States Ready Reproductive Health Battles as New Trump Term Nears

Reproductive health groups are gearing up for policy fights over abortion and contraceptive access in state legislatures as the second Trump administration is expected to roll back key protections at the federal level.

Legal analysts across the political spectrum expect President-elect Donald Trump’s administration to withdraw Biden administration policies aimed at protecting abortion care in emergencies and health data privacy. The US Department of Health and Human Services could also resurrect a regulation from Trump’s first term limiting funding for family-planning centers.

Governors and state lawmakers are preparing for these changes by readying reproductive health legislation to pass within the next two months. Policy groups on both sides of the abortion debate are reaching out to state legislators on priorities for the 2025 sessions, including legislation to restrict or expand access to abortion medication and other reproductive health care.

The renewed efforts come as a growing number of abortion-seeking patients are turning to travel and telehealth while navigating a patchwork of state reproductive health laws in the aftermath of the US Supreme Court’s 2022 decision overturning the constitutional right to abortion.

“Trump had said that these are now state issues” and “our governors are taking that to heart and trying to make sure that they are protecting people’s rights to access this care,” said Christina Chang, executive director of the Reproductive Freedom Alliance. The coalition includes more than 20 governors and their staff who share strategies for protecting reproductive health care.

Abortion Pills Targeted

A key focus is mifepristone—a medication approved by the US Food and Drug Administration to be used with another medication called misoprostol to end pregnancies within the first 10 weeks.

A coalition of three Republican-led states is trying to keep a lawsuit going against the FDA’s regulation of mifepristone after the Supreme Court in June dismissed a challenge from anti-abortion doctors. Analysts have said the incoming administration could withdraw its legal defense of mifepristone.

Governors that take part in the alliance announced earlier this year efforts to stockpile medication abortion doses, and are having additional conversations in anticipation of “more restrictions or attempts to restrict medication abortion,” Chang said in an interview.

Oregon Gov. Tina Kotek (D) announced Nov. 18 an updated agreement to extend the state’s mifepristone stockpile expiration date to September 2028. Kotek said in a press release that “Oregon is not immune from federal attacks on our reproductive rights.”

At the same time, anti-abortion groups are bringing the fight to state legislatures, calling on lawmakers to limit the harms they say have resulted from the FDA’s regulation of mifepristone.

Students for Life of America earlier this month launched a Make America Pro-Life Again policy roadmap, outlining types of legislation the national anti-abortion group is urging lawmakers to support. In the document, the group highlighted a first-of-its-kind law enacted in Louisiana this year classifying abortion medication as dangerous controlled substances.

The law, which is being challenged in court by a coalition of Louisiana health workers, inspired a bill that’s been filed in Texas (HB 1339) ahead of the state’s next legislative session.

Americans United for Life, which has developed anti-abortion model legislation for states, is also putting attention on mifepristone.

“We are concerned about the fact that there aren’t those guardrails that did exist, including the doctor’s visit and follow up, as well as reporting on that,” Brad Kehr, the organization’s government affairs director, said of mifepristone’s previous in-person dispensing requirement and other restrictions the FDA has removed since 2016.

Privacy, Funding Worries

Abortion rights groups say they are preparing for the ramifications states would face if Trump’s HHS withdraws a Biden administration rule that expanded Health Insurance Portability and Accountability Act (HIPAA) protections for abortion.

Another concern is a previous Trump-era regulation barring Title X funding for family planning facilities that offer information about abortion care.

Jennifer Driver, senior director of reproductive rights at State Innovation Exchange, said in an interview that she is working with state legislators across the country to determine how to “shore up privacy” and ensure “data is not shared across state lines.”

More than 20 states have some form of protection for reproductive care, but only eight have laws shielding abortion providers from investigations involving care given to patients located in another state. Those states are California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington.

In Michigan, where Republicans earlier this month regained control of the state House, Democrats are making a last-ditch effort to get reproductive health privacy protections passed while they still hold a majority in both chambers.

More actions could come out of California in the next month. Gov. Gavin Newsom (D) has called a special session to begin Dec. 2 focused on protecting “California values and fundamental rights in the face of an incoming Trump administration,” including “reproductive freedom.”

State funding for abortion providers is at risk with any changes to regulations around Title X of the Public Health Service Act, under which the federal government provides public and private health care providers grant funding for family planning services.

In 2021, the Biden administration finalized a rule reversing the Trump-era regulation by requiring providers in the program to offer pregnant people information about abortion and other services, and where this care could be obtained.

Serra Sippel, executive director of the referral-based abortion travel fund the Brigid Alliance, said in an interview that reinstating the Trump rule would affect not only abortion care, but would “result in fewer Title X providers and less access to contraception.”

Driver said withdrawing federal funding for these family planning centers means “states are going to be really stretched in to fill in those gaps.”

“There’s going to need to be a lot of conversations, not only about budgets, but how to increase state revenue so that they are able to support and provide assistance to their residents,” Driver said.