![\"An](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/09\/meridian-clinic-1024x683.jpg\")
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An exam room inside the Planned Parenthood in Meridian, Idaho. It is the last Planned Parenthood in the state, following funding cuts during the first Trump administration and a near-total abortion ban enacted in 2022. (Photo by Kyle Pfannenstiel\/Idaho Capital Sun)<\/p>\n
First in a five-part series.<\/em><\/p>\n To some, the warning bells started sounding years ago.<\/p>\n <\/p><\/a> When a Republican supermajority in the Texas legislature gutted the state\u2019s family planning budget in 2011 and then in 2015 kicked Planned Parenthood \u2014 the country\u2019s largest reproductive health care provider \u2014 out of its Medicaid family planning program, reproductive health advocates assumed they would one day see the same script unfold on the national stage. Other states followed with their own legislation to cut public funding to abortion-associated providers, including Iowa, Wisconsin, Indiana, Missouri and Kansas. In Arkansas,\u00a0more than 60%<\/a> of the state\u2019s counties no longer have maternal health services.<\/p>\n By many accounts, the way the reproductive health care landscape has shifted in the years since, particularly in Texas, has been horrifying.<\/p>\n \u201cPeople have been screaming about these changes and these erosions in access to care and what that means for people,\u201d said Kathy Kleinfeld, director of Houston Women\u2019s Reproductive Services, who has worked in Texas for more than 30 years.<\/p>\n \u201cWe see patients here who can\u2019t find an OB and just need a basic ultrasound,\u201d she said.<\/p>\n Anti-abortion groups\u00a0rejoiced<\/a> this summer when Planned Parenthood Gulf Coast announced the Sept. 30 closure of\u00a0two of its six Houston-area clinics<\/a> in the nation\u2019s fourth largest city. The last two clinics in Louisiana that are part of the same affiliate also will shut down. None of the four provided abortions. In 2024, the Gulf Coast affiliate reported serving nearly 54,000 people at all of its clinics.\u00a0\u00a0<\/p>\n The Healthy Texas Women program, created after the 2011 state cuts to fill the need for free reproductive health care without Planned Parenthood and other clinics, today lists a mere five doctors to choose from in a 30-mile radius who can provide family planning and breast and cervical cancer screenings within one clinic. About 161 providers offer family planning only.\u00a0<\/p>\n \u201cThere\u2019s a natural tendency to think, \u2018That\u2019ll never happen,\u2019 until it does,\u201d Kleinfeld said.\u00a0<\/p>\n Now it is happening on a national scale. In July, Republican majorities in the U.S. House and Senate passed a massive budget bill that stripped Medicaid funding from organizations that provided abortion care and received more than $800,000 in reimbursements in fiscal year 2023. Signed by President Donald Trump, the new law is in effect until July 2026 and also affects independent clinics like Health Imperatives in Massachusetts and Maine Family Planning.\u00a0<\/p>\n Medicaid, the federal-state insurance program for low-income individuals and families, is expected to lose\u00a0nearly $1 trillion<\/a> over 10 years under the law.\u00a0<\/p>\n Planned Parenthood\u2019s national operation and two of its nearly 50 affiliates quickly sued and\u00a0won an injunction<\/a> that allowed clinics to continue billing Medicaid. But the Trump administration appealed the decision, which was\u00a0granted\u00a0<\/a>Sept. 11, blocking Planned Parenthood from Medicaid funding without explanation. It left some affiliates telling Medicaid patients that their insurance will no longer be accepted, while others are leaning on promises from elected officials to backfill the lost funding, such as\u00a0clinics in Washington state<\/a>.<\/p>\n Maine Family Planning filed a separate lawsuit, followed by<\/a>\u00a022 states and the District of Columbia<\/a> who argue the new rule harms their residents.\u00a0<\/p>\n Danika Severino Wynn, vice president of care and access at Planned Parenthood Federation of America, said nearly 200 of their approximately 600 clinics around the country could close because of the provision, based on affiliate-reported data and public information from the Guttmacher Institute.<\/p>\n \u201cEven in states that don\u2019t experience closures, there will be ripple effects across the country, putting pressure on sexual and reproductive health providers in every state and driving up wait times, travel distance, and staffing needs,\u201d Severino Wynn said in a written statement.<\/p>\n Dozens of Planned Parenthood clinics closed after the Trump administration pulled their family planning grants earlier in the year. And so far nearly a dozen clinics have cited the new Medicaid provision. Planned Parenthood health centers are still encouraging patients to call them for help finding care.<\/p>\n The money that Trump and Congress barred does not cover abortion services. The Hyde Amendment<\/a> \u2014 renewed annually since 1977 \u2014 already prohibits federal funding of most abortions. But the fact that Planned Parenthood provides abortions and lobbies for access is what motivates anti-abortion advocates, who have called for the organization to be \u201cdefunded\u201d for decades.<\/p>\n \u201cWhat\u2019s been very kind of unclear in the messaging, deliberately, is that we\u2019ve never, ever billed Medicaid for abortion, not one penny ever,\u201d Health Imperatives president and CEO Julia Kehoe said. \u201cBut no, what they\u2019re saying is we\u2019re not letting any organization that provides abortion also provide cancer screenings. \u2026 How could that be anything but punishment?\u201d<\/p>\n It\u2019s not just anti-abortion groups using that rhetoric. The U.S. Department of Justice has argued\u00a0in federal court<\/a> that to fund any abortion provider for broad reproductive health services is to indirectly fund abortion.<\/p>\n One thing Kehoe and many Planned Parenthood leaders say they are unwilling to do is erase abortion services from their reproductive health menu \u2014 something that over decades has happened in many OB-GYN practices around the country.\u00a0<\/p>\n \u201cFor us, abortion is a standard,\u201d said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts, one of the co-plaintiffs that sued the federal government. \u201cIt is an evidence-based procedure that really does address a reproductive health need, whether that\u2019s ending a pregnancy for a medical reason or a personal reason or even a safety reason.\u201d<\/p>\n Severino Wynn said Planned Parenthood will continue providing abortion everywhere it is legal, but that the organization is considering structural changes to adapt to the federal policy change.\u00a0<\/p>\n \u201cFaced with the threat of Medicaid \u2018defund\u2019 and devastating harms to patients, Planned Parenthood Federation of America and its member organizations have explored whether \u2014 depending on how the courts rule \u2014 there are options for members to continue to provide care to Medicaid-insured patients while another Planned Parenthood member provides abortions in the same area,\u201d she said.<\/p>\n Last week, Planned Parenthood of Wisconsin was the first affiliate to\u00a0pause its abortion services<\/a>.<\/p>\n As the largest and most politically influential advocate for abortion rights, Planned Parenthood has for decades been the anti-abortion movement\u2019s most focused target.<\/p>\n More than a century old,\u00a0Planned Parenthood<\/a> was started by nurse Margaret Sanger, who opened the first birth control clinic in New York in 1916, when terminating a pregnancy was against the law and many women died or suffered injury attempting illegal abortions. According to the\u00a0Margaret Sanger Papers Project<\/a>, Sanger was motivated to find safe family planning options for women after watching her mother\u2019s health decline after 18 pregnancies and seven miscarriages.\u00a0\u00a0<\/p>\n Throughout their decades-long effort to remove Planned Parenthood from public health programs, anti-abortion leaders, high-profile lawmakers and others branded Planned Parenthood as a eugenicist organization, using Sanger\u2019s documented ties to the eugenics movement and speeches to white supremacists, something Planned Parenthood\u00a0finally addressed<\/a> in 2021.\u00a0\u00a0<\/p>\n In the 1920s, Sanger founded the American Birth Control League and the Birth Control Clinical Research Bureau, laying the foundation for what was to become Planned Parenthood Federation of America, and whose clinics started offering abortion services in the 1970s, after abortion became legal first in New York and then throughout the country.\u00a0\u00a0<\/p>\n The nonprofit has since grown into a complex organization made up of 49 independently structured and operated affiliates, including PPFA. Many of its approximately 600 clinics do not offer abortion at all.\u00a0<\/p>\n Planned Parenthood has faced significant challenges in the last few years, from state and federal anti-abortion policies and lawsuits to union workers pushing back on\u00a0layoffs<\/a> and\u00a0working conditions<\/a>. In February, the\u00a0New York Times<\/a> reported on malpractice claims and allegations of substandard care at Planned Parenthood clinics in New York and noted standards are suffering at some clinics because of funding cuts and a lack of fundraising support. Anti-abortion groups have used that report to argue Planned Parenthood does not deserve federal funding.\u00a0<\/p>\n Brandi Swindell, a leader in the anti-abortion movement who has long accused Planned Parenthood of shoddy care, argues Planned Parenthood \u201cstole women\u2019s health care and made women\u2019s health care about abortion on demand.\u201d She runs Stanton Healthcare, a small network of pregnancy centers headquartered in Meridian, Idaho, that offers free limited OB-GYN and prenatal services and that discourages abortion and most forms of contraception, beyond natural family planning. Stanton\u2019s clinic is across from the Meridian Planned Parenthood, which\u00a0led to a lawsuit<\/a> over accusations that protesters and staff were harassing Planned Parenthood patients.\u00a0<\/p>\n Nearly a decade later, Stanton has grown to four physical centers offering varying services that span Idaho, California and Ireland; two mobile clinics; and a public policy center in Washington, D.C. The Idaho centers see about 1,000 new patients every year and book approximately 4,000 appointments annually, Swindell said.\u00a0<\/p>\n She said part of her long-term goal is to replace Planned Parenthood as a trusted health care brand for people with limited income and health care options.<\/p>\n Swindell told States Newsroom that Stanton continues to grow but will likely not scale up to Planned Parenthood\u2019s size, but noted they are part of the wider and growing \u201cpregnancy center and life-affirming women\u2019s clinic movement.\u201d\u00a0<\/p>\n \u201cPart of that means replacing Planned Parenthood in the hearts and minds of the women who walk through our doors, that women wouldn\u2019t feel any sort of cultural pressure that because they don\u2019t have the perfect circumstances surrounding their pregnancy that they don\u2019t deserve to have the support and the ability to carry that pregnancy to term and to have that baby,\u201d Swindell said.\u00a0<\/p>\n The movement at large has dismissed concerns about Medicaid patients losing access to affordable sexual and reproductive services, including contraception.\u00a0<\/p>\n The Charlotte Lozier Institute, a research arm of anti-abortion lobbying organization Susan B. Anthony Pro-Life America, released an\u00a0analysis in April<\/a> claiming an estimated 5,500 federally qualified health centers and 3,300 rural health clinics nationwide can provide women\u2019s health services, compared to 579 Planned Parenthood clinics, as of earlier this year. The study excluded schools and sites located in shelters or other residential buildings, and the researchers said they called clinics and reviewed websites to ensure they offered women\u2019s health services, including OB-GYN care, well-woman care, and family planning. But they also acknowledged the study could be overestimating the availability of women\u2019s health at those centers.\u00a0<\/p>\n By contrast, the Guttmacher Institute, a research and policy organization that works to advance sexual and reproductive health and rights,\u00a0analyzed<\/a> the number of patients seeking contraception at Planned Parenthood clinics versus other available health care options. The study included all 50 states and the District of Columbia, using 2020 data, and found that on average, the increase to other health sites would be about 50%. Some states would have to increase the capacity of other health centers by two or three times, such as Minnesota (192%), Vermont (209%), Connecticut (263%) and Utah (302%).\u00a0<\/p>\n \u201cWhen you look solely at the number of clinics, Planned Parenthoods look like a small share; they\u2019re only about 6%, but they\u2019re serving 33% of all the patients seen at these clinics across the country,\u201d said Alicia VandeVusse, senior research scientist at Guttmacher. \u201cIt\u2019s just not realistic to assume that federally qualified health clinics can double their capacity overnight. It\u2019s not feasible.\u201d<\/p>\n Tessa Cox, senior research associate at the Lozier Institute, told States Newsroom in an email that women have access to contraception in many venues, including over the counter, and said Guttmacher\u2019s numbers could be inflated based on insurance coverage or those who paid out of pocket. And besides that, Cox said, focusing on contraception \u201cignores the full picture of women\u2019s health care needs.\u201d Cox said Planned Parenthood\u2019s focus is on abortion, not health care.\u00a0<\/p>\n \u201cWomen deserve comprehensive care from providers who offer real health care,\u201d Cox said.<\/p>\n The Texas legislature first moved to reduce the statewide family planning program budget in 2011 from $111 million to $37.9 million, rocking the entire network of providers and clients.<\/p>\n State officials repeatedly reassured those who were worried about reproductive health clinics closing their doors that there were enough providers through federally qualified health centers and other programs to fill in whatever gaps might emerge from the cuts. But public health researchers warned that the capacity wasn\u2019t there to take on the number of reproductive health patients served by Planned Parenthood. An\u00a0academic study from George Washington University<\/a> at the time showed community health centers around Texas would have to expand their capacity fivefold to close the gap.\u00a0<\/p>\n Instead, many of them closed.<\/p>\n Within the first two years, Texas lost about 25% of all clinics, most of which were not Planned Parenthoods, according to\u00a0Resound Research for Reproductive Health<\/a>. Out of 334 clinics, 82 closed or stopped offering family planning services, and 49 reduced their hours of operation. Planned Parenthood closed 28 of these clinics. Others that remained stopped offering sliding scale fees, and fewer clinics offered birth control options such as IUDs, implants and vasectomies to cut costs.<\/p>\n \u201cThe impact was immediate and significant,\u201d said Kari White, executive and scientific director at Resound Research.<\/p>\n Then in 2015, the Texas Legislature officially booted Planned Parenthood from the full benefit Medicaid program. The nonprofit and some Medicaid patients sued, and Planned Parenthood clinics continued normal operations for several years, until an appellate court allowed the provision to stand in 2020.\u00a0<\/p>\n Between 2012 and 2022, Texas was among the top five states for\u00a0repeat teen births<\/a>. Nearly half of Texas counties are classified as maternity care deserts by the March of Dimes. Less than 3 family planning clinics are available per 100,000 women, compared to more than 5 per 100,000 on average in the rest of the country. About 30% of women statewide have not had a cervical cancer screening in more than three years, and cervical cancer rates remain higher in Texas than the national average.<\/p>\n Now that the U.S. Supreme Court has allowed South Carolina to strip Planned Parenthood from its state Medicaid program (which Planned Parenthood is\u00a0once again fighting<\/a>), other states are following.<\/p>\n White said not long after the Medicaid exclusion became final in Texas, Resound Research for Reproductive Health made nearly 200 calls to Medicaid providers around the state to determine how much access still remained. The\u00a0study<\/a>, released in 2022, found that only one-third of the sampled providers were able to fulfill the caller\u2019s requested contraception method and accepted their Medicaid plan. Just 14% could see patients for contraception within two weeks.<\/p>\n \u201cThe safety net is just not ready to take on these patients,\u201d White said.<\/p>\n The federal tax and spending cuts bill didn\u2019t single out Planned Parenthood clinics by name, but the dollar amount and the language ensured it would mostly affect their clinics, whether or not those clinics provide abortions. In the two months since Trump signed the bill into law, numerous Planned Parenthood clinics have already closed or announced they will soon close, including\u00a0two in Ohio<\/a>,\u00a0two in Louisiana<\/a>, and\u00a0five in California<\/a>.<\/p>\n Kleinfeld\u2019s clinic used to provide abortions before the U.S. Supreme Court\u2019s Dobbs v. Jackson Women\u2019s Health Organization decision in 2022 ended federal abortion rights. Now she counsels patients about their options for leaving the state if they need an abortion. And she knows what\u2019s coming for every other person nationwide who needs sexual and reproductive health care if the Medicaid cuts are allowed to stand.<\/p>\n \u201cIt has much farther-reaching consequences than people realize,\u201d she said. \u201cWe\u2019re not talking about Medicaid paying for abortion. We\u2019re talking about Medicaid covering reproductive health care that encompasses pap smears, breast exams, and sexually transmitted infections.\u201d<\/p>\n Providing services to people with low incomes has been a priority for Planned Parenthood since the Title X program providing federal funding for family planning services became law in 1970, when Republican Richard Nixon was president.<\/p>\n Providers are reimbursed through Medicaid after the fact for specific health services, not granted large sums of money to use as they please. In 2023, the Planned Parenthood affiliates collectively received more than $792 million in government health services reimbursements and grants, including Medicaid, according to the national organization\u2019s\u00a02024 report<\/a>.\u00a0<\/p>\n The report also notes that affiliates served more than 2 million patients and provided nearly 9.5 million services, including more than 360,000 cervical and breast cancer screenings, 5.1 million tests and treatments for sexually transmitted infections, and 2.2 million birth control services, including intrauterine devices and implants.<\/p>\n The ability to provide services to anyone, regardless of their ability to pay, is a key feature that clinic and affiliate directors tout. But many of them also cite the speed with which a patient can be seen, especially in states with abortion bans where it is becoming more difficult to see an OB-GYN in a timely manner because physicians are leaving and rural clinics are closing.<\/p>\n In some ways, Planned Parenthood clinics are an urgent care option for sexual and reproductive health. Patients in places like Idaho and Kentucky, but also in states without near-total abortion bans like Massachusetts, say they were told they\u2019d have to wait months to get an annual wellness exam \u2014 which includes cancer screenings \u2014 at a primary care or OB-GYN clinic, but were able to get in the same day or within a few days at their local Planned Parenthood.<\/p>\n \u201cIn this area, we hear a lot about patients coming in who can\u2019t get into their gynecologist for four to 12 weeks,\u201d said Marissa Brown, health center manager of the Planned Parenthood clinic in Bloomington, Indiana. \u201cThat\u2019s for routine care and specific issues. We can do that in a few days to two weeks, and we offer walk-in appointments too.\u201d\u00a0<\/p>\n It\u2019s already commonplace for people who need to terminate a pregnancy to have to travel, even in life-threatening situations. What the future potentially holds is more people now having to travel for routine cervical and breast cancer checks or a painful urinary tract infection, for HIV testing or birth control. Many who can\u2019t afford to travel will forgo treatment entirely.<\/p>\n Ruth Richardson, president and CEO of Planned Parenthood North Central States, said her affiliate could lose $11 million with the new federal rule.\u00a0<\/p>\n \u201cWe\u2019re really in a moment of what I\u2019ve described as manufactured chaos,\u201d Richardson said. \u201cWe\u2019re also going to see, with the delay of getting access to care, it\u2019s going to overwhelm our emergency rooms, and that impact is not just going to be on individuals that are the lowest income. That\u2019s going to have impacts across the board, on everyone.\u201d<\/p>\n Coming Tuesday: <\/strong>Planned Parenthood clinics offered a range of services from primary care to behavioral health services before the federal funding cuts.<\/em><\/p>\n\n\n ![\"Unraveling](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/09\/unraveling-logo-v5.png\"){kind=logo}
<\/div>\n<\/div>\n<\/div>\n\n\n ![\"Kathy](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/09\/kleinfeld.jpg\")
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<\/div>\n<\/div>\n<\/div>Anti-abortion groups tout federally qualified health centers as alternative\u00a0<\/h4>\n
\u2018The safety net is just not ready to take on these patients\u2019<\/h4>\n
\n\n ![\"Protesters](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/09\/pro-life-protest.jpg\")
<\/div>\n<\/div>\n<\/div>Same-day services have become just as important as low cost in some places<\/h4>\n