A Planned Parenthood clinic in Salt Lake City, Utah, is pictured on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

WASHINGTON — The federal government cannot withhold Medicaid funding from Planned Parenthood for at least the next two weeks, after a district court judge issued a temporary restraining order the same day the organization filed a lawsuit.

Republicans included language in their “big, beautiful bill” that would block Medicaid payments from going to Planned Parenthood for the next year, a move that would effectively prevent enrollees in the state-federal health program for lower income people from visiting any of its clinics for routine health care.

The ban began when President Donald Trump signed the bill into law on Friday.

Congress already bars federal funding from going to abortion services with limited exceptions.

Planned Parenthood filed a lawsuit over the change in federal law Monday in U. S. District Court for the District of Massachusetts and quickly requested the temporary restraining order, which was issued later that day.

The suit alleges Planned Parenthood was singled out “in order to punish them for lawful activity, namely advocating for and providing legal abortion access wholly outside the Medicaid program and without using any federal funds.”

The filing also says more than 1 million Medicaid enrollees go to Planned Parenthood in a given year and that the organization received more than one-third of its total aggregate revenue from Medicaid reimbursement during fiscal year 2023. 

District Court Judge Indira Talwani’s brief two-page temporary restraining order called on the Trump administration to file a status update later this week. And she set an in-person hearing later this month to hear from Planned Parenthood and the Trump administration.

Talwani was nominated to the bench by former President Barack Obama.

The Trump administration has yet to file any documents in the case and the Department of Health and Human Services did not immediately respond to a request for comment from States Newsroom about the judge’s temporary restraining order. 

Attorney General Pam Bondi indicated during a Cabinet meeting Tuesday afternoon that the Department of Justice plans to challenge the temporary restraining order.

“Absolutely, yes. We’re on it,” Bondi said.  

Planned Parenthood Federation of America, Planned Parenthood League of Massachusetts and Planned Parenthood Association of Utah — the three groups that filed the lawsuit — wrote in a statement they were “grateful that the court acted swiftly to block this unconstitutional law attacking Planned Parenthood providers and patients.

“Already, in states across the country, providers and health center staff have been forced to turn away patients who use Medicaid to get basic sexual and reproductive health care because President Trump and his backers in Congress passed a law to block them from going to Planned Parenthood. There are no other providers who can fill the gap if the ‘defunding’ of Planned Parenthood is allowed to stand. The fight is just beginning, and we look forward to our day in court.”

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.”

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.”

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.”