Health Equity blog

The One Big Beautiful Bill Act, signed into law on July 4, included a section that bars federal Medicaid funds from being “used to make payments” to a “prohibited entity” for items and services furnished during the year following enactment of the Act. The definition of “prohibited entity” is a non-profit entity that meets certain criteria including providing abortions (other than in the case or rape or incest or where the women’s life is in danger) and has received more than $800,000 in Medicaid reimbursements in 2023. Medicaid beneficiaries were barred from coverage with a health care provider that also provides abortion services. Although the bill did not specifically name Planned Parenthood, the narrowly defined provision is widely viewed as an attempt to defund Planned Parenthood. On July 28, a Federal District Court judge in Massachusetts issued a preliminary injunction that stops enforcement of the funding ban against Planned Parenthood and any affiliates. In issuing the order, the court reasoned that Planned Parenthood demonstrated a “substantial likelihood” that the legislation’s exclusionary language that was targeted at Planned Parenthood was unconstitutional and “threatens an increase in unintended pregnancies and attendant complications because of reduced access to effective contraceptives, and an increase in undiagnosed and untreated STIs.” The administration has appealed the ruling and also sought to stay the preliminary injunction pending the appeal.

In examining previously published research, the Kaiser Family Foundation issued a recent “data note” that analyzes if, and to what extent, immigrants contribute to the economy in U.S. rural areas. Although immigrant adults comprise only 5% of both the rural adult population and rural adult workforce, they hold a disproportionate share of certain occupations, such as agriculture workers (28%), physicians (14%), and construction workers (10%). Nonetheless, among them, noncitizen immigrant workers in rural areas are more likely to have lower incomes and be uninsured.

On July 24, President Trump issued an executive order addressing homelessness, particularly for such individuals afflicted with mental health complications or substance use disorders (SUD), by shifting federal policy toward involuntary civil commitment, public safety, and treatment-based interventions, and away from a top priority of trying to get people living on the streets into appropriate housing. The order also directs several federal departments, including the Department of Health and Human Services (HHS), to evaluate federal grant programs and prioritize funding for states and municipalities that actively crack down on unlawful drug use, urban camping and loitering, and urban squatting “to the maximum extent permitted by law.”

There have been several updates with litigation centered around gender affirming care. On August 1, sixteen states and D.C. filed a federal suit against the Trump administration for what the plaintiffs claim have been efforts to establish a “de facto” national ban on gender affirming care for adolescents. The plaintiffs’ complaint alleges numerous instances of concerted efforts, including criminal investigations and threatened prosecutions, by the Department of Justice (DOJ) and others arguably as a means by which to intimidate and instill fear among providers who might otherwise provide such services to their patients. Meanwhile, on August 6, the 10th Circuit Court of Appeals affirmed an Oklahoma Federal District Court’s decision denying the plaintiffs’ request to enjoin a state law that bans providers from providing gender affirming care to minors. Lastly, on August 8, several representative state prison transgender inmates filed a class action lawsuit in federal court against Georgia over a new law that bans them from receiving gender affirming care, claiming it is unconstitutional under the 8th Amendment’s prohibition of cruel and unusual punishment.

On August 4, the Department of Veterans Affairs (VA) published a proposed rule to reinstate its exclusion of nearly all abortions and abortion counseling from the scope of its “medical benefits package” for veterans and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) benefits program beneficiaries (available to eligible family members, caregivers, and survivors of veterans). In 2022, the VA under the Biden Administration had narrowly loosened these exclusions, determining that abortions are also necessary and thus covered for veterans and CHAMPVA beneficiaries to protect health or in cases of rape or incest. The Proposed Rule would only allow for abortion, if necessary, in life threatening situations.

On July 4, President Trump signed the One Big Beautiful Bill Act (P.L.119-21). Congress used the budget reconciliation process to extend expiring 2017 tax cuts and other Administration priorities, while using health care, especially Medicaid, to partially pay for the new law. The Congressional Budget Office (CBO) estimates that Medicaid would be cut by over $1 trillion through work requirements, changes to provider taxes and other provisions leaving an estimated 10 million people uninsured by 2034. The negative effects to health care from this bill will be wide-reaching. Check out our HLB summary here.

There have been notable federal developments related to gender-affirming care in recent weeks. On July 2, a federal judge ordered the FDA, CDC, and other federal agencies to restore the health care-related webpages they had “arbitrarily and capriciously” removed following Executive Order 14168 “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” The court ruled that in implementing the executive order the agencies ran afoul of the Administrative Procedure Act. On July 9, the FTC hosted a workshop entitled, “The Dangers of ‘Gender-Affirming Care’ for Minors”. The DOJ has also recently announced that it has subpoenaed more than 20 health care providers who provide gender-affirming care to minors. These actions are part of its ongoing investigations into potential health care fraud related to these procedures, as previously directed by Attorney General Pam Bondi (more on the DOJ’s orders here).

On July 14, HHS issued a notice reinterpreting the definition of “Federal public benefit” under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. As a result, HHS has identified additional HHS programs now considered to provide “Federal public benefit[s]” including, for example, Head Start and Mental Health and Substance Use Disorder Treatment block grants. HHS Secretary Robert F Kennedy, Jr. stated that the reinterpretation “restores integrity to federal social programs, enforces the rule of law, and protects vital resources for the American people.” On July 22, a group of 21 attorneys general have sued the Trump Administration, asking a court to stop the policy change arguing that the change is unlawful.

On June 26, the U.S. Supreme Court issued its decision in Medina v. Planned Parenthood South Atlantic, ruling that the Medicaid Act’s any-qualified provider provision does not contain language that clearly shows Congress’s intent to create a private right of action against a state for non-compliance with the Medicaid Act. Since other provisions of the law similarly lack explicit language granting a private right of action, the ruling may have broader implications for future litigation under the Medicaid Act. You can read more about this decision here.

On June 18, in Purl v. U.S. Department of Health and Human Services, the U.S. District Court for the Northern District of Texas vacated the 2024 HIPAA Privacy Rule to Support Reproductive Health Care Privacy (“New HIPAA Rule”). The New HIPAA Rule, which amended the HIPAA privacy regulations, imposes additional restrictions on the disclosure of a person’s reproductive health information for criminal and civil investigations and prosecutions. The Purl decision did not, however, affect the New HIPAA Rule’s amendments to the HIPAA privacy regulations regarding certain Notice of Privacy Practices provisions pertaining to substance use disorder (SUD) regulations.