A 2024 provision under the Health Insurance Portability and Accountability Act (HIPAA) protects reproductive health information from disclosure to law enforcement when care was legally obtained, such as in another state with abortion access. (Photo by Dave Whitney/Getty Images)

Two pending lawsuits over a 2024 federal rule protecting certain reproductive health information from disclosure are on hold while the Trump administration decides whether to appeal a Texas judge’s June decision that declared the rule unlawful and void.

U.S. District Judge Matthew Kacsmaryk issued an opinion nullifying the federal rule that shielded reproductive health information from law enforcement when care was legally obtained, such as in another state with abortion access. In this case, Dr. Carmen Purl argued that the U.S. Health and Human Services rule conflicted with the laws requiring her to report child abuse. Purl said in court documents she believes abortion and gender-affirming care fall under the definitions of child abuse.

Purl lives in the judicial district where Kacsmaryk — who has taken anti-abortion stances in the past — is the only judge. His ruling applied nationwide and took effect immediately.

Without the rule, law enforcement officials in states with abortion bans may issue subpoenas for records related to reproductive health care obtained legally in another state, as some have already recently tried to do. According to health policy nonprofit KFF, 22 states and the District of Columbia have laws limiting what reproductive health information can be obtained, but others with legal abortion access do not, such as New Hampshire and Virginia.

Abortion-rights advocates say it’s largely an intimidation tactic meant to sow fear in patients and providers. Since the Dobbs decision in 2022,  anti-abortion attorney Jonathan Mitchell filed nine petitions in Texas seeking to legally question abortion funds, providers and researchers, and two individual women who sought abortions in other states, according to the Texas Tribune.

Carmel Shachar, a Harvard law professor who has extensively researched data privacy and health policy, said it’s possible for a patient to travel to a state with legal access and have that information stored in their medical records that is shared with their providers back home.

“Without the reproductive privacy rule, the concern will be, ‘OK, will some of these states that have taken a very strong stance against abortion be able to pinpoint where residents of their states travel to receive abortion care?’” Shachar said.

Tennessee plaintiffs push for separate ruling after Texas decision

Two lawsuits challenging the legality of the rule are frozen at least until the government’s Aug. 18 deadline to appeal. One case is in Missouri, and Texas Attorney General Ken Paxton filed the other. Paxton’s office had also challenged the legality of the underlying privacy rule or HIPAA established in 2000, which could have opened more avenues for state investigations if a judge agreed to throw it out. But according to recent court filings, the state is no longer asking the court to do that.

A Tennessee lawsuit includes 17 other states that heavily restrict or ban abortion as plaintiffs. Their attorneys general asked the court to find the 2024 rule unlawful because they said it impedes their right to investigate cases of waste, fraud and abuse. In the most recent court brief, attorneys for Tennessee Attorney General Jonathan Skrmetti said the case can still be decided by U.S. District Judge Katherine Crytzer, an appointee of Republican President Donald Trump.

Until judgment is affirmed on appeal and no further appellate review is available or the deadline to appeal passes, “the plaintiff states’ claims remain live and ready for this court to resolve,” the brief said.

Legal organization continues attempts to intervene so they can appeal

The Health Insurance Portability and Accountability Act (HIPAA) allows law enforcement to obtain health information for investigation purposes. But the addition of the 2024 provision under former Democratic President Joe Biden prohibited disclosure of protected health information in investigations against any person for the mere act of seeking, obtaining, or facilitating reproductive health care, to impose criminal or civil liabilities for that conduct, or to identify the person involved in seeking or obtaining that care. It also applied to gender-affirming care.

The U.S. Department of Justice did not respond to a request for comment. Whether it appeals Kacsmaryk’s ruling is in question, as the Justice Department under Trump did not address whether it thought the 2024 rule was proper and lawful prior to Kacsmaryk’s decision. Attorneys instead said they were reviewing the rule but had no other updates. In the Missouri and Tennessee cases, DOJ attorneys have argued for dismissal for other legal reasons, but also have not defended the 2024 rule itself.

In March, the DOJ dropped the case that argued the federal law mandating stabilizing emergency care should apply to those who need emergency abortion care. And in early June, U.S. Health and Human Services rescinded guidance that said that care should be required in emergencies.

Attorneys for Democracy Forward, a nonprofit legal organization, are representing Doctors for America and the cities of Columbus, Ohio, and Madison, Wisconsin, and attempted 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.

Kacsmaryk denied their motion, while a decision in the other three cases is pending. Carrie Flaxman, senior legal adviser for Democracy Forward, said they have appealed that denial to a higher court. Given that the Department of Justice attorneys chose not to defend the rule on the merits in court proceedings, Flaxman said, she thinks they have a good argument for appeal.

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

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.”

The seven members of the Wisconsin Supreme Court hear oral arguments. (Henry Redman/Wisconsin Examiner)

In a 4-3 decision, Wisconsin Supreme Court ruled Wednesday that the state’s 1849 law banning abortion had been “impliedly repealed” by the Legislature when it passed laws over the past half century “regulating in detail the ‘who, what, where, when, and how’” of abortion. 

The Court’s majority opinion, authored by Justice Rebecca Dallet and joined by Justices Ann Walsh Bradley, Jill Karofsky and Janet Protasiewicz, finds that the Legislature could not have passed laws regulating abortion access if the 1849 statute was believed to remain in effect. 

“This case is about giving effect to 50 years’ worth of laws passed by the Legislature about virtually every aspect of abortion including where, when, and how health-care providers may lawfully perform abortions,” Dallet wrote. “The Legislature, as the peoples’ representatives, remains free to change the laws with respect to abortion in the future. But the only way to give effect to what the Legislature has actually done over the last 50 years is to conclude that it impliedly repealed the 19th century near-total ban on abortion, and that [the statute] therefore does not prohibit abortion in the State of Wisconsin.” 

Dallet wrote that when the Legislature passed laws restricting abortion under narrower circumstances, guiding “where, when and how” health care providers could perform an abortion and outlining how public money could fund abortion providers, it was repealing the 1849 law. 

The ruling comes three years after the U.S. Supreme Court overturned Roe v. Wade, the landmark Court ruling that found there was a constitutional right to abortion access and marks the conclusion of a legal dispute that helped Protasiewicz win election to the Court in 2023 and Susan Crawford win election this April. 

In response, the Court’s three conservative justices filed dissents, accusing the majority of “propaganda,” “smoke-and-mirrors legalese” and “pure policymaking.” 

“The majority’s smoke-and-mirrors legalese is nothing more than ‘painting a mule to resemble a zebra, and then going zebra hunting. But paint does not change the mule into a zebra,’” Justice Annette Ziegler wrote. “Those in the majority know better, but they do so anyway because they like the result and promised to deliver it.” 

In his dissent, Justice Brian Hagedorn wrote that the majority failed to show when the law was presumably repealed by the Legislature, saying that the opinion doesn’t properly address the Legislature’s actions in 2011 and 2015 amending the 1849 law.  

“The majority does not say when over those 40 years the Legislature once and for all repealed [the statute],” he wrote. “Was it when the Legislature passed a postviability ban? A partial-birth abortion ban? A twenty-week ban? A waiting period? A physician licensing requirement? The majority fails to say.”

23AP2362 Mandate

Following the ruling’s release, the state’s Democratic elected officials and abortion access activists celebrated the decision as a “win” for reproductive health care in the state. 

“Thanks to our lawsuit, today’s decision affirms that access to reproductive healthcare will continue to be available, helping ensure Wisconsin women today are not forced to face firsthand what it’s like to live in a state that bans nearly all abortions, even in cases of rape and incest,” Gov. Tony Evers said in a statement. “Today is a win for women and families, a win for healthcare professionals who want to provide medically accurate care to their patients, and a win for basic freedoms in Wisconsin, but our work is not over. I will continue to fight any effort that takes away Wisconsinites’ reproductive freedom or makes reproductive healthcare, whether birth control, abortion, IVF, or fertility treatments, any less accessible in Wisconsin than it is today. That is a promise.”

Attorney General Josh Kaul, who brought the lawsuit against the law, said at a Wednesday morning news conference that the decision was an important step toward ensuring all Wisconsinites have the freedom to access abortion care, but that the Legislature should step up and further clarify the law.

“I thought we were right on the law. The arguments we made have now been vindicated,” Kaul said. “But at a time when the rights of Wisconsinites and Americans are under threat, this case is a stark reminder of how important it is that we fight for our rights, that we advocate for what is in the best interest of the people of our state, and that we stand on the side of freedom. Here today, we were able to achieve a significant victory for the freedom of Wisconsinites.”

Wisconsin’s state and federal Democratic lawmakers responded to the ruling by saying it wasn’t enough, promising to continue working to codify abortion access in law. 

U.S. Sen. Tammy Baldwin said she will continue to work to enact her proposal to ensure women across the country have access to abortion care. 

“Today’s ruling tells women across Wisconsin that we will not go back,” Baldwin said. “Today’s ruling tells women that our government trusts you to make decisions about your own body and your future. Today’s ruling tells women in our state that they are not second-class citizens. But, this fight is not over. Every woman, in every zip code, in every state deserves the same rights and freedoms. I will not stop fighting until we make that a reality and pass my bill to restore the right to abortion nationwide and allow women to make their own health care decisions without interference from judges or politicians.”

State Sen. Lisa Subeck (D-Madison) said the Legislature must now pass a bill guaranteeing the right to an abortion. 

“Now that the courts have made it clear that Wisconsin does not have a total abortion ban, we must go further,” Subeck said. “It’s time to protect reproductive rights not just in practice, but in law. We must pass the Abortion Rights Restoration Act to guarantee the right to abortion and eliminate the medically unjustified, politically motivated restrictions that still exist in our state statutes. The people of Wisconsin deserve nothing less than full access to safe and legal reproductive health care without unnecessary barriers and free from judgement.”

In a concurring opinion, Karofsky wrote that interpreting the 1849 law as banning abortion gives the state the authority to “exert total control” over women and “strips women and pregnant people of the dignity and authority to make intimate and personal choices by exposing medical professionals who perform abortions to 15-year prison terms.” 

In her opinion, Karofsky details the history of abortion access in the U.S. and highlights four women who died because of restrictive abortion bans, including the recent deaths of two Black women in Georgia and a Honduran immigrant in Texas as well as the death of her own great-grandmother in Boston in 1929. 

“I tell the stories of Amber, Candi, Josseli, and my great-grandmother Julia to remind us that severe abortion restrictions operate like death warrants,” Karofsky wrote. “Under such restrictions women, children, and pregnant people are denied life-saving medical care while medical professionals are forced to sit idly at their bedsides, unable to do their jobs. Extreme abortion restrictions revive a time in our history driven by misogyny and racism, divorced from medical science; it is a world that must be left behind.” 

In her dissent, Justice Rebecca Bradley accused Karofsky of rewriting history to achieve a desired outcome in the case. 

“Not content with effacing the law, Chief Justice Jill Karofsky rewrites history, erases and insults women by referring to mothers as ‘pregnant people,’ slanders proponents of the pro-life perspective, and broadcasts dangerously false narratives about laws restricting abortion,” Bradley wrote. “Laden with emotion, steeped in myth, and light on the law, the concurrence reads as a parody of progressive politics rather than the opinion of a jurist.”

Rachel Castor, a single mom of two and teacher, stands outside her home in Sandpoint, Idaho. Castor’s son could not be admitted to the local hospital during an asthma attack because Bonner General Health lost its pediatrician coverage at the same time it closed the labor and delivery unit in 2023 following the Dobbs decision. (Photo by Erick Doxey for States Newsroom)

Editor’s note: This report examines the impact of the U.S. Supreme Court decision that struck down the federal right to abortion three years ago.

Of all the outcomes Rachel Castor could have predicted from Idaho’s abortion ban, her teenage son being denied hospital admission during an asthma attack wasn’t on the list.

Bonner General Hospital in Sandpoint announced its decision to end obstetric services in March 2023, roughly six months after the near-total ban took effect. Among the stated reasons were the state’s legal and political climates concerning health care, and the loss of pediatrician staffing.

Castor saw the fallout from that decision on a night in early April. Her 17-year-old son spent several hours in the Bonner General emergency room, before the staff informed her if his breathing didn’t improve enough for discharge by the morning, he would need to be transferred an hour south to the hospital in Coeur d’Alene. Bonner General had no pediatricians.

“And I was like, ‘Excuse me?’” Castor said.

Elaine Gloeckle, a 66-year-old Boise resident, said she started having trouble with urinary tract infections and hormonal balances recently and found it hard to get an appointment to see a specialist, even with a referral. It was even more difficult to see a doctor for gynecological care. That wasn’t always the case in the more than 30 years she’s lived in the area — she used to have no trouble seeing doctors.

But now for the gynecology visits, along with care for diabetes management and kidney issues, she has seen physician assistants, who are supervised by the doctors within a practice. While she has had good experiences with the assistants, it’s sometimes difficult to feel confident in their assessments when she isn’t sure how much they are consulting with doctors. And the wait times are still long — at least six weeks, usually, in her experience.

“I have no idea who the doctors are, I’ve never met them,” Gloeckle said. “And I don’t know if that means anything, or if it’s just peace of mind that there is a doctor in the mix.”

It’s been three years since the U.S. Supreme Court issued the Dobbs ruling that ended federal abortion protections and allowed more than a dozen states to implement abortion bans. States that were already struggling with physician shortages say they’re getting worse, especially in rural areas, where many labor and delivery units have also closed their doors. Clinics have closed and resources become more strained with every passing year.

Patients and providers have been left to adjust to barriers accessing abortion care; legal battles that continually redraw access lines; and heartbreak and tragedy as women die from easily treatable conditions like miscarriage and infection.

In places like Florida, Kansas and Louisiana, patients have had to find other providers who will help them with miscarriage complications, often requiring them to travel to a neighboring state with legal access because doctors in states with bans are afraid to see them. Other patients experiencing miscarriage or the threat of miscarriage have reported waiting hours in emergency rooms to be seen while hospital staff consult with attorneys about their legal exposure before taking any action. A Florida Republican lawmaker who opposes abortion said recently that she waited hours to receive treatment for an ectopic pregnancy, which is dangerous and nonviable.

Besides Texas, few states that implemented abortion bans after Dobbs have been as much of a spectacle as Idaho. Between a so-called “abortion trafficking” law that first passed in Idaho, the very public loss of many OB-GYNs and maternal-fetal medicine specialists, and a legal fight with the federal government over whether abortions should be permitted in emergencies — a lawsuit that made its way before the U.S. Supreme Court — the state has been a testing ground of sorts for how a near-total abortion ban can play out for communities.

Many health care providers and advocates warned it wouldn’t just be abortion care, or even pregnancy-related care, that would be affected by the Dobbs decision. Dr. Stacy Seyb, a maternal-fetal medicine specialist in Boise, said in July 2023 that the near-total ban would lead to more consequences as time went on.

“It feels like a step backward in improving the health of women and children in the state,” he told The Guardian. Soon, he warned, the state would “see a collapse in women’s health care.”

‘It makes me wonder what else we’ve lost that we don’t know about’

Bonner General Health’s obstetrics unit was one of many rural hospitals that was already struggling before Dobbs with changing community demographics that meant lower birth rates and difficulty recruiting and retaining physicians. Among its population of about 10,000, the hospital admitted fewer than 10 pediatric patients in 2022 and delivered 265 babies, a decrease from prior years.

It’s a familiar situation nationwide. More than 100 hospitals across 26 states have closed labor and delivery services since 2020. To be sure, the reasons for those closures include many more factors than abortion bans, such as low reimbursement rates from Medicaid programs for obstetrical services and difficulty recruiting and retaining physicians.

In its announcement, Bonner General representatives said they tried to recruit active and retired pediatrics providers in the area, but no long-term sustainable solutions were available.

At that time, it didn’t sink in for Castor that having no pediatrician coverage at the hospital would mean no admission to the hospital for minor children.

Sandy Brower, director of quality and risk management at Bonner General Health, told States Newsroom via email that their staff is well-equipped to see pediatrics patients, who are always seen, treated and stabilized in the emergency department. But she confirmed that the hospital does not admit minors because they have no pediatricians on staff.   

“This approach is not unusual in rural health care,” Brower said. “Around the country, critical access hospitals often rely on stabilization and transfer protocols to ensure that patients …  are seen in the most appropriate setting.”

Faced with the prospect of driving her son to Coeur d’Alene herself or guessing what a 44-mile ambulance ride might cost, Castor — a single mom of two and a teacher — decided to drive to the hospital she’d never been to before. But with little information to go on about the transfer process, she was left wandering around the hospital looking for the right place to go while her son’s condition deteriorated.

“He’d already been away from the hospital for an hour for the drive, and he was starting to not do OK, and it was really stressful because I didn’t know what we were supposed to do,” Castor said. “He had his arms wrapped around himself and he just didn’t look good.”

Once she found her way, Castor said everything went well and they were discharged after one more night. But she was left shaken by the experience and her sense of stability about where she lives. She shares custody with a former partner who lives nearby, so it’s difficult to consider moving.

“I think everyone at the hospital is lovely, but it does seem like we don’t have all the services we need,” Castor said. “It makes me wonder what else we’ve lost that we don’t know about.”

Physician recruitment difficult for pediatrics in populous areas too

Amid the implementation of the abortion ban, Idaho’s population exploded. Between 2020 and 2024, more than 152,000 people moved in and the total number crossed 2 million statewide for the first time in its history. On top of all that, at least three clinics that provided labor and delivery services closed, including two in the Boise area, the most populous portion of the state. The combination created longer wait times and more complicated staffing scenarios.

Christine Myron, spokesperson for Idaho’s largest health care system St. Luke’s, told States Newsroom via email that the time to get an appointment with an OB-GYN has increased over the last two years in all of their service areas, which include every region of the state.

Myron also said in recent weeks, a candidate for a pediatrician position declined their offer because of the restrictive obstetrical care environment in Idaho. She said the difficulties in recruiting extend to every specialty of physicians because young families hesitate to move in.

As of Wednesday, St. Luke’s had 10 pediatric physician vacancies, including specialists for pediatric nephrology, oncology, infectious disease and endocrinology. 

Shifting providers, delays frustrating while trying to conceive

For women like Cynthia Dalsing, who has lived in Sandpoint for more than 30 years, it’s difficult because of her age and location. She is 71, and a recent exam showed a polyp in her uterus that needed to be biopsied and removed. That type of exam and procedure could have been done 3 miles away from her house a few years ago, she said, before Bonner General closed its labor and delivery services.

Instead, she drove back and forth to Coeur d’Alene to complete pre-operative steps, including X-rays, blood work and an EKG, then to have the procedure, then to go back again to talk about the results.

“It’s taken weeks to get care that normally would be pretty routine,” Dalsing said. “It’s a 20-minute procedure.”

The procedure was dilation and curettage, Dalsing said, often referred to as a D&C, which is the same treatment sometimes used for an early abortion or miscarriage where pregnancy tissue needs to be removed from the uterus. When she mentioned the upcoming appointment to a friend, Dalsing said they asked if that was still allowed, given the abortion ban, not knowing it’s a common procedure for many other conditions.

“That’s how clueless and confused people are about all this,” Dalsing said. 

Younger women like 36-year-old Danielle Young, who has lived in Boise since the early 2000s, report issues receiving care as well. Young said since 2016, she has switched providers five times because they kept leaving — three of those were within the past three years.

Young said she had to wait eight months for an annual gynecological wellness appointment with a nurse practitioner, and when the time came, the exam felt rushed and chaotic. After that, she decided to switch practices. Young said it took another six months to be seen by the doctor she chose, but it has been worth the wait.

At the same time, Young said she and her husband are trying to conceive, and he has had difficulties finding a clinic where he can get fertility testing. She said most of the past year has been wasted just trying to reach someone on the phone who can tell them where he should go and when he can get an appointment.

“It’s been frustrating for us, because we would like to have children or a child, and I’m getting older,” Young said.

Former Democratic President Joe Biden’s administration added the 2024 rule prohibiting disclosure of protected reproductive health information for criminal, civil or administrative investigations to the Health Insurance Portability and Accountability Act or HIPAA. (Connect Images for Getty Images)

A 2024 federal rule that shielded reproductive health information from disclosure to law enforcement when care was legally obtained, such as in another state with abortion access, was struck down by a federal judge in Texas on Wednesday evening.

U.S. District Judge Matthew Kacsmaryk of Texas’s decision applied nationwide, nullifying the rule immediately. Kacsmaryk had temporarily blocked its enforcement against Dr. Carmen Purl, who sued HHS because she said the rule created a conflict with the laws requiring her to report child abuse.

“Striking down this critical rule is cruel,” said Maddy Gitomer, senior counsel at Democracy Forward, in an emailed statement. “The 2024 HIPAA Privacy Rule has helped protect pregnant people and health care providers from invasive government intrusion into private medical information.’’

The rule did not allow disclosure of protected health information for criminal, civil or administrative investigations against any person for the mere act of seeking, obtaining, or facilitating reproductive health care, to impose criminal or civil liabilities for that conduct, or to identify the person involved in seeking or obtaining that care. It also applied to gender-affirming care.

Two other cases challenging the same rule are still pending in federal courts in Tennessee and Missouri, but it’s unclear what  Kacsmaryk’s decision means for those cases, or another Texas lawsuit led by Attorney General Ken Paxton that also seeks to strike down a broader 2000 privacy rule.

Former Democratic President Joe Biden’s administration added the rule to the Health Insurance Portability and Accountability Act, a 30-year-old federal law meant to protect patient health information, especially when that information travels between providers. The law contains exceptions for when information can be disclosed to investigators, who can subpoena records for a law enforcement matter. After the 2022 Dobbs decision returned abortion regulation to the states, prompting more than a dozen to pass abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Lauren Paulk, senior research counsel for If/When/How, a nonprofit that provides legal support for reproductive health care, told States Newsroom on Wednesday evening that people are still protected by the federal HIPAA law, including the foundational 2000 privacy law that requires certain procedural steps to be met before records can be subpoenaed. The 2024 rule was meant to provide reassurance to patients who are afraid to seek abortion or gender-affirming care, even where it is legal, by specifically exempting those records.

Kacsmaryk’s decision, she said, will erode trust between patients and providers and potentially damage that relationship. And it could be a sign of more actions to come.  

“There’s a laundry list of things that I think could start to be added here whenever the courts are saying there really aren’t protections for private reproductive health information,” Paulk said.

Democracy Forward, a nonprofit legal organization, filed a filed a motion to intervene earlier in the case on behalf of the cities of Columbus, Ohio, and Madison, Wisconsin, because attorneys said they no longer had faith that the U.S. U.S. Department of Health and Human Services would adequately defend the law under Republican President Donald Trump’s administration. Kacsmaryk denied that motion to intervene, and Democracy Forward appealed that decision to the 5th U.S. U.S. Circuit Court of Appeals. That appeal is pending.

“Vacating this regulation will be detrimental to the privacy rights of pregnant people across the country, and will interfere with the ability of healthcare providers and patients to communicate confidentially and openly about a patient’s health needs,” Gitomer said.

Gitomer said Democracy Forward will continue to explore all of its options to defend reproductive rights from “political interference and anti-abortion extremists.”

Conservative law firm Alliance Defending Freedom represented doctor in Texas judge’s district

Purl is the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas. In court documents, she said:

“I consider both a pregnant woman and her unborn child to be human persons, and both are entitled to medical care and deserve the protection of the law. I believe … that elective abortions harm patients’ health and public health.”

The location of Purl’s clinic put her in Kacsmaryk’s district, where he is the only judge. Most federal cases are assigned randomly to a group of judges in a district, but since Kacsmaryk, a Trump appointee, is the sole jurist, some advocates and attorneys have accused law firms like Alliance Defending Freedom, who is representing Purl in the case, of “judge shopping.” That phrase refers to finding a plaintiff in a certain area for the purpose of putting it in front of an ideologically friendly judge.

In an earlier high-profile case, Kacsmaryk attempted to order the U.S. Food and Drug Administration to rescind its decades-old approval of mifepristone, one of two drugs used to terminate early pregnancies and treat miscarriages. That decision was eventually returned  by the U.S. Supreme Court to a lower court for consideration.

Officials in Texas have already attempted to investigate women who left the state, which has a near-total abortion ban and other abortion-related laws, to terminate a pregnancy.

In a 65-page opinion, Kacsmaryk said the U.S. Department of Health and Human Services’ leadership under Biden “invoked HIPAA as a shield against abortion-restrictive states.” He determined the rule unlawfully limited disclosures about abuse and public health to state authorities, and said it exceeded statutory authority because it employed HIPAA to impose special rules for abortion. Such action should only be taken by Congress, he said, especially because the issues at hand are of major political significance.

“People of good faith vehemently disagree on both these issues,” Kacsmaryk wrote, referring to abortion and gender-affirming care. “These issues transcend politics, implicating anthropology, philosophy, and concepts of self. … The 2024 rule creates special rules for information about these politically favored procedures that implicate fundamental and hotly debated questions.”

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.”

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule.

Dr. Eve Espey has many stories she can tell about patients who travel to her clinic in New Mexico from their homes in Texas, where abortion laws are some of the most restrictive in the country.

In one recent case, Espey said a patient flew from Texas to Albuquerque for an abortion after her doctor advised that an autoimmune disease she has made being pregnant incredibly dangerous. At the same time, she had an IUD placed as future contraception.

Shortly after returning home, the patient had some cramping and discomfort that prompted her to have the placement of the IUD checked and make sure it hadn’t moved. But her doctor turned her away because she’d had an abortion.

“She flew back to New Mexico to get her IUD examined,” Espey told States Newsroom.

In this case, Espey’s patient voluntarily told her doctor that she’d had an abortion. But if a rule exempting reproductive health information from law enforcement investigations is struck down or altered by one of three federal cases brought by Republican attorneys general from more than a dozen states, that information could become mandatory to disclose.

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule under the Health Insurance Portability and Accountability Act (HIPAA), including a case in Texas before the same judge who tried to revoke government approval of an abortion drug.

The plaintiffs in the cases, which include 17 states that heavily restrict or outright ban abortion, say the rule undermines their state rights to investigate waste, fraud and abuse. Chad Kubis, spokesperson for Tennessee Attorney General Jonathan Skrmetti, told States Newsroom via email that the office could not comment because of the ongoing litigation. But the complaint in the case led by Tennessee said, “The final rule will hamper states’ ability to gather information critical to policing serious misconduct like Medicaid billing fraud, child and elder abuse, and insurance-related malfeasance.”

HIPAA is a federal law passed nearly 30 years ago to protect the privacy and security of patient health information, especially as that information travels between clinics in an increasingly all-digital world. It includes some exceptions under limited conditions, such as law enforcement investigations. After the 2022 Dobbs decision returned abortion regulation to the states, prompting more than a dozen to pass abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Former Democratic President Joe Biden’s administration sought to remedy those concerns by adding a rule to the HIPAA law in 2024 restricting disclosure of the information. Meanwhile, states with legal abortion passed their own shield laws to protect providers and patients from out-of-state investigations.

In New Mexico, doctors like Espey are protected by a shield law that covers patients, providers and those who help someone obtain an abortion. Even with that, Espey worries and makes sure she’s careful with the notes she puts into writing. Lawmakers in New Mexico have considered going further with the shield law to require patient consent for any release of reproductive health records, but that could become an issue in emergencies.

“That is a colossal barrier to a provider,” Espey said. “Somebody could come into the ER and you can’t access the fact that they had an abortion two days ago.”

Lauren Paulk, senior research counsel for If/When/How, a nonprofit that offers legal support to those seeking reproductive health care, said the rule is important to keep intact because it helps patients and providers feel safe. Without it, more people will be turned away from clinics and hospitals, she said.

“Since Dobbs, there have been documented cases of at least seven people who have died in part because they were afraid to seek care or were denied care. We know that patients see these stories too,” Paulk said. “We also run a help line, so we hear people calling in every day who are scared to seek health care.”

For many years, people have considered health privacy to be a basic right, Paulk said, and have taken it for granted that when they see a doctor, the information shared will be confidential. But she said it’s vital that it stays that way.

“Having the state involved in health care poisons the well of the patient-provider relationship,” Paulk said. “When I go to my health care provider and I can’t be frank with them, it means I’m not going to get care to the extent that I need.”

Since Republican President Donald Trump’s administration took office in January and Secretary Robert F. Kennedy Jr. is now at the helm of U.S. Health and Human Services, the agency that administers the rule, the suits have become more complicated, including how the government is responding to each case.

They are:

State of Missouri v. U.S. Department of Health and Human Services: Republican Missouri Attorney General Andrew Bailey filed this lawsuit in January, claiming that the rule infringes on state powers to investigate fraud, abuse and public health violations. U.S. District Judge John A. Ross, who was appointed by former Democratic President Barack Obama, is weighing the Trump administration’s request to dismiss the case for lack of standing. 

State of Tennessee v. HHS: Republican Tennessee Attorney General Jonathan Skrmetti filed this lawsuit in January, also claiming that the rule infringes on state powers of investigation. Republican attorneys general in 14 other states joined as plaintiffs. U.S. District Judge Katherine A. Crytzer, an appointee of Republican President Donald Trump, has been asked by the Trump administration to dismiss the case for lack of standing or grant the states’ request to block the rule. 

Purl, M.D. v. HHS: Dr. Carmen Purl, the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas, sued in October because she said the rule creates a conflict with the laws requiring her to report child abuse. The case is before U.S. District Judge Matthew Kacsmaryk, an appointee of Republican President Donald Trump. Kacsmaryk granted a preliminary injunction, but is expected to rule soon on a permanent injunction. 

State of Texas v. HHS: Republican Texas Attorney General Ken Paxton sued in September, claiming the 2024 rule violates state investigative authority. Paxton argued the underlying 2000 HIPAA rule should be struck down as well — a move that could open many more avenues for state investigations if it is granted. U.S. District Judge James Wesley Hendrix, a Trump appointee, has given the federal health agency two extensions of time to decide whether they want to rescind and rewrite the rule.

The judges presiding over the cases in Missouri and Tennessee, as well as the Purl case in Texas, could issue decisions at any time Missouri filed its lawsuit alone, while 14 other states with Republican attorneys general joined Tennessee’s lawsuit as plaintiffs: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Louisiana, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota and West Virginia. All but three of those states either heavily restrict or outright ban abortion, and if the lawsuits are successful, records kept by doctors and pharmacists in other states could be subpoenaed.

If the underlying 2000 HIPAA privacy rule is somehow altered by court rulings in Texas, it could have even more effects, Paulk said. If/When/How receives phone calls from therapists living in states with abortion bans who are afraid of facing criminal charges just for talking about abortion with a patient, or for not reporting a person considering an abortion to the police, she said. That’s not true under existing laws, but if privacy rules change, records like therapy notes could also be subject to investigation.

“It’s clear to me that the folks who are pursuing the overturn of these laws and the folks who are in states where they’re trying to get access to health information are seeking to criminalize people and further stigmatize health care like abortion and gender-affirming care,” Paulk said. “They want people to be afraid to access care and providers to be afraid to provide it, and they’re using this specter of punishment to do that.”

DOJ asked two courts to dismiss Republican-led lawsuits

Democracy Forward, a nonprofit legal organization, is representing the cities of Columbus, Ohio, and Madison, Wisconsin, and Doctors for America, and has attempted to intervene in all four cases — Kacsmaryk denied the request, but the other three are still pending. If any of the motions are granted, attorneys for Democracy Forward could defend the rule, because they do not think the DOJ attorneys will adequately defend it, said Carrie Flaxman, the nonprofit’s senior legal adviser.

The cities and Doctors for America filed a friend-of-the-court brief after Kacsmaryk’s denial, arguing that HIPAA is vital to protecting patient confidentiality, including the 2024 rule.

At the end of March, Trump’s Department of Justice attorneys asked the federal courts in Missouri and Tennessee to dismiss the cases for lack of standing, saying the states have not demonstrated any harm.

“Missouri’s complaint vaguely alleges that the rule impedes state investigations and requires the state to expend resources to comply with the rule’s requirements,” the motion to dismiss says. “But absent from the complaint are any concrete facts supporting these conclusory assertions of harm, which one would expect to see if the rule truly posed the risks that the state alleges.”

In Texas, Kacsmaryk ordered the Department of Justice to provide an update about the health services agency’s review of the Biden-era rule in May, and asked if they wished to pause the court proceedings while they conduct that review. Acting Assistant Attorney General Yaakov Roth told the court in a brief that the rule remains “under consideration” but no imminent action on the rule is expected. He added that they were not requesting any pause in the case.

That response differed in Paxton’s suit, which was already on hold. DOJ attorneys asked for more time to “evaluate the agency’s position in this case and determine how best to proceed.” The judge granted the extension, and another update is expected in July.

“Blocking either or both of these rules could pave the way for government investigations by Attorney General Paxton or others and threaten the foundations of medical privacy that we all rely on,” Flaxman said. “Patients nationwide should be concerned about investigations … into the most personal of their medical records.” 

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. 

Barbara Collura, CEO and president of Resolve: The National Infertility Association, spoke outside the Alabama Statehouse in Montgomery on Feb. 28, 2024, after a court decision likening embryos to people led fertility clinics to halt services. (Photo by Brian Lyman/Alabama Reflector) 

Republican President Donald Trump, who called himself the “father of IVF” on the campaign trail, issued an executive order in February directing policy advisers to create a report on how to make in vitro fertilization more accessible for Americans.

“Today, many hopeful couples dream of starting a family, but as many as one in seven are unable to conceive a child,” the order read. “Despite their hopes and efforts, infertility struggles can make conception difficult, turning what should be a joyful experience into an emotional and financial struggle.”

Trump gave domestic policy officials a 90-day deadline to send him a list of recommendations on how to protect access to IVF and reduce out-of-pocket costs for fertility care.

Leaders at the American Society for Reproductive Medicine and Resolve: The National Infertility Association — leading IVF advocacy groups — told States Newsroom they were not consulted by the Trump administration about the IVF plan.

“We’ve been leading the effort for over a decade and passed legislation in state after state that now has improved coverage for 60 million Americans,” said Sean Tipton, American Society for Reproductive Medicine’s chief advocacy and policy officer. “We clearly have the expertise to be of assistance, but they didn’t want to talk to us.”

Resolve President and CEO Barbara Collura said the administration did not consult her organization, either.

The White House did not immediately respond to a request for comment.

Both Collura and Tipton said they hope the administration will call for expansion of IVF insurance coverage for servicemembers, veterans and other federal employees.

Collura said the U.S. Office of Personnel Management can require health insurance plans to offer comprehensive IVF coverage, the U.S. Department of Health and Human Services could declare IVF an essential health benefit through the Affordable Care Act and the U.S. Department of Defense could mandate coverage under Tricare. Members of the military can only get IVF covered today if they prove infertility stemmed from combat duty.

“The Veterans Health Administration also does not offer IVF as routine care, and we want to change that, but we believe that that has to be done through Congress,” she said.

Congress would also have to direct private insurers to mandate IVF coverage. Trump first raised this idea in August during a Wisconsin town hall, but NBC News reported that GOP members of Congress were skeptical of the costs.

Republicans on Capitol Hill are focused on passing a “big, beautiful bill” that includes tax cuts for the wealthy and a massive decrease in Medicaid funding, according to our D.C. Bureau. It’s unclear if Congress would be open to insurance coverage mandates.

The Trump administration laid off health care researchers and other government employees this year. HHS fired its six-person Assisted Reproductive Technology team in April. 

The advocates are also wary of a faction of conservatives who have pushed a concept called “restorative reproductive medicine,” the notion that providers should treat the root causes of infertility through hormonal therapies, testing and nutrition, and turn to IVF as a last resort.

“It’s a political term backed by political groups that has nothing to do with medicine,” Tipton said. “When you look at the details, it sounds a lot like what our clinicians would refer to as the diagnostic workup for infertility patients, but make no mistake, this is a term that is pushed by groups who oppose IVF.”

Officials at the Heritage Foundation, a conservative think tank, have backed restorative reproductive medicine. Emma Waters, a policy analyst at the foundation’s Center for Technology and the Human Person, cowrote a report released in March backing the concept and calling for increased regulation of the infertility industry.

Janae Stracke, the vice president of Heritage Action, the foundation’s advocacy arm, praised a law Arkansas passed in April requiring the use of fertility awareness-based methods — checking body temperatures and cervical fluid levels to track menstrual cycles — in Title X programs.

“The RESTORE Act is groundbreaking legislation that champions reproductive healthcare for women in Arkansas by prioritizing restorative reproductive medicine and empowering women with the tools they need to thrive,” Stracke said in a statement. 

Little Rock-based Arkansas Fertility and Gynecology has a header at the top of its website warning against restorative reproductive medicine, saying it’s “not a medically proven alternative to IVF.” 

Collura said she fears restorative reproductive medicine could grow in popularity and lead insurance companies to mandate that patients try it before getting approved for fertility treatments.

“That bypasses what the diagnosis is. Reproduction is time-based: The longer you wait, the poorer outcomes you have,” she said. “We certainly don’t want people to be forced into certain treatments that are actually not going to help them.”

Dr. Karenne Fru, a reproductive endocrinologist at Muna Fertility in the Atlanta area, said proponents of restorative reproductive medicine misunderstand what physicians do, and doing tests for patients seeking fertility services is a basic standard of practice.

“It is not a cure-all for someone with a total sperm count of, say, 100,000 or an absent vas deferens — the sperm can’t get out. There’s no way you can exercise, eat right, sleep well and fix that. That is how you’re born,” Fru said.

Her state just passed a law protecting IVF, but she said that conflicts with Georgia’s fetal personhood language in the six-week abortion ban that allows prospective parents to claim fetuses on their income taxes. Fru testified before state lawmakers in March during a hearing for a bill that would have banned all abortion and jeopardized fertility care, Georgia Recorder reported.

Trump’s promises about IVF insurance coverage have led some of her patients to postpone their reproductive plans, she said.

“There are a lot of patients who are delaying care because they think that the president is going to make IVF free,” she said. “And I think that playing with people’s hopes and dreams in this way is unnecessarily cruel.”

“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.