Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America. 

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Closures would affect already fragile health care system, Midwest doctor says

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

‘Changes to Medicaid … only adds to the chaos’

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Program, recently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program. 

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”

A recreation of the spaceship from "Doctor Who," made by artist Sheila Roberts, sits on a Kansas prairie trail owned by Laura Mead, who opens up the trail to help people find a deeper understanding of self. (Grace Hills/Kansas Reflector)

DOVER — A recreation of a TARDIS — the blue British police box and time-traveling spaceship from “Doctor Who” — sits on a Kansas prairie with one purpose: fostering connection, both with oneself and with others.

Other art installations along a walking path in Laura Mead and Dave Kendall’s backyard in Dover form a meditative journey and, like their well-attended virtual town hall in February for an absent U.S. Sen. Jerry Moran, represent the couple’s mission to reignite dialogue.

There are a few other literal and figurative bells and whistles — the TARDIS leads to an artistic interpretation of the spaceship, complete with a console, for example.

Mead hears a common response to their work: “I feel less alone.”

“People are longing to feel connected. They’re longing to feel a part of something, and shared values,” Mead said. “As we become more isolated in these bubbles, it becomes harder to even talk to people who think differently. It’s hard to find them.” 

The virtual town hall they hosted lasted two and a half hours, which signaled to them that Kansans are looking for a space to talk. As a next step, they’re producing a forthcoming podcast about how government changes affect people’s lives. At the town hall, both Republicans and Democrats shared their lived experiences.

Mead sees the value of diverse opinions and perspectives reflected back in the prairie — but also the harm of negativity.

During a walk through the prairie, she pointed to a small patch of land with about a dozen types of plants. Farther down the path, closer to the highway and before the art installations, an invasive species had taken over a stretch. The couple consulted with specialists and sprayed the grass with chemicals, which stopped the spread.

“This just blows my mind,” Mead said. “There are seed banks underground where these seeds can last for 50 or more years. And if the conditions are right, they just bloom. And unfortunately, metaphorically, I think the conditions are right right now for some of the less established parts of human nature to bloom.”

Their property is a registered agritourism site, and they offer free appointments to walk the trails. Mead has seen people who were initially resistant to the walk, usually brought there by an eager partner, return more connected with themselves. 

Mead gestured toward a white bench nestled between two trees. She recalled an older man who had been unsure about joining the walk but was eventually persuaded by his wife. Mead said the man sat on the bench for about 30 minutes and upon return shared that he had been able to truly listen to himself. 

“In this liminal space we’re in, there’s an opportunity for some of our best qualities to bloom,” Mead said. “I think there is a basic human goodness. And if we can create the right environment, that will arise.”

Kendall, who has written opinion columns for Kansas Reflector, grew up on a Kansas farm. After some time in California, he returned. Mead grew up in Vermont, then moved to the prairie — a part of the world where both Kendall and Mead feel a connection. Kendall is especially worried about the Trump administration’s approach to climate change. 

“You can’t care about the climate until you’re in it,” Kendall said.

They believe stability, both emotional and political, can be achieved through connection. Their forthcoming podcast series will provide a platform where people from all backgrounds can answer the questions: How have changes in the federal government affected your life? What kind of America do you want to live in? What is important to you?

“This dehumanizing and othering is a difficult thing for people. It makes me unpopular in some circles, but we can’t other even the people that are following the policies of this administration,” Mead said, referring to President Donald Trump. “We can disagree, which I do.”

Mead said that connection has allowed her to see that people on the other side of her politically are wanting safety, security, and respect.

The couple run Prairie Hollow Productions, a documentary production company, for which they interviewed former Republican U.S. Sen. Nancy Kassebaum. 

“I learn every time I talk to Senator Kassebaum, because she’s intelligent. She’s thoughtful. Even if we don’t necessarily agree with certain budget items or whatever, I like that kind of exchange with people. It’s healthy,” Mead said. “So my hope is that our society will deescalate some of this vitriol, deescalate some of this othering and find a way to talk again.”