Is it possible to separate politics from patient care when the nation’s largest reproductive health provider is on the line? The past week has delivered a resounding answer. In a one-two punch, conservatives have secured two major victories in their long-running campaign to cut off Medicaid funding to Planned Parenthood—a move with sweeping consequences for millions who rely on these clinics for everything from birth control to cancer screenings.
First came the Supreme Court’s decision in Medina v. Planned Parenthood South Atlantic on June 26, 2025. By a 6-3 majority, the Court held that Medicaid enrollees can’t sue states in federal court to enforce their “free-choice of provider” rights. As KFF explains, this means states now have broad authority to exclude Planned Parenthood and similar providers from Medicaid, regardless of whether the exclusion is about abortion or not. Justice Jackson, in her dissent, didn’t mince words: “Denying access to care among South Carolina’s Medicaid beneficiaries is simply the latest chapter in a long history of civil rights deprivation by certain states.”
Hot on the heels of the Court’s decision, Congress passed a sweeping tax-and-spending package that includes a one-year ban on Medicaid payments to Planned Parenthood for all services—not just abortion. The provision, which President Trump made a top priority, will block Medicaid reimbursement for everything from annual exams to prenatal care. The Congressional Budget Office projects that this move will actually increase federal spending by $300 million, since Planned Parenthood plays a key role in helping beneficiaries avoid unintended pregnancies and costly births (KFF).
The roots of this strategy stretch back nearly two decades. It was in 2007 that then-Rep. Mike Pence first introduced legislation to defund Planned Parenthood. While early efforts failed, the campaign gained traction in the states—especially Texas, which pioneered the exclusion of abortion-affiliated clinics from Medicaid. When Texas replaced its Medicaid family planning program with a state-funded alternative that excluded Planned Parenthood, researchers found a sizable drop in Medicaid claims for long-acting contraceptives and a spike in Medicaid-funded births (KFF). The data from Texas is telling: when the distance to the nearest clinic increased by 100 miles, the fertility rate for unmarried women rose by 2.4% (University of Chicago Press).
Medicaid is the main source of family planning coverage for low-income people in the U.S., covering more than 20 million adults ages 18 to 49 (KFF). All state Medicaid programs must cover family planning, but states have flexibility in defining what services are included and can impose utilization controls that affect access. The federal government pays 90% of the cost for family planning services, a higher match than for other Medicaid services, underscoring the importance placed on these benefits.
With the Supreme Court’s ruling and the new federal ban, states now have a green light to exclude any provider that offers abortion—even if those providers are also delivering a full spectrum of reproductive health care. The impact will be especially acute in states already struggling with “contraceptive deserts,” where millions live in counties with too few providers offering the full range of FDA-approved birth control methods (Health Affairs). In South Carolina alone, over 300,000 women live in these deserts, and nearly 40% of counties lack maternity care.
The consequences extend far beyond the walls of Planned Parenthood clinics. If hundreds of clinics close—as some predict—over a million low-income patients could lose access to trusted providers. Research consistently shows that unintended pregnancies rise when access to contraception falls, leading to increased debt, missed educational and job opportunities, and poorer outcomes for families.
The mechanics of Medicaid funding mean that even non-abortion services—like STI treatment, cancer screenings, and prenatal care—are now at risk for millions. Medicaid’s unique structure as a federal-state partnership gives states significant discretion, but the new legal and legislative landscape shifts the balance of power even further away from individual patients and toward state policymakers.
As the dust settles, the nation’s approach to reproductive health care is being rewritten in real time. The next chapter will hinge on how states wield their new authority, and whether alternative providers can fill the void left by Planned Parenthood’s exclusion from Medicaid. For now, the message is clear: the intersection of law, policy, and health care access has never been more consequential—or more personal—for millions of Americans.
