State Action Needed to Maintain Access to Reproductive Health: What Advocates Can Do

In the wake of the devastating Republican health care cuts, including sweeping reductions to Medicaid and the ACA, millions of Americans are being forced to grapple with the fallout. Patients seeking reproductive health care, the providers who serve them, and the state policymakers working to protect their coverage and access are now left to reshape a health care system that is under attack.

As detailed in our previous column on the essential role of Planned Parenthood and other reproductive health care providers, one of H.R. 1's most damaging provisions is the ban on Medicaid funding for large abortion care providers and their affiliates.

The real-world impact

While the Hyde Amendment already prohibits federal Medicaid funds from covering abortions (with very narrow exceptions), the H.R. 1 ban goes far beyond that, deliberately targeting the other essential health services that many women receive from reproductive health clinics across the county. These services include routine wellness visits, breast and cervical cancer screenings, and contraceptive care. Regardless of whether the ban is upheld by courts, the impacts are already being felt nationwide. More than 200 clinics across the country are at risk of closing - and some have already shuttered their doors. Since H.R. 1 was signed into law, over 20 Planned Parenthood health centers have been forced to close.

In Maine, Maine Family Planning, the largest network of family planning clinics in the state, was forced to stop providing primary care on October 31 due to the loss of Medicaid funding, impacting routine access to care for over 800 Mainers. As closures like this happen across the country, it will only making it harder for the over 41 million women who already live in areas with no or limited access to reproductive health care.

State responses to the "defund" 

With access to essential reproductive health care and family planning services now hanging in the balance, consumers need states to act fast. Many states have taken important measures to counteract H.R. 1's attack on reproductive health, including:

• Washington: Governor Bob Ferguson pledged to temporarily fill the $11 million gap in federal funding to preserve access to critical health care services for one year. "The real victims are Washingtonians who will lose their health care provider. I will not allow that to happen," Ferguson said in his press release.
• Colorado: The state legislature convened a special session to pass a bill directing state dollars to backfill the federal funding lapse for abortion providers while H.R. 1 is in effect. Within days of H.R. 1's passage, Planned Parenthood health centers were forced to cancel nearly 1,000 appointments across the state, prompting swift and decisive action from the Governor's office and the legislature to stabilize access to care.  The state legislature convened a special session to pass a bill directing state dollars to backfill the federal funding lapse for abortion providers while H.R. 1 is in effect. Within days of H.R. 1's passage, Planned Parenthood health centers were forced to cancel nearly 1,000 appointments across the state, prompting swift and decisive action from the Governor's office and the legislature to stabilize access to care.
• New Mexico: Governor Michelle Lujan Grisham moved quickly to protect reproductive health services, directing state resources to support the three Planned Parenthood locations and other affected providers. In August, she went a step further, signing an executive order designating funding toward the development of a new reproductive health care clinic, ensuring access to care in the state not only survives, but expands.
• California: Governor Gavin Newsom reaffirmed the state's commitment to reproductive freedom by announcing $140 million in stopgap funding to support Planned Parenthood health centers in the coming months. He also committed to working with the state legislature on a long-term funding solution. "[President] Trump's efforts to defund Planned Parenthood put all our communities at risk as people seek basic health care from these community providers," said Newsom.
• New York: Governor Kathy Hochul launched an aggressive, multi-pronged response to protect providers and patients. In October, she committed to allocate state funds to replace lost federal dollars, saying "I will always stand up for reproductive rights and the health care that New Yorkers deserve."

In addition to offsetting funding losses, many states have other tools within their state Medicaid programs to help maintain access to reproductive health services, such as expanding Medicaid family planning programs, covering over-the-counter contraceptives, and enforcing network adequacy standards for Medicaid managed care organizations.

The limits of state action 

While several states have stepped up to secure critical short-term funding for reproductive health care, this approach isn't sustainable. The funding gaps are massive, and we cannot expect even well-intentioned states to fully mitigate losses of this scale. Not only are communities grappling with the loss of Medicaid dollars for reproductive health care providers, the Trump administration is also "withholding" Title X funds that support safety net reproductive health services in states from a reproductive health care system that continues to be deeply strained. Sexual and reproductive health care has long been under attack at the federal level and as a result, woefully underfunded.

For the time being, it appears current Trump administration and Congressional attacks on reproductive health will continue. Should GOP leadership choose to pursue an additional reconciliation package, there could be further attempts to continue or even expand the "defund" of Planned Parenthood and other reproductive health care providers. A conservative think tank has reportedly pitched Republican congressional staff on this idea of extending the provision.

What advocates can do 

Ahead of any future action by the states or Congress, advocates can act now to safeguard reproductive health care in your communities. Here is how you can help:

• Add reproductive health priorities to your policy agenda. Reproductive health must be a core component of your federal and state policy strategy, and you should join the leaders of the reproductive justice movement in your state and at the federal level to advance these goals. Specifically, advocates should work to:
  • Secure state dollars for nonprofit health care providers, including Planned Parenthood, that deliver essential services such as birth control, cancer screenings, STI testing and treatment, and abortion care, and that have been harmed by recent "defund" provisions.
  • Advocate to fully fund reproductive health services through Medicaid, ensuring that family planning benefits are comprehensive, accessible, and reflective of patients' holistic needs.
  • Support providers of reproductive health care, including abortion services, by establishing legal safeguards that shield them from civil or criminal liability.

To advance these priorities, begin integrating them into federal and state comment letters, supporting aligned legislation, and ensuring that reproductive health remains central in your meetings, coalitions, and organizational strategy.

• Share what you see. Work with your network to document and report when health centers are struggling to stay open or provide services, when health care providers are affected by health center closures, when patients face barriers to accessing care, and when rising health care costs are impacting the state and health systems.
• Find storytellers. Encourage individuals to share their experiences with trusted organizations, like your own organization or Families USA, so that their voices can be amplified through social media, advocacy materials, and outreach to elected officials, while maintaining their privacy.
• Help policymakers see the bigger picture. Contact your local, state, and federal elected officials to share your story, documented impacts on your community, and connect this to intersectional issues such as rising health care costs, health center closures, accessibility barriers to care, and health care provider shortages. Partner with reproductive health organizations to support short- and longer-term solutions at the national, state and community level.
• Engage the media. Reach out to local journalists to help ensure the impacts of this provision are being covered within your community.
  • For additional tools and resources, see Planned Parenthood's advocacy materials and palm cards, as well as data from the Guttmacher Institute and amicus briefs filed by the National Women's Law Center and the National Health Law Program (NHeLP) in support of reproductive health care providers.

Moving forward 

Defunding nonprofit providers of abortion care is not just a policy change - it's a backdoor abortion ban. Some states can help fill the gaps, but the long-term solution must be that Medicaid dollars are reinstated, and this "defund" provision does not continue.

Until then, it's up to all of us, advocates, providers, and patients to speak up about the need to ensure that essential reproductive health care services are accessible to all.