Medical Association came into being to elevate male doctors over female midwives and then go on an anti-abortion crusade over the next 30 years that eventually changed the laws in almost every state in this country.

[Addressing Long:]And you get into this in your book, too: The father of gynecology did non-consensual experiments without anesthesia on enslaved women. And I’m learning this history of women’s healthcare and gynecological care and being like, this is how we ended up here.

Long: We have a long history in the beginning of our book — it’s literally called “How We Got Here” — to sort of explain how our attitudes have changed over the years on pregnancy and pregnancy loss. Because, for example, the way we view pregnancy — this was really surprising to me — the way we view pregnancy today is really only like 47 to 48 years old, and it has to do so much with modern medical advances, sonograms, the home pregnancy test. Our ideas about how we bond and the way we discuss pregnancy is just so different. 

SN: What have been some of the impacts of increased anti-abortion laws on health care and grief and loss?

Long: My OB-GYN came from Oklahoma [where abortion is banned] because she was, like, “I feel as though I can’t practice safely.” … And the other thing we’re noticing is that doctors — not OB-GYNs, but like any doctors — they’re considering where to go to medical school. And the states in which the abortion laws are very strict, they’re sort of looking away from those states because … they’re afraid of their own medical care. So I would expect us in — I don’t know, five years, maybe, let’s say six years — we’re going to start seeing like a real disparate situation in the United States, where we have some states with very good medical care, and other states, which, let’s face it, already had poor medical care, are going to have worse medical care.

Becker: You don’t find out about a lot of really bad fetal abnormalities until the 20- to 21-week anatomy scan, so [people] made really difficult decisions, and a lot of them that I’ve spoken to feel like they can’t even grieve that openly because of what’s in the public discourse right now about abortion and abortion bans. Yes, they had an abortion, but they’re grieving a pregnancy that they very much wanted and a child that they very much wanted, and I think it’s just making it more difficult for people to talk about.

Long: This is where politics is tricky. … We interviewed a lot of women who identified as politically left-leaning who felt they weren’t allowed to mourn their miscarriage because they didn’t want to be seen as a traitor to the cause of abortion rights, which is hard.

And then … you have what has happened with the restrictions and the fetal personhood laws. … This is a very new concept, to have the sort of baby and the mother have the same legal rights, and that’s what we’re seeing play out in some of these places. And it plays out in really strange ways. Because when you have a life or death situation and you have these two entities, one does not exist without the other. And like, who is worth saving more? It’s just a really complicated morass.

Becker: If you talk to experts, both legal and medical, in fetal personhood and what it means in practice, they will tell you that in a fetal personhood situation where you’re putting at odds the rights of a fetus versus the right of the gestational parent, the fetus always wins when we apply fetal personhood. And so we’re going to see more and more of that.

Audience Member: It seems to me that in the last political campaign, we started to hear a lot about the impact of these laws on women, and somehow that’s fallen out of the news. And so how do we mobilize around this issue?

Becker: I think we were hearing about it in part because it was an election season and a presidential election, and I would expect that to come back around for the midterms and the next time we have a lot of abortion ballot measures on ballots. … Politicians pay attention to what gets them elected or not elected. So if that’s a reason you’re going to elect someone or not elect them, let them know that. 

Long: I covered the [presidential] campaign, and like even during the campaign, I felt like these issues sort of only caught fire when they thought it could be a winning issue. And the Democrats are in a weird rebuilding phase right now, and so I think they’re trying to figure out what works and what doesn’t. … They were really hoping that reproductive rights and reproductive health was going to drive people to the polls, in particular women, and in the end, they lost. … And the conversation is no longer happening. But if you think about it, the conversation was never happening. It only just started happening, and then it was a blip. And then now we’re sort of back to where we were, which is super annoying. 

“We just want to ensure that the most popular method for abortion in Virginia and beyond is protected no matter who sits at the White House and who sits in the FDA,” said Whole Woman’s Health founder and president Amy Hagstrom Miller outside of the U.S. District Court of the Western District of Virginia in Charlottesville, Virginia, on May 19, 2025. (Photo by Charlotte Rene Woods/Virginia Mercury)

CHARLOTTESVILLE, Va. — Abortion pills — and questions over their inherent safety — were back in federal court Monday. Unlike a lawsuit rejected by the U.S. Supreme Court last year, plaintiffs this time are not anti-abortion activists arguing medication abortion should be banned, but abortion providers arguing the remaining restrictions should be lifted to match the drug’s 25-year record of safety and efficacy.

The suit seeks to make abortion pills more accessible by removing several existing restrictions on the U.S. Food and Drug Administration’s mifepristone-misoprostol regimen first approved in 2000. The drug was approved under the FDA’s drug safety program called Risk Evaluation and Mitigation Strategy (REMS), provisions of which have been steadily eliminated over time but not fully.

On behalf of independent providers in Virginia, Montana, and Kansas, Center for Reproductive Rights senior counsel Linda Goldstein argued the FDA’s most recent evaluations did not properly assess whether remaining restrictions are still medically necessary. She argued that the biggest risks the FDA has identified with mifepristone — serious bleeding and infection — are not exclusive to the drug but with all pregnancy terminations, including spontaneous miscarriages, which she said affected about 25% of all pregnancies. Beyond abortion, for which the drug has captured attention, mifepristone is also used to treat miscarriages so that they conclude safely to help prevent infection.

“The FDA has acknowledged that staying pregnant is more dangerous than not staying pregnant,” said Goldstein, arguing that at minimum the FDA should be required to explain why drugs that pose similar risks are not subject to the same restrictions.

She noted that of the 20,000 drugs the FDA has approved, only 73 have REMS provisions, and that mifepristone has proven to be a safe drug over time. About 7.5 million U.S. patients have taken it as of the end of last year, Goldstein said. As of December 2024, the FDA has reported 36 patient deaths associated with mifepristone since it was first approved in 2000.

Whole Woman’s Health Alliance v. FDA is the first time the U.S. Department of Justice is arguing a position on mifepristone in court since the Trump administration took office. Justice Department attorneys said current regulations are necessary for the most common form of pregnancy termination to be considered safe. When asked by the judge, DOJ attorney Noah Katzen did not confirm or deny whether or not the FDA still considers the drug to be safe and effective overall.

“That is what the FDA determined in the past,” Katzen said during the hearing at the U.S. District Court for the Western District of Virginia in Charlottesville, where the case was originally filed in 2023.

Katzen, the FDA’s former associate chief counsel until 2021 and currently a trial attorney for the Consumer Financial Protection Bureau, said the FDA has found that the evidence was “not sufficient” to conclude the REMS are no longer necessary.

U.S. District Judge Robert S. Ballou, appointed by Democratic President Joe Biden, appeared more sympathetic to plaintiffs’ argument that some of the requirements appear arbitrary in that they don’t apply to other drugs with equal or greater risk, including drugs his parents have taken. 

Ballou did not rule at the end of Monday’s hearing but said he would as soon as possible.

After the hearing, Whole Woman’s Health Alliance founder and president Amy Hagstrom Miller told States Newsroom she took note of Katzen’s response about whether the FDA considers mifepristone to be safe and effective.

“It was an interesting choice of words,” she said.

This lawsuit is among several federal cases involving mifepristone. Earlier this month, the Trump administration filed a brief in the case Missouri v. FDA, requesting the court dismiss three states’ lawsuit to restrict mifepristone on procedural grounds, but did not comment on the merits of the case or explicitly defend the FDA’s current medication abortion policy.

While the Missouri v. FDA lawsuit seeks to reinstate regulations loosened between 2016 and 2021, the Whole Woman’s Health v. FDA lawsuit takes aim at restrictions that require: medical professionals who prescribe mifepristone to register with the drug manufacturer; pharmacies to apply for special certification and maintain copious records, and patients to review and sign a counseling form.

On behalf of plaintiffs, which include Whole Woman’s Health Alliance in Virginia and other states, All Families Healthcare and Blue Mountain Clinic in Montana, and Trust Women in Kansas, Goldstein argued that these existing rules are burdensome and make these medications harder to access by limiting the number of providers and pharmacies who can provide and dispense it and impede access to time-sensitive care.

Goldstein noted the “political climate” surrounding mifepristone and pointed to how abortion opponents seek either rescinding of FDA approval for mifepristone or a return to the in-person dispensing requirements. She added how efforts to make abortion medication more difficult to obtain are outlined in Project 2025 — the conservative Heritage Foundation’s playbook.

Before and especially since Roe v. Wade was overturned in 2022, anti-abortion groups have tried to convince courts that abortion pills, in addition to ending the lives of embryos and fetuses, harm pregnant people at rates that warrant being pulled from the market or at the very least heavily restricted.

During his presidential campaign and since taking office, President Donald Trump and his health appointees have messaged strategically on medication abortion, on the one hand promising to retain its access while also open to examining new evidence suggesting it is unsafe.

Just last week, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said he would direct the FDA to review abortion pill safety and potentially change its drug label, following the release of an anti-abortion white paper commissioned by far-right funders, whose analysis has been widely criticized by reproductive health scientists and is outflanked by hundreds of studies showing a very low rate of serious adverse events.

Significant for the South 

Hagstrom Miller called the current restrictions “politically motivated” and said overturning them would be especially significant for Virginia, which as the least restrictive state in the South, has seen an uptick in people traveling from elsewhere to receive care.

“They’re not related to the safety of the medication,” Hagstrom Miller said, of the current restrictions. “We just want to ensure that the most popular method for abortion in Virginia and beyond is protected no matter who sits at the White House and who sits in the FDA.”

Virginia is in the process of amending its state constitution to enshrine abortion and other reproductive health care procedures or medications. The constitutional amendment passed the legislature on party-line votes this year and must pass again next year before appearing on ballots for voters statewide. Its continued success or failure hinges on the outcome of the state’s competitive House of Delegates elections — where Democrats hold a slim majority.

While governors don’t have a say in constitutional amendments, the issue is a divergence between gubernatorial candidates Lt. Gov. Winsome Earle-Sears and Democratic challenger former Congresswoman Abigail Spanberger. This means that should the amendment fail and partisan control of the House shift, whoever is the next governor could advance or block potential future efforts to walk back Virginia’s current abortion access laws. 

“It’s really important that we protect that safe access to medication abortion no matter where people live — Virginia is playing a key role in the South right now,” Hagstrom Miller said.