WASHINGTON — Republicans celebrated last year when they barred Medicaid payments from going to Planned Parenthood for one year, predicting the financial impact would hollow out the organization. 

A year later, with that section of the “big, beautiful” law set to expire July 4, GOP lawmakers are trying to find a way to keep the nationwide prohibition in place, though they won’t be able to accomplish that before the deadline. 

That means states will now determine whether people enrolled in the program for lower-income individuals can, once again, get routine healthcare services from the Planned Parenthood clinics that remain open.  

Nora Walsh-DeVries, vice president of political and legislative affairs at Planned Parenthood Action Fund, said the law forced the organization to close nearly 30 of its healthcare centers.

“The impact is really horrible for us and some of it is unfortunately irreversible,” she said. “And it’s tough to try to deal with what’s happened in this past year, kind of also knowing that there is an intention from Republicans to permanently defund us.”

Some Planned Parenthood clinics, she said, tried to find ways to keep treating Medicaid enrollees, but ultimately that was “unsustainable” and not something every affiliate could manage. 

The result meant “tens of thousands of patients have been denied access to basic care services like cancer screenings, which I think we can all agree is something we should want people to get when they need it, where they need it, how they need it,” Walsh-DeVries said. 

The impact was ultimately less widespread than Planned Parenthood originally predicted, when its president said in a statement just days before the law took effect that “nearly 200 Planned Parenthood health centers in 24 states across the country are at risk of closure.”

The expiration won’t have an impact on abortion access for Medicaid enrollees, since a decades-old rider on government spending bills, which blocks taxpayer dollars from going to abortion with limited exceptions, remains in place. 

Republicans view the closures as a victory and are trying to renew the provision in an attempt to shutter more Planned Parenthood clinics. They believe any healthcare organization that provides abortions, even if those largely aren’t covered by taxpayer dollars, shouldn’t be included in any federal health programs. 

Pressure from conservatives

The House Freedom Caucus, a collection of far-right Republicans, wrote to Speaker Mike Johnson in late June, pressing him to include a similar prohibition in another party-line bill. 

“The American people rightfully expect a Republican-led Congress to deliver real results, not excuses or half-measures,” they wrote. “After years of broken promises, voters have entrusted us with majorities in both the House and Senate. This is our last and best chance to prove they were right to send us here to fight for them.”

They added that another reconciliation bill must prohibit “federal funding for abortion providers to ensure that taxpayer dollars are not being used to subsidize the radical abortion industry.”

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser and other anti-abortion organizations are lobbying Republicans to again block Medicaid funding from going to Planned Parenthood.

“Defunding Big Abortion is now the default expectation of the pro-life movement,” Dannenfelser wrote in a statement. “When they return to D.C., Republicans must do all they can through reconciliation to once again block taxpayer dollars from Planned Parenthood and abortion businesses.”

Republicans used the complex budget reconciliation process to enact their “big, beautiful” law and the $70 billion package to fund immigration enforcement. The special process allowed GOP leaders to get around procedural votes in the Senate that would otherwise require bipartisanship as long as each provision has an impact on federal revenues or spending that is not deemed “merely incidental” by that chamber’s parliamentarian.

Strained system

Subasri Narasimhan, research director at the Center on Reproductive Health, Law, and Policy at UCLA Law School, said there often aren’t other health centers to cover the gaps left when a Planned Parenthood closes or is no longer reimbursed for treating a Medicaid enrollee. 

“We have a pretty strained healthcare system in so many different respects, but we’re looking at an extremely strained system when it comes to reproductive healthcare,” Narasimhan said. 

Some state governments, she said, tried to cover the budget holes created during the last year, though ultimately weren’t able to fully replace the loss of federal funding. 

Republicans reinstituting the same prohibition on Medicaid payments for non-abortion healthcare services, she said, would likely lead more people on the program to delay or skip preventative care altogether. 

“We’re looking at folks who are quite vulnerable and often use Planned Parenthood as their primary source of care,” she said. “And so there’s no option to look for another health center.”

Kathleen Adams, professor in the Rollins School of Public Health at Emory University, said that if a program can vary state to state, it will, and this was no exception. 

“What I’m seeing is the states are finding emergency funds, other ways to channel funds to Planned Parenthood to sort of keep that part of their system active,” she said. 

There are also other programs and clinics, like federally qualified health centers and safety-net providers, that Adams said could play a part in filling some of the gaps.

“I don’t lose heart so much as we might otherwise about these provisions to Planned Parenthood because states are aware of these issues,” she said. “And if they don’t provide access to contraceptives, they’re more likely to get unintended pregnancies, or pregnancies amongst uninsured women.”

State action

Laurie Sobel, associate director for Women’s Health Policy at KFF, wrote in a post that after the nationwide moratorium expires, a Supreme Court ruling from late June 2025 will allow state governments to block certain healthcare providers, like Planned Parenthood, from participating in their Medicaid programs. 

“This ruling marked a significant departure from longstanding interpretations of the Medicaid ‘free choice of provider’ provision, which guarantees enrollees the right to obtain care from any qualified and willing Medicaid provider,” Sobel wrote.

Alabama, Arizona, Arkansas, Florida, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina and Texas have either blocked or tried to block Medicaid reimbursements to Planned Parenthood, according to Sobel’s analysis.

Other states, she wrote, “may follow suit” once the nationwide Medicaid prohibition expires July 4.

A spokesperson for U.S. Health and Human Services confirmed to Stateline on Friday that the agency is canceling 53 out of 67 grants, worth about $68 million, under the Teen Pregnancy Prevention Program, affecting grantees in more than two dozen states.

A list obtained by Stateline of canceled grants includes those awarded to universities, community organizations, city and state health departments and Planned Parenthood affiliates in states such as Arizona, Montana, Michigan, Texas and West Virginia. The grants were canceled two years before their expiration dates because the programs did not align with agency priorities, according to one of the grantees who received a termination notice.

The program is part of the agency’s Office of Population Affairs and is a “national, evidence-based grant program that funds diverse organizations working to prevent teen pregnancy across the United States,” according to the HHS website. The agency provides funding to programs that develop and evaluate innovative approaches to prevent teen pregnancy as well as to prevent sexually transmitted infections among adolescents, and to promote positive behaviors.

Ayana Bradshaw, president and CEO of AccessMatters in Philadelphia, told Stateline her organization received the termination notice of its $1.2 million grant on Friday, and it was effective the same day. Bradshaw said the letter cited a misalignment with agency priorities, specifically that the program “normalizes or promotes sexual activity for minors.”

AccessMatters’ Adolescent Health Initiative is entirely funded by the federal grant and provides free sexual and reproductive health programs to more than 1,100 teens between the ages of 13 and 19. The program provides information, education and referrals for healthcare as needed.

“This is devastating for the youth that we serve,” Bradshaw said. “It also impacts us as an organization, our staff, and it impacts the partners that we had who supported us in implementing this program.”

During the first administration of President Donald Trump in 2017, HHS took the same action, ending grants for more than 80 recipients two years before they were set to expire. Legal advocacy organization Democracy Forward sued the administration on behalf of several grantees and won a permanent injunction after courts ruled the action violated agency regulations.

The Trump administration identified the teen pregnancy program as one to cut in its 2025 budget request, and it was included in the final 2026 appropriations bill. The language accompanying that bill said grants for sexual risk avoidance must use medically accurate information and teach youth about risky behaviors “without normalizing teen sexual activity.”  

Teen birth rates have fallen dramatically in the past 20 years, according to federal Centers for Disease Control and Prevention data — about 72% since 2007. Experts attribute that decline to fewer teens deciding to have sex earlier, sex education and better access to contraception, especially for girls. 

The agency also released two new grant programs this week, one of which is titled “Replicating Effective Teen Pregnancy Prevention Programs,” with $63.4 million available to be awarded. The other is “Rigorous Impact Evaluation of Programs to Prevent Teen Pregnancy and Achieve Optimal Health,” with $8.3 million available.

Both opportunities tell applicants that they must pass an alignment review process to ensure they meet agency priorities. That language mimics Trump administration language in the 2027 Notice of Funding Opportunity for Title X grants, which a national family planning organization filed a lawsuit over last week, arguing that it violates Congress’ intentions and administrative procedure.

Tara Mancini, director of public policy at reproductive health advocacy organization Power to Decide, said she expects the administration’s decision to cancel the grants to be challenged again in court.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

WASHINGTON — U.S. Senate Republicans approved a budget resolution early Thursday intended to speed the way for billions for immigration enforcement, sending the measure to the House, where GOP lawmakers in that chamber need to adopt it to unlock the reconciliation process. 

The 50-48 vote followed a marathon amendment voting session that Democrats used to highlight policy differences on cost-of-living issues and stalled federal emergency relief dollars for states. 

Alaska Sen. Lisa Murkowski and Kentucky Sen. Rand Paul were the two Republicans to vote against approving the measure. Sens. Charles Grassley, R-Iowa, and Mark Warner, D-Va., did not vote.

Senate Minority Leader Chuck Schumer said just before the vote-a-rama began that Democrats would put Republicans on the record about the soaring cost of living and the Trump administration’s immigration crackdown. 

“America will see even more clearly tonight where the Republicans are — not on the side of lowering costs, but on the side of masked agents occupying our streets,” he said. 

Republicans plan to use the complex budget reconciliation process, which avoids the need for Democratic support in the Senate, to provide between $70 billion and $140 billion in additional funding for Immigration and Customs Enforcement and the Border Patrol.

The money is supposed to cover those agencies for the next three years, avoiding the need for Republicans to negotiate constraints on immigration activities with Democrats, who have been calling for guardrails since federal agents shot and killed two U.S. citizens in Minneapolis in January. 

When combined with the Senate-passed bill that funds the vast majority of the Department of Homeland Security for the current fiscal year, the two pieces of legislation are expected to end the ongoing shutdown at that department, which began in mid-February. 

One amendment adopted, 15 turned down

Senators ultimately debated 16 amendments, 12 offered by Democrats and four proposed by Republicans. The only one adopted was from South Carolina Republican Sen. Lindsey Graham, which senators approved on a 98-0 vote. 

The proposal would create a reserve fund to bolster federal immigration agents’ ability to detain and deport adults who entered the country without proper documentation and were then convicted of rape, murder, or sexual abuse of a minor.

“Everybody in this body should be for this,” Graham said. “These people need to be caught, put in jail, or kicked out of our country.”

Illinois Democratic Sen. Dick Durbin said he supported the amendment because “under current law, undocumented immigrants who are convicted of rape, murder, or sexual abuse of a minor are subject to mandatory detention and deportation.” 

“What we object to is what is happening in the streets of Minneapolis and Chicago,” he added.

SAVE America Act sidelined

Louisiana Republican Sen. John Kennedy tried but was ultimately unable to convince his colleagues to add a new set of instructions to the budget resolution that would have allowed the Rules & Administration Committee to write a voter identification law. 

Kennedy said he wanted that bill to have three provisions. 

“Require that in federal elections, you have to be an American citizen to vote and provide for the provisions to enforce that. Number two, it would require that in federal elections, you have to prove you are who you say you are in order to vote, and it would provide provisions to enforce that,” he said. “Number three, it further instructs the Rules Committee that we’re going to go back to having an Election Day and not an election month, and it instructs the Rules Committee to provide the provisions to enforce that.”

California Democratic Sen. Alex Padilla, the ranking member of the rules panel, opposed the amendment during debate, saying he couldn’t believe lawmakers were once again experiencing a “partisan attempt to rush through what I refer to as a solution in search of a problem.”

“Despite the president’s claims, there is zero evidence of massive voter fraud across the country, which is the premise of these proposals,” he said. “So not only is it a solution in search of a problem, to paraphrase a wise man, this measure is all foam and no beer.”

Padilla added that a provision in Kennedy’s amendment would have required states to count ballots within 36 hours of an election, a new mandate he said could cause considerable problems for larger states with millions of voters. 

“It’s unfortunate elections administration has been turned into a partisan issue,” he said. “I actually ask our colleagues to protect the early voters, not just in my state but in yours. Protect vote-by-mail opportunities, not just in my state but in yours. Let’s protect women who are married and change their name and their right to vote, not just in my state but in yours.”

Senators did not agree to waive a point of order against Kennedy’s amendment on a 48-50 vote. Republican Sens. Susan Collins of Maine, Mitch McConnell of Kentucky, Murkowski and Thom Tillis of North Carolina voted with Democrats. 

Ban on Planned Parenthood funding via Medicaid

Missouri Republican Sen. Josh Hawley tried unsuccessfully to create a pathway to extend the one-year prohibition on Medicaid funding to Planned Parenthood that the GOP included in its “big, beautiful” law. That funding ban expires on July 4. 

Hawley didn’t speak about abortion access during debate but focused his criticism of the organization on gender-affirming health care services for transgender youth. 

“Under no circumstance should Medicaid money dedicated to the poor and the needy be used for transgender surgeries and treatments for minor children,” he said. “It is a moral outrage. This body has a duty to stand against it.”

Planned Parenthood’s website states the organization provides surgery referrals as well as hormone therapy, puberty blockers and “transition support.”

Oregon Democratic Sen. Ron Wyden argued the amendment represented “Republicans’ latest attempt to strip women of the health care they need and depend on so that they can go score some political points.” 

Senators didn’t agree to waive a point of order against the amendment, which would have allowed it to move forward, by a vote of 50-48. Collins and Murkowski voted with Democrats. 

Private equity and home ownership

Senators rejected an amendment from Oregon Democratic Sen. Jeff Merkley that would have addressed the rising cost of housing after he invoked comments President Donald Trump made during his State of the Union address. 

“We have an opportunity tonight to send a message that we agree with the president, that we have a challenge in home ownership, because home ownership is dying,” Merkley said. “And one of the factors is private equity buying up the homes.” 

Ohio Republican Sen. Bernie Moreno spoke out against adopting the amendment, saying lawmakers have already addressed it in a bipartisan way. 

“I obviously urge my colleagues to oppose this amendment, because we’ve already passed it,” he said. We’ve already solved this problem. In fact, congratulations to all of us. 89 to 10. We banned institutional ownership of single-family homes. I think that’s fantastic.”

The Senate voted in March to approve a bill designed to increase the country’s housing supply, according to reporting from NPR. But since the House has approved a bill of its own, the two chambers will need to work out their differences before any housing bill becomes law. 

Senators did not agree to adopt Merkley’s amendment following a 46-52 party-line vote. 

Disaster relief funds from FEMA

California Democratic Sen. Adam Schiff proposed an amendment that would have addressed stalled funding from the Federal Emergency Management Agency, which he said is “holding more than $3 billion in disaster relief funding for California.”

“But as we debate this budget resolution, I know our state of California is not alone,” he said. “North Carolina is waiting on millions in relief designated for Hurricane Helene in 2024. Kentucky saw landslides and flooding just weeks after Los Angeles County burned. Florida and the Gulf Coast have also been battered. Texas communities under siege from last year’s floods have still not seen the federal relief their communities need and deserve.”

Oklahoma Republican Sen. James Lankford opposed the amendment, saying that while he agrees FEMA funds need to get to communities, the best way to do that is for the House to pass the annual funding bill for the Department of Homeland Security, which the Senate already approved. 

House GOP leaders are holding on to that bill instead of putting it on the floor as they wait for the reconciliation process to play out. That Senate-passed DHS bill funds FEMA and all of the agencies that make up the department except ICE and Border Patrol. 

“Our challenge has been, we’ve been in a government shutdown on DHS now for two months,” Lankford said. “We’ve got to be able to get those funds released. That means we’ve got to get DHS funding completely done for all of DHS. We have FEMA employees that are being paid but they don’t have program dollars that they can actually release.”

The Senate rejected the amendment following a 49-49 vote. Collins, Florida Sen. Ashley Moody and Murkowski voted with Democrats.