On July 4th, H.R.1, also known as the One Big Beautiful Bill Act, was signed into law, with a provision that caught the eyes of reproductive health centers across the country and triggered a number of lawsuits.
What Does H.R. 1 Say About Abortion?
Among one of its most controversial provisions, the bill states that any healthcare nonprofit that:
- Received over $800,000 in federal funds in 2023, and
- Provides abortions for reasons other than rape, incest, or the a threat to the life of the mother
is barred from receiving medicaid reimbursement for one year. The provision would also include the “affiliates, subsidiaries, and clinics” of such organizations.
Medicaid and other federally funded insurance programs have not covered abortions except for in cases of rape, incest, and threats to the life of the mother since the Hyde Amendment went into effect in 1976. The One Big Beautiful Bill builds upon that, however, and would withhold federal reimbursements to health centers for Medicaid patients receiving non-abortion services like STI screenings, cancer screenings, or gynecological care.
According to Planned Parenthood’s CEO, Alexis McGill Johnson, about half of Planned Parenthood patients access care through Medicaid. This places Planned Parenthood clinics in a difficult spot;while it’s estimated that abortions make up approximately 4% of services Planned Parenthood provides, independent abortion clinics have been closing in significant numbers following the Dobbs decision, leaving patients seeking abortions increasingly reliant on Planned Parenthood to provide them.
How Are People Responding?
Planned Parenthood has estimated that the provision could force the closure of 200 of their clinics nationwide, with smaller clinics providing abortions alongside other women’s health services also expressing concern about their abilities to remain open.
Proponents of the bill argue it diverts federal funding away from abortion while retaining other healthcare services. Susan B. Anthony Pro-Life America, an anti-abortion advocacy organization, called the bill “a major step toward ending the forced taxpayer funding of the Big Abortion industry.” Supporters have pointed towards Federally Qualified Health Centers (FQHCs) as an alternative to places like Planned Parenthood for patients seeking reproductive care through Medicaid, with the organization Americans United for Life stating that as a result of the bill’s provision, “Congress will now be free to direct these funds toward authentic women’s health care and other pro-family initiatives.”
Researchers at the Guttmacher Institute, however, are skeptical of the ability of these centers to replace Planned Parenthood’s accessibility for a large client base. One report found that in order to compensate for the closures of clinics like Planned Parenthood, FQHCs would need to increase their capacity to provide contraceptive care by 56%.Opponents of the provision have also branded it as an indirect attempt to prohibit abortion in states where it’s protected. George Hill, CEO of Maine Family Planning, a healthcare organization that offers both abortion and other women’s health services, called the bill “a backdoor attack to limit access to abortion care in blue states where abortion is legal and accessible.”
What Have the Courts Said?
On July 28th, U.S. District Judge Indira Talwani issued a preliminary injunction temporarily preventing the Department of Health and Human Services from enforcing the provision, declaring that it was an unconstitutional “bill of attainder,” whereby Congress specifically seeks to punish individual organizations without trial. The judge also stated that the provision violated the rights to speech and due process under the first and fifth amendments by punishing Planned Parenthood clinics that don’t provide abortion services for their association with Planned Parenthood at large. This comes after Judge Talwani had previously granted a 14 day restraining order earlier in the month directing the Department of Health and Human Services to “take all steps necessary to ensure that Medicaid funding continues to be disbursed” to Planned Parenthood. The Trump Administration responded to the ruling, stating that “The Trump Administration is ending the forced use of Federal taxpayer dollars to fund or promote elective abortion – a commonsense position that the overwhelming majority of Americans agree with.”
On July 29th, 22 states and the District of Columbia filed suit against the Department of Health and Human Services over the provision with arguments echoing Judge Talwani’s statement. New York Attorney General Letitia James, a plaintiff in the suit, released a statement on behalf of the lawsuit, arguing that the provision “violates the First Amendment by retaliating against Planned Parenthood for its protected speech and advocacy; violates the Spending Clause by forcing states to implement a vague, unrelated and coercive federal policy without clear notice; and violates the Constitution’s ban on bills of attainder by singling out a group for punishment without due process.”
What’s Likely to Happen?
Whether and when the Department of Health and Human Services can enforce the provision depends largely on whether or not the Supreme Court decides to take up the case when it reconvenes this Fall. The Court had previously sided with the states’ abilities to exclude Planned Parenthood from Medicaid funding in a case this June. In the case Medina v. Planned Parenthood South Atlantic, the Court ruled 6-3 that a South Carolina law prohibiting Planned Parenthood from receiving state Medicaid funds did not violate the Medicaid Act’s “any qualified provider” provision, which plaintiffs argued created a right for Medicaid beneficiaries to choose their own providers.
Though the current lawsuit presents a different argument for the unconstitutionality of the exclusion of Planned Parenthood from Medicaid funding, many see it as a signal of the court’s likely reluctance to affirm Medicaid funding as a right that cannot be restricted via legislation. White House spokesman Harrison Fields expressed confidence in the administration’s Court prospects, stating, “we look forward to ultimate victory on the issue.” Delaware Attorney General Kathy Jennings reaffirmed that “we are going to fight [the provision] every step of the way.” While the future of the specific provision remains unclear for now, what remains certain is a lengthy continued legal battle.
How the Legal Battles Concluded
While the immediate aftermath of H.R. 1 sparked intense litigation, the primary legal battles have fully concluded. Following Judge Talwani’s initial nationwide preliminary injunction in July 2025, the Trump administration immediately appealed to the U.S. Court of Appeals for the First Circuit. In September 2025, the First Circuit lifted the injunction, allowing the bill to proceed with its Medicaid funding cuts. The legal battle concluded when the First Circuit formally canceled the injunctions on the grounds that losing federal funds was not an illegal punishment and that the law was constitutionally valid. Planned Parenthood subsequently dismissed all claims on January 30, 2026.
Although Planned Parenthood’s lawsuit was fully dismissed, the multi-state coalition found success. On December 2, 2025, a federal court granted a preliminary injunction protecting the 22 states and the District of Columbia. The court ruling affirmed that the defunding law would force the states to take on heavy financial and administrative burdens, thus giving them the right to sue. The judge also agreed that the law violated the Constitution’s Spending Clause by failing to give states clear notice about the sudden changes to their existing healthcare systems.
These legal developments effectively enabled the administration to successfully enforce the defunding mechanism across conservative and non-litigating states, leading to widespread health center closures. In contrast, the multi-state injunction has allowed protected states to successfully run out the clock until the bill reaches its automatic one-year expiration on July 4, 2026.