A Federal Judge May Have Just Saved Planned Parenthood

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Since Congress passed the Big Beautiful Bill, supporters of abortion rights have framed it as a stealth abortion ban. The 900-page bill includes a provision establishing that health care providers specializing in reproductive services that offer abortions can’t accept Medicaid for other care they provide. (The Hyde Amendment, which has been on the books since 1976, bars Medicaid reimbursement for abortion itself.) The provision is conveniently scheduled to expire in a year, at roughly the time the 2026 midterm should be heating up. But in the meantime, it’s predicted to have a major impact on Planned Parenthood, the primary target of the legislation, with officials estimating that as many as a third of Planned Parenthood clinics may be forced to close. This week, a federal judge handed Planned Parenthood a major victory, blocking the bill from being enforced on constitutional grounds. That’s not likely to last as the case moves through the appellate courts, but one way or another, the court ruling will make Republicans’ decision about whether to renew the ban all the more painful: will the GOP let the Medicaid ban expire to improve their own chances of holding Congress, relying on this decision to try to run out the clock, or will they cater to their base and renew the measure after the court wrangling plays itself out?

The Big Beautiful Bill delivers on a long-standing goal of the anti-abortion movement: defunding Planned Parenthood, a stated objective of prominent organizations since the 1980s. While no provider can use Medicaid dollars for abortion, abortion foes have long argued that because money is fungible, federal family planning and Medicaid dollars have freed up money that Planned Parenthood can use for abortion. States had already tried passing their own laws kicking Planned Parenthood out of Medicaid, and in June, the Supreme Court handed down a ruling in Medina v. Planned Parenthood South Atlantic explaining that these state laws didn’t violate the federal laws governing Medicaid. More conservative states are expected to defund Planned Parenthood, but that wouldn’t change the organization’s access to federal Medicaid dollars.

With control of the White House and Congress, it was becoming increasingly awkward for Republicans to explain to abortion foes why they have failed to deliver a major blow to abortion access. The Trump administration hasn’t changed the rules governing access to mifepristone, a drug used in more than half of all abortions, or transformed the Comstock Act, an obscenity law, into a ban on mailing abortion-related drugs or paraphernalia. Defunding Planned Parenthood seemed like a better fit for an administration interested in slashing certain types of spending.

But including a defunding provision wasn’t obviously smart politics. Republicans stand a real chance of losing the House (and less plausibly the Senate) in 2026, and congresspeople in vulnerable districts argued that defunding Planned Parenthood would be a spectacular own goal, raising the salience of abortion, an issue that often hurts Republicans but which Donald Trump had managed to more or less push to the sidelines. That’s probably why the GOP settled on a strange compromise: The Big Beautiful Bill would kick Planned Parenthood out of Medicaid, but only for a year. The decision about whether to make that change permanent would come later.

For Planned Parenthood, a year may well be too long. That’s why the organization immediately went to federal court. It made two primary constitutional arguments. The first involves a doctrine called unconstitutional conditions, which establishes that lawmakers can’t strip away benefits to which people or entities are entitled in order to penalize them for exercising a constitutional right. Planned Parenthood isn’t arguing that it has a right to federal Medicaid dollars; instead, it argues that Planned Parenthood affiliates that don’t provide abortions are being impermissibly penalized for something they do have the right to do: associate with abortion-providing affiliates. The First Amendment protects a freedom to associate on the theory that membership in a group can be central to speech and expression. Joining a group of like-minded people, like the Republican Party or the American Civil Liberties Union, can be not only a powerful form of self-expression but a necessary step in collective advocacy. Planned Parenthood affiliates, reasoned Judge Indira Talwani in her ruling, were involved in that kind of association since Planned Parenthood is arguably the nation’s most effective advocate for reproductive rights. Talwani, an Obama appointee, also accepted a related argument under the equal protection clause. Planned Parenthood argued that the Big Beautiful Bill discriminated against its affiliates while exempting similarly situated health care providers. Talwani agreed. Planned Parenthood affiliates couldn’t secure funding under the bill by declining to provide abortions, she reasoned; they would have to disaffiliate from Planned Parenthood altogether. Other providers who offered similar services and made a similar decision faced no such issue.

Planned Parenthood even prevailed on its argument that the bill amounted to what’s called a bill of attainder, which prevents legislators from passing a bill punishing someone for past conduct without due process. Planned Parenthood had to show that the bill specifically targeted it and that the bill was both punitive and focused on past, rather than future, conduct. That wasn’t straightforward: The Big Beautiful Bill never mentions Planned Parenthood by name. The loss of Medicaid dollars might not strike some judges as a classic punishment, and Congress framed the proposal as regulating future conduct. Judge Talwani still saw the law as a bill of attainder. She reasoned that the bill punished Planned Parenthood affiliates for abortions that others in the organization had already performed, and she thought that it was obvious that the bill took aim at Planned Parenthood specifically.

None of this is likely to last if the case makes it to the Supreme Court. Unconstitutional conditions doctrine has been notoriously opaque, convoluted, and inconsistent, even when the court was less conservative. That leaves plenty of room for the court to say that Congress was actually trying to defund entities that provide abortions rather than those that associate with them, and to argue, as the court has in the past, that Congress can fund other services but not abortion.

And the Supreme Court may not see this law as a bill of attainder either. The court’s conservative supermajority could easily conclude that this bill has a nonpunitive component, or that affiliates can avoid the bill’s consequences by modifying their conduct today and disaffiliating from Planned Parenthood.

What may matter for Planned Parenthood is not winning on appeal but buying time. Affiliates rely on a variety of funding sources, including private donations, state Medicaid programs, family planning funds, and patient fees. Wins in the lower courts may run out the clock on the Medicaid exclusion, which is set to expire next year. Even if Planned Parenthood loses on appeal, the lawsuit will have bought affiliates more months of funding in what for the moment appears to be a finite period before the restriction expires.

The reality is that Planned Parenthood’s lawsuit will raise the stakes for Republicans when they are forced to consider whether to reenact a similar provision next year. The GOP faced a difficult choice between placating base voters staunchly opposed to abortion and moving to the center on an abortion issue that could cost them vulnerable seats. Kicking the can down the road didn’t make that decision any easier. And with this win in court, Planned Parenthood has made the stakes of Republicans’ choice that much higher.

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