A new federal law that would “defund” Planned Parenthood could gut the system people have used to obtain abortions since the fall of Roe v. Wade, disproportionately closing the clinics in states that have become abortion havens for people living under bans. 

Backed by President Donald Trump, the spending law prohibits reproductive health clinics from billing services to Medicaid if they provide or are part of health networks that perform abortions, are nonprofits and receive over $800,000 per year from the federal government. Although that part of the law is blocked for now, Planned Parenthood is gearing up for major financial losses that, unless new funds emerge, could shutter health centers across the country, particularly in states where abortion is legal and Medicaid programs more robust. 

The move has been framed by politicians across the spectrum, anti-abortion activists and reproductive health providers alike, as an effort to eliminate a major source of funding for Planned Parenthood, specifically. Abortion opponents have claimed this “defunding” as their biggest victory since the 2022 Supreme Court decision to overturn Roe v. Wade and end federal abortion rights. 

Currently, about one-third of all of Planned Parenthood’s revenue comes from federal and state funding; Medicaid, the health insurance program for low-income Americans, is the biggest single source. Medicaid insures 1 in 5 Americans, and it does not cover abortion unless states allot their own specific funds to do so. But the program remains a major source of income for Planned Parenthood because it covers other services patients might get at clinics such as testing for sexually transmitted infections, breast exams and contraception. If clinics can’t bill any of those services to Medicaid, patients covered through the program will have to go elsewhere for health care — or simply go without.

A federal judge in Massachusetts blocked that part of the law after a legal challenge by Planned Parenthood, which argued it violates the U.S. Constitution’s free speech and due process protections. A hearing in the case will take place later this month. But across the country, Planned Parenthood representatives expressed worry that this relief is temporary at best. Many clinics have already stopped accepting Medicaid. Others are continuing to see patients covered by the program, but refraining from submitting those insurance claims for payment. All are making contingency plans in case they are unable to reenter the Medicaid program.

Many are scrambling to find alternative sources of revenue to stay afloat. Clinics are particularly vulnerable in places where abortion is legal and Medicaid programs receive more state investment. In many of those states — such as Colorado, Maryland, New Mexico and New York — abortion clinics have seen a dramatic influx in out-of-state patients since the fall of Roe. Clinic closures in those places could force patients to travel even farther for abortions, get care later in pregnancy or drive up what patients have to pay. It could also mean more people stay pregnant. 

“This just feels like this could be another huge shock to the system,” said Caitlin Myers, an economist at Middlebury College who has tracked abortion-related travel patterns over the past three years.

Last year alone, 155,000 people traveled to another state for an abortion, according to the Guttmacher Institute, a nonpartisan research organization. About 1 in 4 abortion patients in Colorado came from another state. In New Mexico, it was 69 percent. More than 7,000 patients traveled to New York, the fourth-largest state by population, for an abortion last year. Thousands more made the journey to Maryland.

Clinic closures would likely create new challenges for those patients, including longer waits and more expensive journeys to find abortions.

“In a lot of states that have received a lot of people traveling from out of state that have become critical, there really is a strain on clinic capacity,” said Isaac Maddow-Zimet, a data scientist at Guttmacher who tracks abortion-related travel patterns. “Clinics have learned to scale up capacity to serve those patients. If there were a significant number of clinic closures, it would really have an impact on people’s ability to get in-person care.”

That’s a looming possibility in New York, where the Planned Parenthood affiliate with 23 health centers could lose about $35 million in federal Medicaid dollars. That’s about a third of the $103 million in operating revenue it reported last year.

Organization leaders are hoping the state government could step in — but if not, most of the affiliate’s clinics could shut down, said Robin Chappelle Golston, who heads Planned Parenthood Empire State Acts, the organization’s advocacy arm. That wouldn’t just affect New Yorkers, she said. Clinics in the state see patients from numerous other states, including hundreds from Texas and thousands from Florida last year.  

“It’s just going to make it harder for people to get the care they need. We will have to reduce services and put a burden on other providers,” she said. “You clog up the whole system, where people aren’t able to get care in the time they need it.”

Planned Parenthood Rocky Mountain, which operates clinics in New Mexico and Colorado, is already turning away patients covered by Medicaid. Medicaid covers about a fourth of their patients in each state.

“Planned Parenthood Rocky Mountain has been around for over 100 years. We’re not going to go away,” said Jack Teter, the organization’s vice president of government affairs. “We need our state legislatures to step in.”

In the immediate future, he said, the organization may actually have more availability to see out-of-state abortion patients: there are slots now that would otherwise have gone to people covered by Medicaid, who can no longer get treatment. But he wouldn’t say if the organization might have to scale back if New Mexico and Colorado, which are both fully governed by Democrats, don’t or can’t replace those federal funds.

“These are safe haven states with strong reproductive health care access supporting trifecta governments. If they can’t find 3 or 4 million dollars to replace the loss of federal funding, that’s embarrassing,” he said.

While it’s still not clear how many clinics might close across the country, the consequences could be vast, making the journeys patients must make  to travel for care — already hundreds or in some cases thousands of miles — too arduous to complete. With that, more people may be forced to stay pregnant.

One study, published this June in the American Journal of Public Health, found that the average travel time for an abortion after states began putting near-total bans in place jumped from 2.8 hours to 11.3. And 17 percent of people traveling for an abortion had their procedure at 13 weeks of pregnancy or later, compared to only 8 percent before the end of Roe, a development the researchers attributed to the greater challenges they faced in finding care.

Already, patients crossing state lines for care have had to navigate increasing delays in getting abortions, in part because traveling hundreds of miles for an appointment involves logistics: finding child care, taking time off work or raising the funds necessary to finance a trip. 

Planned Parenthood Illinois, which receives about $4 million per year in Medicaid funds, does not immediately anticipate many of its clinics closing, said Tonya Tucker, the organization’s interim CEO. But, she added, clinic closures in other states could mean even more patients traveling to Illinois —  resulting in longer wait times and care that comes later in pregnancy, thus costing more. Already, abortion providers there saw more than 35,000 out-of-state patients last year.

“We have an expectation that people may have to travel farther distances, and how we prepare for that is really important,” said Megan Jeyifo, who runs the Chicago Abortion Fund, one of the largest such funds in the country. “If the safety net is going to continue to shrink in this country and people have less resources, that will mean our costs go up.”

In Illinois, she said, abortion providers and reproductive rights activists are brainstorming ways to undercut potential clinic losses. That could mean expanding the capacity of independent clinics, which already provide a large share of abortions, recruiting more health care providers or leaning on options such as telehealth, which does not require travel and is far cheaper than in-clinic abortion. About 1 in 4 abortions are already performed through telehealth, with half of abortion provided for people who live in states with bans and who receive abortion pills from providers in other states. 

But building out those alternatives will require time and resources. Separate from their efforts to cut funding for physical clinics, abortion opponents have been pressing for federal restrictions on abortion medication, including a national ban on telehealth.

“As people’s options get more and more constrained you never know what that one additional obstacle is going to be that says someone is not able to obtain an abortion,” Maddow-Zimet said.