As we near the end of 2025, and as public health becomes increasingly politicized, attacks on sexual and reproductive health are more apparent than ever. Whether it be through Supreme Court cases, political opposition, or funding cuts, the same forces driving policies that negatively impact people living with and vulnerable to HIV are also behind the effort to erase reproductive healthcare access.
Everyone deserves the right to make informed, autonomous decisions about their health, well-being, care, and treatment. How will the current political landscape negatively impact one’s decision-making power?
The Supreme Court and Medicaid
On June 26, the Supreme Court released its decision in Medina v. Planned Parenthood South Atlantic. The case was brought by Planned Parenthood and Medicaid user Julie Edwards in South Carolina, challenging the state’s policy barring clinics that provide abortion from participating in the state Medicaid program. The Supreme Court ruled that Medicaid enrollees do not have a right to sue for access to a provider of their choice under Medicaid’s “free choice of provider provision.” AIDS United’s blog on this case, among other recent Supreme Court cases, can be found on our website.
This ruling will have a devastating impact on healthcare as we know it, as Medicaid plays a crucial role in providing reproductive health services to millions of individuals who have low incomes. Based on the decision, Medicaid enrollees in South Carolina and potentially in other states with historical opposition to reproductive rights will have significantly curtailed access to preventive care services such as contraception, STI testing and treatment, pre- and post-natal care, and cancer screenings that Planned Parenthood clinics provide. This will lead to more unintended pregnancies, worse pregnancy outcomes, undetected illnesses, and overall poorer health outcomes. Furthermore, because other states are expected to follow South Carolina’s example, we must also consider the effect such a loss in Medicaid revenue will mean for clinics. Likely, many will be forced to limit their service hours or shut down completely, exacerbating existing barriers to healthcare access for ALL patients, not just Medicaid recipients.
Budget Reconciliation
The Medina v. Planned Parenthood South Atlantic ruling comes amid Congressional efforts to slash Medicaid and “defund” Planned Parenthood in its recent budget reconciliation bill, H.R. 1. After an exceptionally rushed process, both chambers passed the bill, and on July 4th, Donald Trump signed it into law. This bill includes several harmful provisions that have major implications for sexual and reproductive health.
The bill calls for a $1 trillion cut to the Medicaid program – the biggest cuts in U.S. history. While Medicaid provides health care coverage to one in five Americans, cuts to the program would be devastating across the board, even if you aren’t a Medicaid recipient. Massive cuts would leave states with huge budget deficits that they can’t possibly fill on their own, which could lead to states either scaling back or completely eliminating their Medicaid expansions; cutting optional benefits and supplemental programs like over-the-counter contraception; deepening workforce shortages by not increasing reimbursement rates; and increasing uncompensated care costs. It’s likely to result in hospital closures, and potentially other clinics and maternity wards – particularly in rural and underserved areas.
Additionally, work reporting requirements are Medicaid cuts by another name. As we’ve seen in states such as Georgia and Arkansas that have implemented work reporting requirements, millions of people will lose health coverage due to administrative hurdles and the exemptions and carve-outs for specific populations that don’t work as they were intended to. Additionally, they do little to support or increase Medicaid enrollees’ employment – it would waste billions on administrative burdens, instead of putting that money back into healthcare directly.
Title X
This April, the Trump Administration stated it was withholding $35 million in Title X funding
from clinics in California, Hawaii, Maine, Missouri, Mississippi, Montana, Tennessee, and Utah without explanation, and these shifts come at a pivotal moment for the nation’s HIV response. The Title X program is intended to provide low- and no-cost contraception to everyone, regardless of their ability to pay. But, many Title X providers also offer other reproductive health care services like wellness exams, family planning education, basic infertility services, STI testing and treatment, and cervical and breast cancer screenings.
A July 18 New York Times article reported on a Department of Health and Human Services (HHS) request for a new program that would encourage women to get pregnant rather than use Title X resources for the full suite of family planning options. Any attempts to divert resources from the Title X program can lead to diminished capacity for the patients and communities that rely on Title X for essential health care and services – and that includes HIV testing and referrals. Such a departure from the program’s purpose is disappointing, yet not surprising.
USPSTF
The Supreme Court, in Kennedy v. Braidwood Management, found that the Affordable Care Act’s (ACA) requirement that insurance plans cover preventive services recommended by the United States Preventive Services Task Force (USPSTF) at no cost is constitutional. The decision also affirmed that USPSTF members are appointed constitutionally, and that the HHS Secretary can remove USPSTF members at will and can review and block their recommendations.
This case put preventative services recommended by USPSTF after 2010 (when the ACA was enacted) at risk – which would make services and medications like women’s preventive services and PrEP subject to copays, deductibles, or coinsurance, which could negatively impact access to these services.
The case has direct implications for reproductive health services. Invalidating the preventive services provisions would have caused immense harm nationwide, as it could have eliminated or reduced coverage for services like contraception, screenings for gestational diabetes, and other preventive measures recommended by the USPSTF. Despite the Supreme Court’s decision, there is concern that the case could restrict access to preventive care, as it’s the latest in a string of attacks against the Affordable Care Act.
EMTALA
In 1986, the Emergency Medical Treatment and Labor Act (EMTALA) was enacted to ensure Medicare-participating hospitals provide emergency medical services for all patients, regardless of their ability to pay. In 2022, the Biden administration issued guidance clarifying that EMTALA requires these hospitals to provide emergency abortion care when necessary to stabilize patients’ medical conditions, regardless of conflicting state laws.
This position, though, was rescinded in June of this year by the Trump administration, alongside the administration’s commitment to reviewing the safety record of medication abortion. The decision to revoke this guidance does not change or otherwise disturb EMTALA’s statutory protections, but it will have dire implications.
Whether it’s increased caution from hospitals in abortion-ban states to offer emergency abortion care until a woman’s life is at risk or increasing the existing fears and confusion around accessing reproductive health care, one thing remains clear – this is an attack on health and evidently, lives.
Gender Affirming Care
In the Supreme Court Case United States v. Skrmetti, the Federal Government challenged Tennessee’s ban on gender-affirming care for minors, arguing it violated the Equal Protection Clause of the U.S. Constitution by discriminating based on sex and transgender status.
The Court upheld 6-3 Tennessee’s ban on gender-affirming care for trans minors, saying it doesn’t violate equal protection under rational-basis review. This ruling failed to protect families’ freedoms and allowed politicians’ targeting of transgender youth’s healthcare needs to stand. This erodes support structures for transgender youth in schools, signaling acceptance of state restrictions that could spill over into limiting inclusive curriculum and resources for trans students.
Any attacks on gender-affirming care have a significant and detrimental impact on HIV prevention and treatment, as people are unable to get the care and services they truly need.
ICE
An uptick in ICE operations and attacks on immigrants raises major concerns around patient privacy and health care access. Not only does ICE have access to Medicaid data, which further puts the low-income individuals the program serves at risk, but the presence of ICE itself deters people from seeking the care that they need, and that includes reproductive health care, especially during emergencies. While federal law requires emergency medical services be provided regardless of immigration status, that doesn’t change the fear and prosecution people face when they are accessing health care services.
These barriers only magnify in the custody of immigration authorities. As we’ve seen in the news, there has been restricted access to comprehensive reproductive health care services like emergency contraception, abortion, and prenatal care for people in ICE custody. And, when people can access this care, the quality is often abysmal, and comes with added attacks on the bodily and reproductive autonomy through coercive and unconstitutional policies and practices.
Where do we go from here?
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