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.”

The Trump Administration yanked more than $65 million in Title X funding from clinics nationwide in April, and some of that funding is still frozen, leaving clinics struggling to offer free or low-cost contraception and other family planning services. Some states are suing to get the funding back, but Idaho officials chose to forego it due to a conflict with state law. (Getty Images)

The Idaho Department of Health and Welfare quietly declined the entirety of its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services from a key family planning program. 

Though thousands of Idahoans relied on the health care provided through Title X for over 50 years, the state made no public announcements as the decision took effect in April, leading to the closure of 28 out of 43 — about 65% — Title X-funded family planning clinics in public health districts throughout the state, according to the Idaho Department of Health and Welfare. 

After turning down the Title X money entirely, Health and Welfare said there are no plans for the state to make up the difference by increasing the family planning budget. 

In one district, Eastern Idaho Public Health, spokesperson Brenna Christofferson said contraception services are no longer available at all, which has only been communicated to existing Title X patients. Sexually transmitted infection testing and treatment, and breast and cervical cancer screenings are still provided using different funding sources.

Many of the clinics closed in eastern Idaho, including more populated cities such as Twin Falls and Idaho Falls, and more rural areas such as Salmon, Rexburg and Rigby. Title X services also ended at clinics like Terry Reilly Health Services in one of southwestern Idaho’s most populous areas of Nampa and Caldwell. 

The decision to forego the funds came at the same time the Trump administration yanked more than $65 million in Title X funding from Planned Parenthood clinics and some independent reproductive health clinics across the country, much of which is still frozen, including for Idaho’s last remaining Planned Parenthood in Meridian. Spokesperson Nicole Erwin said Planned Parenthood continues to fundraise to help offset costs and keep family planning services affordable on a sliding scale.

Although Idaho’s move came at the same time national attention was focused on the frozen funds, it was a separate decision, according to Health and Welfare.

“The discontinuation of Title X funding … was not related to the federal administration’s Title X policy changes earlier this year,” said AJ McWhorter, spokesperson for the Health and Welfare Department. “The department made the decision to decline the funding to remain compliant with current Idaho laws concerning parental rights and counseling on pregnancy options.”

Nationally, seven out of 16 grantees have had their funding restored, while others have been waiting nearly seven months for resolution, said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association.

“For Idaho to walk away from the money doesn’t just disadvantage and imperil young people, it imperils all the people in the state,” she said. “It hurts women, it hurts men, and it hurts young people.”

Coleman’s organization sued the U.S. Department of Health and Human Services over the frozen funds, and the case is still pending. A coalition of 20 Democratic-led states sued federal government agencies in July to halt its actions related to several social safety net programs, including Title X. That case is paused while the government is shut down.

In 2023, U.S. Health and Human Services reported Title X provided care to nearly 3 million people nationwide, a 7% increase from the prior year. Under the program guidelines, people with family income levels at or below 100% of the federal poverty level can receive services free of charge, while those making up to 250% of the federal poverty level pay a discounted rate on a sliding scale.  

The program, established by Congress and signed by former Republican President Richard Nixon in 1970, is intended to prioritize low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. Abortion services cannot be covered by Title X dollars.

Pregnancy options and parental consent 

The federal statute guiding the administration of Title X funds includes a section on adolescent services that says grantees cannot require the consent of parents or guardians before or after the minor has requested or received family planning services. Another section directs grantees to allow pregnant patients the opportunity to receive information and counseling regarding prenatal care and delivery, infant care, foster care, adoption and pregnancy termination. Idaho has a near-total abortion ban with few exceptions.

Idaho’s Legislature passed Senate Bill 1329 in 2024, requiring parental consent for “the furnishing of health care services” to a child, with the exception of lifesaving care. Idaho Capital Sun reported the law has also created difficulties for the state’s suicide hotline, because some minors need permission from a parent to receive certain services.

Coleman said the adolescent and pregnancy options requirements have long been part of Title X guidance, and it has not conflicted with state law because federal law should take precedence under the U.S. Constitution.

Idaho is one of at least two states that currently has no Title X funding, Coleman said, after Utah lost all of its Title X money when the Trump administration withheld funding from Planned Parenthood clinics, which were the only places offering those low-cost or free services. Planned Parenthood of Utah closed two of its centers — in Logan and St. George — in the wake of the decision to freeze funding. Logan is less than an hour away from eastern Idaho’s border.

Some states were temporarily left without Title X providers after the Trump administration’s actions in April, but the funding was restored at later dates for certain states, including Missouri and Mississippi. The federal health agency also restored funds in May for two states with abortion bans, Tennessee and Oklahoma, whose grants were revoked under Democratic President Joe Biden’s administration because of their refusal to include abortion among the options during pregnancy counseling. 

In a letter from HHS to Tennessee state officials providing notice of the award, the acting chief grants management officer wrote, “Tennessee is one of only two states to have lost funding for failure to comply with the Title X 2021 regulations requiring counseling and referral for abortion. The department is declining to enforce this provision against the state, and you may rely on this letter to that effect.” 

A total of 7,528 Title X clients were served across Idaho in 2024, McWhorter said. The 15 remaining family planning clinics are supported by other funds, and additional service sites may be added as funding becomes available. Those clinics are in two out of the state’s seven public health districts, which served about 1,400 people combined in 2024. 

The closures add another challenge in an already difficult landscape for sexual and reproductive health care in Idaho. A recent study found that 94 of 268 practicing OB-GYNs left Idaho between August 2022 and December 2024, and care is becoming harder to obtain, according to residents, who say wait times are longer and certain treatment is unavailable locally. 

Coleman said under Biden’s administration, when an entity lost Title X dollars for noncompliance or other reasons, there was an effort to reallocate the funding to another willing participant. Without that action, it would revert back to the U.S. Treasury, and the next opportunity for another Idaho entity to apply for Title X funding will be late 2026. 

Preventing unplanned pregnancies 

Amy Klingler, a clinician in rural eastern Idaho, told States Newsroom she was devastated by the closure of Eastern Idaho Public Health’s family planning clinic. She worked there in addition to another clinical job since 2006 and said there aren’t many other options for family planning care in that area of the state.

“Idahoans don’t trust doctors, but they trust their doctor,” Klingler said. “So when we see rural health care being eroded and doctors leaving Idaho or not coming to Idaho, I think that is really going to impact the health of people in our communities.”

The additional cuts to Planned Parenthood through Medicaid, along with overall Medicaid cuts that may force the closure of more rural hospitals and clinics, will force people to delay care until they are sicker and require more expensive medical care, Klingler said.

The minor consent for treatment bill had good intentions, she said, and in an ideal world, every child would feel comfortable talking to their family members about birth control. But she said she is confident there are young women who don’t get birth control because they don’t want to have that conversation with their parents. 

And with Idaho’s abortion ban, unplanned pregnancies either have to be carried to term or the person must go to another state where abortion is legal. It’s also a felony in Idaho for someone to take a minor to another state for an abortion without parental permission.

“Providing free birth control is really powerful if you’re trying to prevent unplanned pregnancies,” Klingler said.

On her last day at the family planning clinic in June, Klingler said the staffers cried together.

“We often ended the day by saying, ‘We did some really good work today,’” she said. “And to not be able to do that good work kind of hurts the heart.”

Idaho resident Lynlee Lord said she used nutrition assistance programs that helped ease some of the stress she was dealing with while pregnant in the aftermath of her partner’s death. Food insecurity can bring heightened risks of preeclampsia, preterm birth and NICU admission, research shows. (Courtesy of Lynlee Lord)

Millions nationwide could be cut off from access to government food assistance Saturday due to the shutdown, including those who are pregnant or have babies and young children.

That possibility brings back a lot of difficult memories for Lynlee Lord, a mom of three in rural Idaho. In 2014, when Lord was 24, her partner died by suicide. She was 11 weeks pregnant with his daughter and already had a 2-year-old son.

“I went from building my life with my best friend to not having anything, and having to move into income-based apartments,” Lord said.

She was also going to cosmetology school full-time in Boise, Idaho, nearly an hour away from where she lived, spending more than 12 hours away from home each day. She worked on her dad’s ranch and cleaned houses to earn gas money. She tried to keep her stress levels down, but the one thing she didn’t worry about was food, because she had benefits from the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program, or SNAP.

“It took a lot of pressure off of me,” she said.

Many studies have shown adequate nutrition is essential for a developing fetus, and a January study published in the Journal of the American Medical Association found food insecurity in pregnancy is associated with medical complications. The researchers defined food insecurity as being worried about running out of food before there’s money for more. Risks include preeclampsia, preterm birth and NICU admission. 

Those who did not have access to food assistance had the highest risk of complications, according to the January study. The increased rate was alleviated by food assistance. 

It’s unclear how many pregnant people use SNAP benefits on average, but the program helped feed 42 million Americans in 22 million households in the 2025 fiscal year, according to the USDA. A separate supplemental nutrition program for Women, Infants and Children — known as WIC — is often used simultaneously by participants. The federal government temporarily shored up WIC through October and promised more money, but whether the funding will last through November remains uncertain as the shutdown wears on.

The Trump administration has so far declined to use emergency funds to keep SNAP solvent while the government shutdown continues. Republican Senate Majority Leader John Thune said he won’t consider a Democrat-led standalone funding bill to keep the program going during the shutdown.

Though officials in some states are making moves to boost food assistance temporarily, others — including in Indiana and Tennessee — have refused to step in.

Lord doesn’t need food assistance anymore, but about 130,000 Idahoans still do and are set to lose their benefits starting on Saturday, Nov. 1. The Women, Infants and Children program, which helps families afford formula and other supplemental foods, could also soon run out of funds in certain states, including Idaho, the Idaho Capital Sun reported.

Instability and hard choices

Gestational diabetes — one of the more severe complications that can result from food insecurity — affects up to 10% of all pregnancies on average. The condition occurs when the placenta produces hormones that decrease insulin sensitivity, creating unstable blood sugars that necessitate a more strictly controlled diet and potentially the use of insulin or other medication to keep glucose levels in a normal range. Most cases are diagnosed in the third trimester, when the amount of insulin needed to keep blood sugars normal is at its peak.

Blood sugar can also be affected by stress, poor sleep, irregular meals and other physiological factors. If left untreated, or if glucose remains unstable through the last trimester of pregnancy, it can cause the fetus to grow too quickly, increasing the risk of stillbirth and other complications, like high blood pressure and low blood sugars in the baby after delivery.

Dr. Chloe Zera, chair of the Health Policy and Advocacy Committee for the Society of Maternal-Fetal Medicine, specializes in gestational diabetes and said she saw a patient on Tuesday who was worried about losing her SNAP benefits.

“Adding that on top of what is already a stressful diagnosis is incredibly challenging for people,” Zera said. “There’s so much guilt and shame and blame that goes along with gestational diabetes and diabetes in general in pregnancy.”

People with gestational diabetes who already have children and who are food insecure will also most often feed their children before themselves, Zera added.

“They’re going to make really hard choices that mean they have even less control over their nutrition,” she said.

Dr. Andrea Shields, an OB-GYN and maternal-fetal medicine specialist at the University of Connecticut, said uncontrolled gestational diabetes can cause low blood sugar in babies after delivery, which has been linked to neurodevelopmental issues later in life. If the SNAP benefits stop, she said, more people will have to get creative about finding ways to help pregnant patients without assistance from the federal government.

“This is a perfect example of why we pay taxes and why we want to help society in general, because we don’t need to create generational issues, which this will, because it impacts the unborn fetus,” Shields said.

Lord said if she was in the same situation today that she was 10 years ago, she might have had to consider an option that never crossed her mind at the time — an abortion. Even though it was her partner’s only child, and abortion is now banned in Idaho, Lord said she may have needed to find a way to end the pregnancy out of necessity, especially considering the costs of rent, child care, food and other expenses today.

“I would’ve probably picked my child that was living,” she said. “It was really scary for me back then, and I can’t even imagine in today’s world if that happened.”

UPDATE: This story was updated to include more information about WIC on Friday, Oct. 31. 

Miraya Gran and her husband took out a second mortgage and had a family fundraiser to be able to conceive their first child through in vitro fertilization in 2021. She still does not have insurance coverage for IVF, and despite having two embryos waiting to be implanted, she cannot afford the cost on her own to give her daughter a sibling. (Courtesy of Miraya Gran)

Miraya Gran is the kind of person who Republican President Donald Trump and his administration say they are going to help with new policies on in vitro fertilization.

It took a second mortgage on her Minnesota house and a family fundraiser to afford the IVF treatment she needed to have her first child in 2021. Gran’s husband has male-factor infertility, and she has a genetic blood disorder, making it extremely difficult for them to conceive on their own. But unless the cost of IVF goes down a lot, Gran can’t afford to give her daughter a sibling.

“I’ve got two embryos waiting for me, and I’m not accessing them due to lack of insurance coverage,” she said.

But Gran doesn’t have much hope left that IVF costs will drop enough after Trump’s announcement at the White House on Thursday, Oct. 16. The president said his administration negotiated steep discounts on a key fertility drug, as well as a new regulation allowing employers to offer IVF coverage as a standalone policy like dental or vision. EMD Serono, a major pharmaceutical brand, will offer the medication at an 84% discount via direct sales on a government webpage called TrumpRX, according to a company representative who spoke at the White House event.

Gran said that isn’t good enough. The drug prices are only a portion of what makes treatment expensive. One IVF cycle ranges between $12,000 and $25,000 on average but can cost more depending on medical needs. Many people require more than one round of IVF to get pregnant. 

Plus, the new policy only clears the way for employers to offer coverage options — it’s not required by the government.

“They have the ability to put the onus on insurance companies,” Gran said. “There really isn’t a solution for our community until we have insurance coverage.”  

Trump campaigned on a promise to make IVF treatment free for all, either through federal funding or insurance, but has so far not fulfilled that promise.

Dr. Eve Feinberg is an OB-GYN professor at Northwestern University, and a reproductive endocrinologist and fertility specialist who treats IVF patients every day. She said lowering the cost of the drugs is a positive step, but that’s only about one-third of the cost of a typical IVF cycle — less in some cases.

“For some patients, the medications can go as high as half the cost,” Feinberg said. “If you have a good reserve of eggs, you require less medication. If you have a lower reserve, you’ll need more. So for some, it’s $3,000 … and for some, it’s $10,000.”

‘Restorative reproductive medicine’ not a replacement for IVF, doctor says 

Trump’s promise to make IVF free is a difficult one to fulfill not only because of the overall cost but because of divisions among conservative groups about the ethics of the treatment. IVF requires the collection of as many eggs as possible that are then fertilized. Some are later destroyed because they would not make it after implantation in the uterus due to abnormalities or other medical factors.

The Alabama Supreme Court ruled in 2024 that embryos have the same legal rights as children, which threw the medical community into chaos and caused some Alabama IVF clinics to close. Later that year, the Southern Baptist Convention adopted an anti-IVF resolution stating the church’s opposition to the practice.

The ruling happened just as Latorya Beasley was waiting on a transfer date for the embryo she hoped would be her second child. Her clinic temporarily canceled appointments but eventually reopened, and she was able to have a second child. Beasley had IVF insurance through her employer, which only about 25% of companies with more than 200 employees offer nationwide, according to KFF. But there were still out-of-pocket costs.

“There was a point where we ran out of medicine for like one day, and we paid $1,000 out of pocket for that,” Beasley said. “And that was with insurance coverage.”

Feinberg said she was also worried about the aspects of the announcement that talked about “restorative reproductive medicine,” which is a newer field of medicine not recognized by the same medical boards guiding reproductive endocrinology. The practice has been promoted by the Heritage Foundation — a conservative advocacy organization that authored Project 2025 — as the “new frontier” of reproductive medicine.

“There were certain things said in the briefing that made me think the idea of fertility coverage, especially for companies whose beliefs and ideas are religiously focused and religiously based, that may mean offering restorative reproductive medicine and not offering IVF,” she said.

The restorative practice focuses on cycle tracking to conceive, as well as weight loss and nutrition. Feinberg said she had a patient who had been using those methods for four years with no success, and she was 43 by the time a reproductive specialist told her that her husband had such a low sperm count, there was no way they could conceive without medical intervention.

“He had a genetic mutation that the restorative reproductive medicine person was not trained to ever diagnose,” she said. “They could have and should have done IVF.”

Gran and Beasley said if the Trump administration put forward plans that made a real difference for families in need of IVF, they would be the first to celebrate it. But until then, the lack of action is frustrating.

“It just feels like I’m being sold a complete line from a traveling salesman, because until there’s actual substantiated change, I have no faith in what they say,” Gran said.

Hope Broussard, 20, sought care at a Planned Parenthood in Washington in 2023 when her IUD became lodged in her cervix and the clinics in her hometown of Sandpoint, Idaho, weren’t able to help. She now lives in Pullman, Washington. (Photo by Geoff Crimmins for States Newsroom)

Fifth in a five-part series. 

Hope Broussard’s intrauterine device should have brought relief from her severe periods. But at 17, it started causing debilitating pain.

At the Sandpoint, Idaho, clinic where the device was implanted, providers suspected it was embedded in her uterine wall, but lacked the ultrasound equipment to make a diagnosis.

Homeless with no insurance after her mother kicked her out, Broussard couldn’t enroll in Medicaid as a minor without a parent’s involvement. The women’s clinics in Sandpoint couldn’t help. Hospital bills were out of the question.

“The only people that were able to help me were Planned Parenthood,” Broussard said.

She sought care across the border in Washington, at the Spokane Planned Parenthood, where an ultrasound showed the IUD was coiled around her cervix. A specialist carefully removed it in a follow-up appointment and she paid $20 for everything because it was all she could afford.

“It really was my saving grace at the time,” said Broussard, who moved from Idaho to Pullman, Washington, in part because of that experience of being unable to access health care locally. “I have no idea what I would’ve done if I didn’t have that option available to me.”

Broussard is one of more than 2 million people nationwide who used Planned Parenthood for health care between 2023 and 2024, according to the national organization’s annual report. But how many people will be able to afford and access care is changing after a new federal provision prohibits some organizations that provide abortions from receiving Medicaid payments for at least a year. Nationally, Planned Parenthood estimates it could lose $700 million from Title X and Medicaid cuts, forcing affiliates to close some clinics, curtail services and stop accepting Medicaid patients.

Many Republican lawmakers and anti-abortion groups celebrated the provision passed by Congress in July that essentially targeted Planned Parenthood clinics nationwide for “defunding” because abortion care is part of clinical services in many states where access is mostly legal. Federal Medicaid dollars cannot be used to pay for abortions except in limited circumstances, and abortion care makes up a small percentage of overall care provided by clinics. Still, conservatives argue the mere association with any such clinics is equivalent to funding all abortion. 

“Planned Parenthood’s desperate ploy for our tax dollars only underscores why the One Big Beautiful Bill is such a historic win,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a July statement. “It halted, for the first time, over half a billion taxpayer dollars from propping up the corrupt abortion industry.”

Democratic-led states are in troubleshooting mode 

In response, elected officials in some Democratic-led states, including Washington, Hawaii, Colorado and Massachusetts have publicly pledged to backfill the funding needed to allow Planned Parenthood clinics to keep accepting Medicaid and other low-income patients. In July, Washington Gov. Bob Ferguson committed to filling the $11 million gap Planned Parenthood expected to see.

Many states don’t begin their legislative sessions until January, so some of the plans aren’t official yet and still need to make it through the legislative process or the details of allocation are still in progress. That means clinics either have to absorb the costs for now with the promise of reimbursement, or change their payment options and services for the time being. For example Hawaii is moving to sliding-scale fees for some Medicaid patients, and in Maine, a major independent clinic is making changes to its services. 

Idaho’s border with Washington and Oregon is a point of contention among lawmakers across state lines, where the political views could hardly be more polarized between the hard-line conservatives in Idaho and progressive politics in the other two states. But for the people who need abortion care, or even a basic ultrasound, like Broussard, clinics in places like Spokane and Ontario, Oregon, are some of the last options available. 

Oregon lawmakers are also brainstorming ways that the state can provide reimbursement to Planned Parenthood for lost funding. Clinics across the state billed Medicaid nearly $17 million for services in 2024, according to the Oregon Capital Chronicle. 

Courtney Normand, the Washington state director for Planned Parenthood Alliance Advocates, said this latest move from Congress is adding to challenges from the first Trump administration when there were other cuts, along with health care system pressures from the COVID-19 pandemic, and the impact of increasing patient volumes after the U.S. Supreme Court’s Dobbs decision that upended federal abortion rights protections.

“It feels like the hits have just kept on coming in Washington, and that’s why access, affordability and stable funding is our key concern,” Normand said. 

Brita Lund, the health center manager at a Planned Parenthood in Seattle, worries about having to turn away patients if the federal Medicaid cuts and other strains on the health care system become too much to bear. She already feels like she spends too much time grilling a patient about their personal details at an appointment so the staff can find a way to get the treatment paid for by a specific pocket of funding. 

“Who is going to help these people if we’re not going to help them? I want someone to give me that answer,” Lund said. “It literally keeps me up at night.” 

While Washington state is known for being one of the most openly accessible for sexual and reproductive health, a budget crisis led legislators to cut 55% of the funding to the Abortion Access Project, about $8.5 million. Normand said it’s hard to know exactly why legislators made the decision, but some regretted it and are trying to find a solution for the upcoming session. Ferguson pledged to restore the funding as well. 

‘I know the state is supportive, it’s just about what their capacity is’

In Hawaii, Title X cuts from the Trump administration earlier this year amounted to about $2.1 million, said Jen Wilbur, Hawaii state director for Planned Parenthood Alliance Advocates. The state legislature acted quickly in April to approve a new $6 million family planning fund to offset that loss over the next two years, with $3 million specifically allocated to Planned Parenthood clinics. What the funding program will look like exactly is still to be determined, Wilbur said. The needs vary by island, and an assessment of what those needs are is underway.  

Hawaii has trended slightly more conservative than other blue states in recent elections, Wilbur said, but support from lawmakers still feels strong. She and other advocates are trying to game plan in the event that the federal government restricts access to mifepristone through the mail, which would severely affect access for the islands. 

But Wilbur worries about the long-term sustainability of the funding in a small state that already has many challenges with high cost of living, difficulty retaining providers and navigating the unknown. 

“We don’t even know how many more cuts are coming, so is any state really going to be able to sustain this going forward? I don’t know,” Wilbur said. “I know the state is supportive, it’s just about what their capacity is.” 

Short-term state fixes in Maine, Massachusetts 

New England, considered a hub for abortion access and low-cost reproductive health services, has been especially impacted by the federal Medicaid rule. It affects not only Planned Parenthood affiliates, but also two nonprofit health networks that offer wide-ranging health services primarily to Medicaid patients: Health Imperatives in Massachusetts and Maine Family Planning, which, like Planned Parenthood, has sued over the new policy. 

Maine’s legislature this summer appropriated about $6 million for family planning funding, to go to organizations like Planned Parenthood of Northern New England and Maine Family Planning, the largest reproductive health provider in the state with 18 clinics compared to Planned Parenthood’s four. But as Maine Morning Star reports, the temporary relief does not fully meet both organizations’ deficits, and Maine Family Planning this week announced it will end primary care services in Ellsworth, Houlton and Presque Isle at the end of October.

Still, both Maine Family Planning and Planned Parenthood of Northern New England say they will continue to see Medicaid patients free of charge for reproductive health and family planning services. 

Massachusetts Democratic Gov. Maura Healey also announced the state would deliver $2 million to Planned Parenthood League of Massachusetts, which is one of the co-plaintiffs in Planned Parenthood’s lawsuit against the federal government.

“We want the people of Massachusetts to know that if you need reproductive health care services, you should continue to seek this care,” Healey said in a news release. 

Massachusetts has been a leader in policy promoting access to reproductive health including abortions, which is legal in the state up to 24 weeks of pregnancy with exceptions for significant fetal abnormalities and the pregnant person’s health.  

But access to broad reproductive health care even in a city like Boston remains limited, especially for people living in poverty, said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Lee told States Newsroom that making a primary care or OB-GYN appointment in the Boston area can mean having to wait 60 days, while Planned Parenthoods typically have same-day appointments. She noted that the communities with the least access to low-cost reproductive health services are concentrated in central and western Massachusetts, where Planned Parenthood has three clinics.

Lee said she is grateful for the $2 million in state funding, which she calls “short-term relief.” Because Medicaid funding represented about a quarter of her organization’s revenue, Lee said it is like a business losing its biggest customer. Her goal now is to figure out how the affiliate can sustain long term. She said they are brainstorming other revenue streams like offering vasectomies.

“We have gotten really good at contingency planning,” Lee said. “But it would be great to have a business model that is sustainable, that can withstand all of these attacks, and not have to worry about it. That would be a dream.”

The affiliate’s website notes that patients can no longer use their MassHealth or Medicaid Managed plans for care at Planned Parenthood clinics but says they are still seeing “all patients.”

Health Imperatives, which operates seven clinics in southern Massachusetts, is also looking at operations.

Health Imperatives CEO Julia Kehoe said the $19 million nonprofit serves about 23,000 people annually and offers social and psychiatric services to vulnerable populations. About 40% of what Health Imperatives does is offer low-cost sexual and reproductive health services for about 10,000 patients annually, Kehoe said. For now, they are continuing to see the same amount of patients and are working with the state government for funding help. 

But she said the organization is also looking at private funding because they are determined to continue seeing Massachusetts’ poorest residents, many of whom experience food insecurity in places like Nantucket, which is one of the nation’s wealthiest towns but where the main safety net for those who are not wealthy is a single Health Imperatives clinic. 

“I would never, ever make the decision to not see Medicaid patients,” Kehoe said. “We exist to provide services to people who fall through the cracks of mainstream systems of care. So we’re going to prioritize people who are on Medicaid or people who don’t have insurance. What I would do is, rather than further health disparities and wealth disparities in one of the most expensive states in the country, I would have fewer clinics.”

Correction: This article has been corrected to reflect that elected officials in Maine have not yet pledged to support family planning clinics with backfilled funding. The state passed a bill last session that provided family planning funding that was already needed before the congressional bill cut Medicaid funding.

Jess Deis, a nurse practitioner and nurse midwife in Kentucky and Indiana, learned she had cervical cancer after she qualified for Medicaid insurance in 2014. (Sarah Ladd/Kentucky Lantern)

Third in a five-part series.

It had been a decade since Jess Deis’ last women’s wellness exam when Kentucky expanded Medicaid and she finally qualified for the state insurance program.

Physicians recommend a cervical cancer screening — also referred to as a Pap smear, which is a swab of the cervix — as part of a wellness exam once every three to five years for women between the ages of 21 and 65. Deis, 43, was in her last semester of nursing school in 2014 when the test came back with abnormal results. Her doctor ordered additional testing.

“Then I got a call on a Sunday evening from a physician letting me know I had cervical cancer and I needed to see a specialist,” Deis said.

Cervical cancer is one of few cancers that has a known path of prevention after the approval of the first HPV vaccine in 2006. But that also means it falls at the intersection of three cultural issues that are facing strong political opposition — broad access to low-cost or free reproductive health care, access to vaccines for children, and sex education.

Kentucky had the highest cervical cancer incidence rate in the country between 2015 and 2019, according to medical research, and a mortality rate twice as high as the rest of the country. The state tied with West Virginia for the second-highest rate of 9.7 cases per 100,000 residents between 2017 and 2021. Oklahoma topped the list for that five-year period with 10.2 cases per 100,000, according to the National Cancer Institute.

Deis delayed the surgery to remove her uterus until after graduation, and later became a certified nurse practitioner. Now she provides Pap smears to patients multiple times a day at Planned Parenthood clinics in Kentucky and Indiana and other care via telehealth. She recently helped a patient who hadn’t been seen for a screening in 15 years discover she had advanced cervical cancer.

She is troubled by what could happen in the wake of the new Medicaid rule passed by Congress and signed by President Donald Trump in July that barred nearly all Planned Parenthood affiliates from receiving Medicaid reimbursements because some clinics in the nonprofit network provide abortions. Kentucky and Indiana both have abortion bans, but still have Planned Parenthood clinics to provide other reproductive health care.

“I don’t just worry; I know that there’s going to be more folks with stories like mine, but without the happy ending,” Deis said.

‘What we’re really talking about is our daughters getting cervical cancer’

The American Cancer Society recently reported the number of early cervical cancer cases has declined sharply among young people since the vaccine’s introduction nearly 20 years ago. But vaccine adoption rates for children are low in the states where rates are highest — about one-third of boys and girls between the ages of 13 and 17 were vaccinated in Mississippi as of 2020.

The vaccine is most effective when given before engaging in any kind of sexual activity for the first time, because it can prevent the sexually transmitted strains of HPV that present the highest risk of cervical cancer. More than 98% of cervical cancer cases are caused by HPV, and a 2024 study from the Journal of the National Cancer Institute found zero cases of cervical cancer in Scottish women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13.

“We could make (cervical cancer) an eradicated disease,” said Dr. Emily Boevers, an Iowa OB-GYN. “But everything is falling apart at the same time.”

Boevers said limitations on Medicaid coverage and the loss of Title X family planning funding will make screenings and vaccines less accessible for the populations that need them the most, even if clinics don’t close as a result. But it will take years to see the consequences of these changes, she said, because it takes about 15 years on average for HPV to become cancer. 

“So what we’re really talking about is our daughters getting cervical cancer,” she said. 

Kentucky’s legislature acknowledged the importance of HPV vaccines as recently as 2019, when representatives passed bipartisan House Resolution 80, which encouraged females and males between the ages of 9 and 26 to get the HPV vaccine and everyone to “become more knowledgeable of the benefits of the vaccine.” Only four legislators voted against it.

But today, the U.S. Department of Health and Human Services is led by Secretary Robert F. Kennedy Jr., who has made false statements about the HPV vaccine’s safety and effectiveness and played a leading role in organizing a mass lawsuit against one of the vaccine’s manufacturers, Merck. The Associated Press reported the judge dismissed more than 120 claims of injuries from Gardasil, the name of one HPV vaccine, because of a lack of evidence. 

“Secretary Kennedy supports renewing the focus on the doctor-patient relationship and encourages individuals to discuss any personal medical decisions, including vaccines, with their healthcare provider,” a Health and Human Services spokesperson wrote to States Newsroom in September. “The American people voted for transparency, accountability, and the restoration of their decision-making power, and that is exactly what HHS is delivering.”

The response did not clarify whether Kennedy still thinks the vaccine is unsafe and what basis there is for that claim. 

Dr. Linda Eckert, a University of Washington School of Medicine professor and practicing OB-GYN, has an extensive background in immunizations and cervical cancer prevention. She served as a liaison for the American College of Obstetricians and Gynecologists to the CDC’s Advisory Committee on Immunization Practices until 2024. Members of the committee were recently dismissed by Kennedy’s agency and replaced by new members, several of whom have reportedly expressed anti-vaccine views. Eckert said the group had plans in motion to present to the ACIP in June a case for administering the HPV vaccine at the earliest age of 9 before it was disbanded. 

Although Black and Hispanic women are affected by cervical cancer at disproportionate rates because of systemic inequities, Eckert said the fastest rising group experiencing late-stage cancer is white women in the Southeast. But she added that Alabama was the first state in the country that launched a targeted campaign to eliminate cervical cancer. 

Treatment for the cancer once it develops can also be difficult to obtain, Eckert said. It can be expensive and require many follow-up visits, and usually leads to infertility either through hysterectomy or invasive radiation treatments. 

“It is a really devastating disease to treat,” Eckert said. “Even if you live, you are permanently changed.”

Recent study showed zero cases of cervical cancer after HPV vaccine 

Dr. Aisha Mays, founder and CEO of a Dream Youth Clinic in Oakland, California, said the services her clinic offers to young people for free includes most of the same services that Planned Parenthood clinics provide, including the HPV vaccine.

“That’s the work of Planned Parenthood and clinics like mine that are encouraging and doing regular Pap smear screenings and vaccines, and having really clear conversations with young people around the importance of these procedures,” Mays said.

The recent turn against vaccines by some segments of the public and members of President Donald Trump’s cabinet who doubt their effectiveness and baselessly claim that they cause injury and developmental issues like autism has made the promotion of HPV vaccines more difficult for Mays. Overwhelming evidence, including from the Centers for Disease Control and Prevention, shows that they are safe and effective.  

The vaccine can also protect against genital warts, anal cancer and oropharyngeal cancer, Mays said. There are about 40 strains of HPV in total that are known to infect the genitals, and more that can attach to certain patches of skin. Most people who have sex will come in contact with one or more of the strains by the time they reach their mid-20s or early 30s.

Mays’ clinic is largely funded by state and local grants, but it received more than $100,000 in federal funding for a sexual health education program through the U.S. Department of Health and Human Services’ Office of Population Affairs. It was a nationally distributed podcast hosted by adolescents, Mays said, and they chose topics to talk about related to sexual health, including HPV.

The program’s grant was one of many that have been cancelled under the Trump administration. An objective laid out in Project 2025, the blueprint document for the next Republican presidency written by conservative advocacy group the Heritage Foundation, was to ensure no subgrantees of sex education programs were promoting abortion or “high-risk sexual behavior” among adolescents. It also stated that any programming should not be used to “promote sex.”

HHS also terminated funding for one of California’s sexual health programs in August over the state’s refusal to remove references in the programming related to gender, including the idea that biological sex and gender identity are distinct concepts. Another directive of Project 2025 was to make sure biological sex is never conflated with gender identity or sexual orientation.

States with high rates of cervical cancer have low density of physicians

States with the lowest incidences of cervical cancer, including Massachusetts, New Hampshire, Connecticut and Minnesota, also have the highest density of physicians per capita. According to the Association of American Medical Colleges’ state physician workforce data, Massachusetts has the highest number of physicians per 100,000 people, and Oklahoma ranks in the bottom three.

Kentucky is in the bottom 15, and so is Indiana, where Marissa Brown works as a Planned Parenthood health center manager in Bloomington. Brown described her clinic as “an oasis in a desert” because there are few options for gynecological care in the area, and even fewer for obstetrics. Brown said they routinely see patients from rural areas two or more hours away, and many of them are coming for wellness exams that include cancer screenings.

Indiana used to have 38 Planned Parenthood clinics, but through 15 years of funding cuts and targeted anti-abortion legislation, the organization closed 21 of them between 2002 and 2017. In the years since then, another seven shut down to consolidate services. Many of them did not provide abortions.

“We hear a lot about patients coming in who can’t get into their gynecologist for four to 12 weeks,” Brown said. “We can do that in a few days to two weeks, and we have walk-in appointments too.”

Health Imperatives, a nonprofit network of seven community health clinics in southern Massachusetts, can no longer bill for Medicaid because they provide medication abortions and received about $800,000 in reimbursements for other services in 2023, like Planned Parenthood. One of Health Imperatives’ clinics is in Martha’s Vineyard, whose working-class residents have to work three to four jobs just to afford to live on the affluent island, said Julia Kehoe, the organization’s president and CEO.

More than a decade ago, she said she noticed a pattern: Their patients would come in for an annual gynecological exam, receive an abnormal cervical cancer screening, but not follow up, because the closest available specialist would require expensive travel off the island. Kehoe said that once their Martha’s Vineyard clinic purchased a colposcopy machine, from privately raised funds, in 2012, they started diagnosing some of their regular patients with now-advanced cancer.

“In the first year that we did colposcopies, we found four individuals who had stage three or four cancer, who we luckily were then able to connect up to Boston for critical care,” she said. “But if we had had that capacity earlier … we would have caught it earlier.”

States Newsroom reproductive rights reporter Sofia Resnick contributed to this report.

Coming Thursday: Telemedicine could help narrow the care gap in rural communities.