The Budget Reconciliation Bill
By Diane Halcoussis
Proposed cuts to Medicaid and the Affordable Care Act marketplace threaten to strip millions of Americans—especially women and gender-expansive individuals in rural and low-income communities—of vital health coverage. If this budget reconciliation package passes, hospitals and clinics will face financial strain, putting many at risk of closure. One impact of this bill, particularly for women, is the proposal to remove Medicaid’s coverage of family planning services. This bill has broad impacts that would disproportionately impact rural residents and economically disadvantaged populations, leaving women with little or no income most impacted.
Cuts to Medicaid & ACA
If implemented, the budget reconciliation bill would make massive cuts to Medicaid and Affordable Care Act (ACA) marketplace coverage, increasing healthcare costs for many. Despite being on a list of exemptions, parents and pregnant folks will likely be impacted by the provisions that would take away coverage from low-income adults who cannot qualify for an exemption or submit documentation to satisfy the work requirements. Former Medicaid work requirements revealed that many folks who work or qualify for an exemption end up losing their coverage due to red tape. When people have to spend more money on healthcare or become unwell due to a loss of coverage, it makes it harder for them to care for their families. Medicaid currently provides health coverage to 2 in 5 children; cutting the Children’s Health Insurance Program (CHIP) and ACA marketplaces by $1 trillion would increase out-of-pocket expenses for pediatric care, deepening financial strain on families. (CBPP) Whether through strict documentation processes of “work requirements” or drastic reductions in funding for services, the aim seems to be driving people out of the public health system.
Medicaid Expansion at Risk
Medicaid expansion has been crucial for keeping rural hospitals and community clinics afloat—by covering services and underpinning local funding structures. Nationwide, Medicaid serves one in five women of reproductive age (18–49) and more than four in ten with low incomes. Nearly 40% of reproductive age women who are enrolled in Medicaid, rely on coverage through the ACA’s Medicaid expansion pathway. (KFF) Rolling back expansion would cut off essential care in rural areas, many of which are already classified as “maternity care deserts.” 36% of U.S. counties lacked hospitals, birthing centers, or obstetric providers in 2023. Withdrawing from expansion won’t just widen existing care deserts; it will create new ones, forcing rural residents to travel long distances or pay exorbitant fees for basic services. According to the Commonwealth Fund, states that did not expand Medicaid rank among the lowest in women’s health and reproductive care, while states that participated in expansion like Massachusetts, Vermont, and Rhode Island lead national rankings. (TCF) Reducing Medicaid expansion threatens to undermine women’s health and access to reproductive care across the country.
Hospital & Clinic Closures
Independent rural hospital closures would drive up costs and create hardships for local communities across the U.S. When a rural hospital shuts its doors, patients must travel farther for basic care, face steeper prices, and often forgo treatment altogether. Remaining clinics inherit greater patient loads—and greater financial strain—threatening the stability of local health systems. The Senate version of the bill included a new fund to support rural hospitals beginning in 2026, but this fund will not be enough to offset the cuts.
In many communities, Planned Parenthood is the sole provider of reproductive health services—contraception, STI testing and treatment, abortion services, pregnancy testing, cancer screenings (Pap smears, breast exams), and other preventive care. To provide these services, Planned Parenthood relies on one third of its revenue coming from federal and state funding, including Medicaid. The Supreme Court’s ruling last week will allow states in the U.S. to block clinics that provide abortions from receiving Medicaid funds. Currently, there are three more efforts threatening to reduce these services and possibly lead to clinic closures. (KFF)
- Medicaid cuts – the reconciliation bill would bar federal Medicaid payments to Planned Parenthood and similar providers. A provision also repeals cost-sharing reductions in abortion-access states, meaning insurers no longer share patients’ expenses and out-of-pocket costs would rise sharply.
- Title X defunding- The Trump Administration has withheld Title X funds ($20.6 million) from all nine Planned Parenthood grantees, citing misalignment with federal opposition to DEI policies. Altogether, 144 Planned Parenthood clinics in 20 states are affected by the Title X decision to withhold funding.
- Teen Pregnancy Prevention program elimination – The budget bill also proposes getting rid of this program, which currently awards six Planned Parenthood affiliates $5.6 million annually to pilot and evaluate interventions that reduce teen pregnancy and STIs.
Removing Medicaid and Title X support will force patients to travel farther, endure longer wait times, and reduce or eliminate access to contraception, STI screening, and other essential services. A 2021 KFF analysis found that, of the women on Medicaid who obtained family planning services, one in ten received care at Planned Parenthood. 85% of these patients obtained contraception and half received STI or gynecological services. If clinics close, where will these patients go? Unfortunately, clinic closures will lead some folks to migrate away from their communities, possibly out of state, to seek care, and it will lead others to forgo care entirely.
Reduced Family Planning Services
Family planning stands out as one of Medicaid’s most critical and utilized services. In 2021, 48 percent of women ages 15–49 continuously enrolled in Medicaid received family-planning services—ranging from counseling and contraceptive care to STI treatment and gynecological screening. (KFF) Currently, Medicaid reimburses clinics for providing services and its funding accounts for roughly three-quarters of all public dollars spent on family planning.
The reconciliation bill includes a ban on Planned Parenthood and other clinics from participating in the Medicaid program. Historically, excluding these types of providers from Medicaid has resulted in reduced access to contraception and increased births—births that are far more expensive and higher risk than contraception. We saw this in 2013 in Texas when the state saw a steep drop in Medicaid contraceptive claims and a rise in Medicaid-funded births after excluding Planned Parenthood as a participating provider. (KFF) Additionally, the Supreme Court ruling of Medina v. Planned Parenthood will result in fewer people being able to use their Medicaid coverage to obtain preventive services. Ensuring uninterrupted access to family planning not only safeguards health—it also prevents unintended pregnancies and eases financial burdens on low-income women. Everyone deserves access to quality healthcare and the proposed budget reconciliation bill is designed to push folks out of the system, force clinics to close, and reduce access to services.
The House is Next
Just this morning, the Senate passed the bill by a 51-50 vote with J.D. Vance breaking the tie. Now we wait to see if our politicians in the House will stop this bill and stand up for us or if they will capitulate to mass devastation for millions of Americans.
Diane Halcoussis is a writer for ReproHub. She is a member of the Women Donor’s Network where she focuses on reproductive justice in the workplace.