When Senate Republicans voted on Tuesday to pass President Trump’s spending bill, abortion opponents came one step closer to stripping Planned Parenthood of federal funding — a move that could jeopardize abortion access for patients even in states where abortion is legal.
The bill imposes a one-year ban on state Medicaid payments to any health care nonprofit that offers abortions and received more than $800,000 in federal funding in 2023. The restriction jeopardizes Planned Parenthood’s ability to keep operating in some states.
While federal law already prohibits federal Medicaid dollars from paying for abortions, the bill would affect the stream of federal money that covers other services, and thus helps keep clinics open. Though not all individual Planned Parenthood locations provide abortions, the legislative language could knock them out of Medicaid if they are part of a regional network that does offer the procedures.
Planned Parenthood affiliates — each an independently run nonprofit that operates clinics across a geographic region — are in the unusual position of being both an abortion provider and an operator of clinics. The facilities provide a wide range of other medical services for more than two million Americans who cannot afford health care anywhere else.
“This bill threatens to close nearly 200 Planned Parenthood health centers and will create devastating gaps in our health care infrastructure,” Alexis McGill Johnson, the chief executive of Planned Parenthood Federation of America, the national umbrella organization, said in a statement.
The bill most deeply affects Planned Parenthood clinics in blue states, including California, Oregon, Washington and Illinois, where abortion is still legal and where there are also large numbers of patients who are eligible for Medicaid reimbursements for other health care.
Planned Parenthood, whose affiliates already faced dire funding shortfalls in many states even before the latest Medicaid cuts, said in a statement that 200 clinics in 24 states were at risk of closing if the bill passes. Of those clinics, 90 percent are in states where abortion is protected and legal.
The looming funding crisis is one that abortion opponents had wanted for decades.
Republicans have been trying to pass legislation that blocks federal funding to Planned Parenthood for years, but ran into difficulties getting approval from the Senate’s parliamentarian, who determines whether legislation complies with the chamber’s complex rules for the budget process.
This time, to the surprise of many Democratic lawmakers, she blessed the provision. The bill now must be approved by the House of Representatives. The president has said he wants to sign the bill by Friday.
The defunding proposal will not affect states where Republican legislatures have essentially banned abortions. And three states that are hostile to the procedure — Arkansas, Mississippi and Texas — have already blocked Planned Parenthood clinics in their states from receiving Medicaid funding.
Planned Parenthood Federation of America has vowed to continue providing abortions, even in states where funding would be jeopardized by doing so.
That said, it is up to the affiliates, which operate independently from the national organization and are responsible for their own budgets, to evaluate how the bill could affect them and decide how to respond if Congress blocks federal funding.
Medicaid funding accounts for large portions of the operating budgets of many affiliates, and discussions for some of them will be based on how to keep operating without it.
Angela Vasquez-Giroux, a national spokeswoman for Planned Parenthood Federation of America, said that the national office would never recommend that affiliates stop performing abortions. But the national organization “does not direct the actions of an affiliate,” she added. “Our governance structure does not allow for that, by design.”
A decision to halt abortion services by some affiliates could have widespread reverberations. Planned Parenthood is the country’s largest abortion provider, yet nearly two thirds of all abortions across the country are provided not by Planned Parenthood, but by hundreds of independent providers.
On the one hand, few, if any, of these independent providers generate $800,000 in revenue on their own, and thus would not be affected by the law. But if some Planned Parenthood affiliates elect to end abortion access, independent providers in those regions could face pressure to take on more customers — an influx that could quickly overwhelm many of them.
One of the largest affiliates, Planned Parenthood Mar Monte in Fresno, Calif., offers a window into the difficult choice that some clinic operators could face if Mr. Trump signs the spending bill into law. The Mar Monte affiliate runs 35 health centers that serve more than 300,000 patients in mid-California and Nevada.
Mar Monte is one of dozens of Planned Parenthood affiliates that have had to take on a new stream of abortion patients from out of state following the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization that ended federal protection for abortion. Following the Dobbs ruling, 19 states essentially banned abortion, and clinics in states like California have picked up the slack.
A memo prepared for Mar Monte’s leadership in June suggests that the affiliate considered a range of options, including ending abortion.
By offering abortions, the affiliate jeopardizes a good chunk of its revenue. Over the past 12 months, the affiliate estimates, federal Medicaid payments accounted for $70 million to $75 million — or nearly half — of its $152 million in revenue, the affiliate said in an email to The New York Times, and paid nearly 85 percent of Mar Monte’s patients’ bills.
Those revenues covered services such as reproductive health care, birth control, sexually transmitted infection testing and treatment, breast and cervical cancer screening, pediatric and adult family medicine, gender-affirming care, behavioral health services and prenatal care.
A decision to continue performing abortions, the memo said, would most likely lead to a majority of the patients who rely on Medicaid — about 80 percent of the affiliate’s patient base — “no longer being able to access health care.”
It said that preserving abortion access would probably force the affiliate to close 10 health centers and lay off “up to half of our staff.”
On the other hand, the Mar Monte affiliate provided 28,475 abortions in the fiscal year that ended in June of 2024, some to women who could not obtain the procedure in other states.
Stacy Cross, the president of Planned Parenthood Mar Monte, said in an email to The Times that the affiliate evaluated the various scenarios and decided that it would continue to offer abortions even if the spending bill becomes law.
Planned Parenthood’s national leadership said there had never been any serious discussion of ending abortion at Planned Parenthood clinics. The Mar Monte discussions were “robust scenario planning” and nothing more, said Ms. Vasquez-Giroux.
“There is not now, and has never been, a plan to stop providing abortion care in the hopes of preserving federal funding,” Ms. McGill Johnson said in a statement. “Any claims to the contrary are an outright lie.”
As of last month, executives at Planned Parenthood Mar Monte were holding out hope for a third option: “A dedicated and generous philanthropist who is willing to make an extraordinary impact that will prevent either of these scenarios from transpiring.”
Leaders estimated in their memo that it would take $100 million for Mar Monte and $300 million for all seven affiliates in California to “avert this public health nightmare.”
Katie Benner is a correspondent writing primarily about large institutions that shape American life.
David A. Fahrenthold is a Times investigative reporter writing about nonprofit organizations. He has been a reporter for two decades.
Margot Sanger-Katz is a reporter covering health care policy and public health for the Upshot section of The Times.
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