On Tuesday night, a three-judge panel of the 1st US Circuit Court of Appeals cleared the way for significant disruption to healthcare access across a substantial part of America through the implementation of President Donald Trump's broad taxation and domestic policy reforms. The panel upheld a provision supported by Trump that would allow for substantial reductions in funding for Planned Parenthood by removing their clinics from Medicaid reimbursement programmes. This means that pregnant women on Medicaid would now be ineligible for coverage at these clinics, a move widely expected to have a disproportionately adverse impact on low-income women seeking abortion services.
This ruling marks another major victory for the Trump administration in support of their often-discussed 'One Big Beautiful Bill Act,' while representing a significant setback for many states that have argued this law infringes upon constitutional restrictions established by Congress.
A Law with a Narrow Focus
A central point of controversy is the provision that prohibits Medicaid from reimbursing tax-exempt agencies—primarily Planned Parenthood—that provide reproductive and family planning services if they perform abortions and receive over $800,000 in Medicaid funding for the 2023 financial year. Proponents of the law argue that it ensures public funds are not directed towards supporting abortion services. Critics, however, contend that the law is targeted specifically at Planned Parenthood, effectively using fiscal policy as a tool to pursue a long-held political objective.
Planned Parenthood has stated that it has already felt the immediate effects of this law. Since September 2017, at least 20 of its health centres across the country have closed, with many more likely to follow as state reimbursements are withdrawn. These closures threaten to leave many low-income women without accessible reproductive healthcare, forcing them to travel longer distances and incur greater costs for essential services.
Legal Battles and State Challenges
In this instance, a coalition of Democratic attorneys-general filed suit, arguing that the law imposed an unconstitutional, retroactive requirement on participating states in the Medicaid programme. They contended that the federal government changed the rules after states had already approved their Medicaid plans, leaving little opportunity for them to adapt in time.
Earlier this month, a lower court judge sided with the attorneys-general, issuing an injunction to halt the law's enforcement. On appeal, however, the 1st Circuit found that the administration was likely to succeed on the merits of the case. The court ruled that Congress acted within its constitutional powers and that the law clearly outlined the obligations placed on states.
Of note, the panel consisted entirely of judges appointed by Democratic presidents, which contradicts claims that the decision was politically motivated.
Clinics Close as Costs Shift to Patients
While legal proceedings continue, the tangible consequences are already evident. As clinics close, patients face longer journeys and increased waiting times for their healthcare. Advocacy organisations warn that, despite funding cuts, demand for services remains high and will be shifted onto the most vulnerable populations. Preventive care—such as cancer screenings, contraceptive provision, and routine check-ups—currently covered by Medicaid, is among the first to be affected by these cuts.
A health policy analyst commented, 'This law takes the funds from Medicaid, but it creates a lot of costs (financially and otherwise) elsewhere in the healthcare delivery system. When we have situations like this, we have people with conditions that could have been treated early on, but because of the lack of access to care and the inability to get their condition treated, they wind up in an emergency situation.'
A Political Win and a Public Health Challenge
Supporters of Trump see this ruling as a validation of their approach to tax and social policy, viewing it as an affirmation of the power of fiscal law to shape healthcare access. Critics, however, see it as an example of Congress using legal mechanisms to restrict reproductive rights indirectly—without directly altering abortion legislation.
This decision is likely to prompt further appeals, potentially reaching higher courts, where questions about the legal limits of Congress's authority to impose requirements on federal healthcare funding will be debated. As the situation develops, thousands of patients are already experiencing the fallout, highlighting the potential long-term consequences of this law on public health and access to care.
