Planned Parenthood St. Louis resumes surgical abortions, while Missouri blocks others
Planned Parenthood on Thursday resumed surgical abortions in St. Louis, months after voters in November enshrined abortion rights in the Missouri Constitution.
The same day, the state health department effectively blocked medication abortions throughout Missouri.
The decision leaves abortion access in Missouri in a confusing state: surgical abortions are legal, but Planned Parenthood still cannot offer medication abortions.
Planned Parenthood now offers surgical abortions in Kansas City, Columbia and St. Louis.
Planned Parenthood Great Plains in February at a Kansas City area clinic performed the first abortion in the state since the fall of Roe v. Wade. A Columbia clinic restarted abortions earlier this month. The first abortion at the St. Louis center since 2022 occurred Thursday.
'We stand ready to welcome more patients to ensure they can get the care they need, when they need it,' Great Rivers President and CEO Margot Riphagen said in a statement.
Missouri banned almost all abortions in 2022 when the US Supreme Court overturned Roe v. Wade. The ban included exceptions in cases of emergencies, but not for rape or incest.
Voters in November responded by passing a constitutional amendment protecting reproductive rights.
While many believed the amendment would undo the ban, the measure left it up to judges to decide whether the state's long list of laws and other regulations are now unconstitutional. A lawsuit filed by Planned Parenthood and other abortion-rights advocates to overturn most of the state's abortion laws is set for trial in January 2026.
Planned Parenthood currently cannot provide medication abortions in Missouri, but affiliates in February submitted complication plans to the state health department in order to begin offering medication abortions.
Complication plans detail what clinics will do in case of complications from abortions.
On March 13, the Department of Health and Senior Services filed emergency complication plan regulations to 'protect Missourians' access to safe and reliable care,' according to the rule.
'The rule will ensure that women can quickly and safely receive proper emergency care for abortion-related complications at a convenient location,' the regulation states.
The regulations took effect Thursday. That day, the health department notified Planned Parenthood that its complication plans do not comply with the new rules, without being more specific.
A spokesperson for the health department did not immediately return Associated Press requests for comment Friday.
Planned Parenthood Great Plains President and CEO Emily Wales said medication abortion is popular among patients who might want a less-invasive abortion because of past abuse.
'We do have patients who've contacted us in the last few months who prefer medication abortion and who will choose to travel rather than exercise their right to abortion in Missouri because medication isn't available to them,' Wales said.
GOP Attorney General Andrew Bailey, whose office is defending Missouri's abortion laws in court, ordered Planned Parenthood to not provide medication abortions in March because the health department has not approved its complication plans.
'This cease and desist letter ensures that basic health and safety standards are met,' Bailey said in a statement after issuing the order. 'Given Planned Parenthood's history, I will continue to ensure their compliance with state law.'
Planned Parenthood said it has no plans to provide medication abortions without proper permission.
'There was nothing to cease and desist,' Wales said.
Missouri's Republican-led Legislature, which passed the near-total ban, is trying again to limit abortions.
A House committee next week is scheduled to advance a new constitutional amendment that would impose additional restrictions on abortion, GOP House Speaker Jon Patterson said.
Any proposed amendment would need to be approved by voters.
It's unclear exactly how House lawmakers want to regulate abortions further. Patterson said the legislation is currently being negotiated.
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How Trump broke the politics of Medicaid
Republicans used to cheer the possibility of Medicaid cuts. Now, as the GOP advances President Donald Trump's 'Big Beautiful Bill' that would reduce Medicaid spending, they're rebranding it as making the program stronger. The shift reflects the striking new politics of Medicaid — and how dramatically the GOP's coalition has changed under Trump. Now Democrats are hoping Medicaid could be the issue that exposes the cracks in the Trump coalition. They have seized on a nonpartisan Congressional Budget Office estimate that the bill would cause 7.8 million people to lose access to the low-income health insurance program. At stake is whether Democrats can start to win back working-class voters who have shifted toward the GOP over the past decade. Medicaid provides health insurance for nearly 80 million people but was long the electoral forgotten sibling of Social Security and Medicare. It's clear in the ads: TV ads for House and Senate races last election cycle were 26 times as likely to mention Medicare, the health care program for seniors, as Medicaid, according to a POLITICO analysis of transcripts from AdImpact, which tracks political advertising. But that's already changing. 'I saw elections 16 years ago where people ran on cutting Medicaid, and there were folks who were on Medicaid who were in the crowd cheering them on,' said Kentucky Gov. Andy Beshear, a potential Democratic candidate for president in 2028. 'That's not the case of where we are today.' The Medicaid provisions in the GOP's budget bill have prompted new debate even among Republicans. To Beshear and others, that provides an opening. Democrats, he said, should stand in front of hospitals and 'talk about how important Medicaid is,' he said, while emphasizing 'the impact on specific communities.' Congressional Democrats have seized on the issue, with moderates and progressives alike speaking in defense of the program. The party's House campaign arm is prioritizing Medicaid in swing-district messaging. And TV ads mentioning Medicaid have already run in more Republican-held districts this year than they did all of last cycle. Republicans are cautious, with an ideologically diverse group of senators wary of cuts and poised to exert significant influence over the bill. Sen. Josh Hawley (R-Mo.), who warned that cutting the program would be 'both morally wrong and politically suicidal,' said last week that Trump had promised him no cuts to benefits. GOP lawmakers have largely rallied around Trump's bill by arguing the House legislation protects Medicaid by only removing people who do not deserve it in the first place. That careful messaging is a stark difference from a decade ago, when congressional Republicans explicitly prioritized cutting Medicaid and governors blocked its expansion. One reason for the turnaround: A series of red states expanded Medicaid by ballot initiative between 2017 and 2020 — largely with backing of Democratic-aligned groups — and GOP voters defied their state and local political leaders in large numbers to support the program. Nationwide, enrollment for Medicaid and the Children's Health Insurance Program rose from just shy of 70 million in 2014 to nearly 79 million at the end of 2024. And at the same time more people were entering the program, including Republican voters in red states, an electoral realignment was shifting working-class voters toward Trump. 'Medicaid has a broader and broader appeal the more people that are on it, and the more people who know someone who's on it. That's incredibly powerful politically,' said Kelly Hall, executive director of the Fairness Project, which backed state Medicaid referendums. The makeup of Medicaid users was changing — and so were its politics. For a long time, the program has been relatively absent from federal races. Even in the 2018 midterms, when defending the Affordable Care Act was central to Democrats' midterm messaging, only 30 TV ads across all congressional elections mentioned Medicaid, while nearly 500 mentioned Medicare, POLITICO's analysis found. But Medicaid expansion was a major issue in many gubernatorial and state legislative races in the 2010s. The success of ballot measures proved the program had a strong constituency, even in red states. And Trump's popularity with working-class voters also reshaped the GOP's coalition. Compared to Republican candidates before him, Trump's 2024 gains were strongest in counties with high Medicaid enrollment, a POLITICO analysis found. In the 2024 election, 49 percent of Medicaid recipients voted for Trump compared to 47 percent for Kamala Harris, according to Morning Consult polling. That means cuts to Medicaid or reductions in eligibility could now pose a political risk for Republicans. People who could lose benefits would not just be Democratic voters in blue states, but Republicans in red states and swing districts who supported Trump last year. Drew Kent, a GOP strategist whose firm recently polled Pennsylvania's voters, found a slight majority, including 30 percent of Republicans, disapproved of work requirements for Medicaid. 'These results are definitely a bit surprising to me,' Kent said. 'It clearly shows the challenges and importance, particularly in a political swing state like Pennsylvania, of getting the policy, messaging, and communications right on an issue of this magnitude.' Republicans are aware of the potential political liability: The GOP's argument about the bill, which could still face changes in the Senate, is that the changes to the program do not amount to cuts for voters. 'The President wants to preserve and protect Medicaid for the Americans who this program was intended for,' White House Press Secretary Karoline Leavitt said at a press briefing last month. 'We want to see able-bodied Americans at least working 20 hours per week, whether that's part-time or full-time, whether that's even looking for work or volunteering for 20 hours a week, if they are receiving Medicaid.' A memo from the National Republican Campaign Committee last month advised the party to go on offense, saying the bill protects Medicaid by 'removing illegal immigrants and eliminating fraud.' Among its provisions, the bill would penalize states such as California that use state dollars to extend Medicaid benefits to undocumented immigrants. According to CBO estimates, of the nearly 11 million people who would lose Medicaid or other health insurance due to the bill, about 1.4 million are immigrants. GOP strategist Josh Novotney argued that approach is in line with what Trump's working-class base wants. "Most blue-collar Trump supporters I have met or spoken with in large groups do not want their hard-earned taxes going to other people, whether that is student debt forgiveness or Medicaid abuse," he said. "That is not at odds with his supporters." A Kaiser Family Foundation poll released Friday found a plurality of Republicans, 42 percent, believed the Trump administration's policies would strengthen Medicaid, with only 22 percent believing the program would be weakened. But Republican Medicaid enrollees were more split, with 35 believing Trump would strengthen the program and 34 percent saying he would weaken it. That is where Democrats see an opening. A nonprofit affiliated with Democrats' House campaign arm is already targeting swing-district Republicans with digital ads accusing members of cutting Medicaid to pay for tax breaks for the rich. And a flurry of other liberal groups have purchased TV or digital ads and planned billboards and other activist campaigns. 'To the extent that this is becoming a bigger political issue, it's simply because their efforts to destroy Medicaid are fundamentally more dangerous and more real than ever before,' said Sen. Chris Murphy (D-Conn.), whose PAC is helping fund a group that opposes Medicaid cuts. As the bill currently stands, the Medicaid work requirements would not go into effect until the end of 2026. That means Democrats largely won't be able to point during their midterm campaigns to people who have already lost access to Medicaid. Instead, they may rely on voter trust on an issue that has historically worked for them. While polls have found voters consistently prefer the GOP more on issues such as the economy and immigration — which helped propel Trump's win last year — health care has remained a rare bright spot for Democrats. 'If there is a debate or chaos or uncertainty about Medicaid cuts, then I think Democrats stand to benefit from that because of the brand advantage on health care,' said Democratic pollster Zac McCrary. 'One of the few places where we have maintained an edge.'
Politico
an hour ago
- Politico
How Trump broke the politics of Medicaid
Republicans used to cheer the possibility of Medicaid cuts. Now, as the GOP advances President Donald Trump's 'Big Beautiful Bill' that would reduce Medicaid spending, they're rebranding it as making the program stronger. The shift reflects the striking new politics of Medicaid — and how dramatically the GOP's coalition has changed under Trump. Now Democrats are hoping Medicaid could be the issue that exposes the cracks in the Trump coalition. They have seized on a nonpartisan Congressional Budget Office estimate that the bill would cause 7.8 million people to lose access to the low-income health insurance program. At stake is whether Democrats can start to win back working-class voters who have shifted toward the GOP over the past decade. Medicaid provides health insurance for nearly 80 million people but was long the electoral forgotten sibling of Social Security and Medicare. It's clear in the ads: TV ads for House and Senate races last election cycle were 26 times as likely to mention Medicare, the health care program for seniors, as Medicaid, according to a POLITICO analysis of transcripts from AdImpact, which tracks political advertising. But that's already changing. 'I saw elections 16 years ago where people ran on cutting Medicaid, and there were folks who were on Medicaid who were in the crowd cheering them on,' said Kentucky Gov. Andy Beshear, a potential Democratic candidate for president in 2028. 'That's not the case of where we are today.' The Medicaid provisions in the GOP's budget bill have prompted new debate even among Republicans. To Beshear and others, that provides an opening. Democrats, he said, should stand in front of hospitals and 'talk about how important Medicaid is,' he said, while emphasizing 'the impact on specific communities.' Congressional Democrats have seized on the issue, with moderates and progressives alike speaking in defense of the program. The party's House campaign arm is prioritizing Medicaid in swing-district messaging. And TV ads mentioning Medicaid have already run in more Republican-held districts this year than they did all of last cycle. Republicans are cautious, with an ideologically diverse group of senators wary of cuts and poised to exert significant influence over the bill. Sen. Josh Hawley (R-Mo.), who warned that cutting the program would be 'both morally wrong and politically suicidal,' said last week that Trump had promised him no cuts to benefits. GOP lawmakers have largely rallied around Trump's bill by arguing the House legislation protects Medicaid by only removing people who do not deserve it in the first place. That careful messaging is a stark difference from a decade ago, when congressional Republicans explicitly prioritized cutting Medicaid and governors blocked its expansion. One reason for the turnaround: A series of red states expanded Medicaid by ballot initiative between 2017 and 2020 — largely with backing of Democratic-aligned groups — and GOP voters defied their state and local political leaders in large numbers to support the program. Nationwide, enrollment for Medicaid and the Children's Health Insurance Program rose from just shy of 70 million in 2014 to nearly 79 million at the end of 2024. And at the same time more people were entering the program, including Republican voters in red states, an electoral realignment was shifting working-class voters toward Trump. 'Medicaid has a broader and broader appeal the more people that are on it, and the more people who know someone who's on it. That's incredibly powerful politically,' said Kelly Hall, executive director of the Fairness Project, which backed state Medicaid referendums. The makeup of Medicaid users was changing — and so were its politics. For a long time, the program has been relatively absent from federal races. Even in the 2018 midterms, when defending the Affordable Care Act was central to Democrats' midterm messaging, only 30 TV ads across all congressional elections mentioned Medicaid, while nearly 500 mentioned Medicare, POLITICO's analysis found. But Medicaid expansion was a major issue in many gubernatorial and state legislative races in the 2010s. The success of ballot measures proved the program had a strong constituency, even in red states. And Trump's popularity with working-class voters also reshaped the GOP's coalition. Compared to Republican candidates before him, Trump's 2024 gains were strongest in counties with high Medicaid enrollment, a POLITICO analysis found. In the 2024 election, 49 percent of Medicaid recipients voted for Trump compared to 47 percent for Kamala Harris, according to Morning Consult polling. That means cuts to Medicaid or reductions in eligibility could now pose a political risk for Republicans. People who could lose benefits would not just be Democratic voters in blue states, but Republicans in red states and swing districts who supported Trump last year. Drew Kent, a GOP strategist whose firm recently polled Pennsylvania's voters, found a slight majority, including 30 percent of Republicans, disapproved of work requirements for Medicaid. 'These results are definitely a bit surprising to me,' Kent said. 'It clearly shows the challenges and importance, particularly in a political swing state like Pennsylvania, of getting the policy, messaging, and communications right on an issue of this magnitude.' Republicans are aware of the potential political liability: The GOP's argument about the bill, which could still face changes in the Senate, is that the changes to the program do not amount to cuts for voters. 'The President wants to preserve and protect Medicaid for the Americans who this program was intended for,' White House Press Secretary Karoline Leavitt said at a press briefing last month. 'We want to see able-bodied Americans at least working 20 hours per week, whether that's part-time or full-time, whether that's even looking for work or volunteering for 20 hours a week, if they are receiving Medicaid.' A memo from the National Republican Campaign Committee last month advised the party to go on offense, saying the bill protects Medicaid by 'removing illegal immigrants and eliminating fraud.' Among its provisions, the bill would penalize states such as California that use state dollars to extend Medicaid benefits to undocumented immigrants. According to CBO estimates, of the nearly 11 million people who would lose Medicaid or other health insurance due to the bill, about 1.4 million are immigrants. GOP strategist Josh Novotney argued that approach is in line with what Trump's working-class base wants. 'Most blue-collar Trump supporters I have met or spoken with in large groups do not want their hard-earned taxes going to other people, whether that is student debt forgiveness or Medicaid abuse,' he said. 'That is not at odds with his supporters.' A Kaiser Family Foundation poll released Friday found a plurality of Republicans, 42 percent, believed the Trump administration's policies would strengthen Medicaid, with only 22 percent believing the program would be weakened. But Republican Medicaid enrollees were more split, with 35 believing Trump would strengthen the program and 34 percent saying he would weaken it. That is where Democrats see an opening. A nonprofit affiliated with Democrats' House campaign arm is already targeting swing-district Republicans with digital ads accusing members of cutting Medicaid to pay for tax breaks for the rich. And a flurry of other liberal groups have purchased TV or digital ads and planned billboards and other activist campaigns. 'To the extent that this is becoming a bigger political issue, it's simply because their efforts to destroy Medicaid are fundamentally more dangerous and more real than ever before,' said Sen. Chris Murphy (D-Conn.), whose PAC is helping fund a group that opposes Medicaid cuts. As the bill currently stands, the Medicaid work requirements would not go into effect until the end of 2026. That means Democrats largely won't be able to point during their midterm campaigns to people who have already lost access to Medicaid. Instead, they may rely on voter trust on an issue that has historically worked for them. While polls have found voters consistently prefer the GOP more on issues such as the economy and immigration — which helped propel Trump's win last year — health care has remained a rare bright spot for Democrats. 'If there is a debate or chaos or uncertainty about Medicaid cuts, then I think Democrats stand to benefit from that because of the brand advantage on health care,' said Democratic pollster Zac McCrary. 'One of the few places where we have maintained an edge.'
The Hill
2 days ago
- The Hill
Trump stokes fear, confusion with pulled emergency abortion guidance
The Trump administration sowed confusion and fear among physicians with its move this past week to rescind Biden-era guidelines to hospitals that provide life-saving abortions. While the move doesn't change the law, doctors and reproductive-rights advocates fear it will have a chilling effect on health care workers in states with abortion bans, ultimately harming pregnant women. Earlier this past week, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced they would rescind guidance issued during the Biden administration, which reinforced to hospitals that under the Emergency Medical Treatment and Labor Act (EMTALA,) abortions qualify as stabilizing care in medical emergencies. Emergency rooms in states with abortion bans have been struggling since the 2022 overturning of Roe v. Wade to understand when they can legally provide emergency abortions. After President Trump pulled the Biden-era guidance seeking to clarify that question, emergency room doctors will experience 'more confusion' and 'more fear,' according to health and legal experts who spoke with The Hill. 'Clinicians are scared to provide basic medical care, and this care is clearly in line with medical ethics … medical standards of care, and they're being put in this situation where they can't win,' said Payal Shah, director of research, legal and advocacy at Physicians for Human Rights. Since the Supreme Court overturned Roe v. Wade in 2022, at least 13 states have enacted near-total abortion bans, according to data from the Guttmacher Institute. There are exceptions in these states when continuing a pregnancy poses a threat to the health or life of the mother. However, most of the language in state laws is unclear on how that determination is made, resulting in instances of emergency rooms denying care. Doctors in states like Idaho, Texas and Tennessee have filed lawsuits requesting that lawmakers clarify when an abortion is allowed to save the life of a pregnant person. The doctors and patients involved in the lawsuits argue that state laws do not adequately protect pregnant patients in emergencies. Many of these states have severe punishments for doctors who violate abortion bans, like steep fines and prison time. 'For clinicians, there is actually no safe way to navigate this in this moment, and ultimately, that's how these laws are designed,' Shah said. 'They're designed to cause chaos and confusion. They're often written in ways that don't use medical terminology.' Without clear guidance, pregnant women suffer and sometimes die, as ProPublica has reported. One striking example of this is the 2023 case of Kyleigh Thurman, a Texas woman who was repeatedly denied care for a nonviable pregnancy after days of experiencing bleeding and pain. Health care workers discovered that she had an ectopic pregnancy, which is when a fertilized egg implants and begins to grow outside of the uterus, usually in a fallopian tube. Ectopic pregnancies are never viable and are life-threatening if not treated properly. It wasn't until her OB/GYN 'pleaded to hospital staff that she be given care,' that the hospital administered a shot ending her pregnancy, according to a complaint filed by the Center for Reproductive Rights on behalf of Thurman. The shot came too late, and the ectopic pregnancy ruptured Thurman's right fallopian tube, which was then removed. 'If a patient is actively hemorrhaging or experiencing an ectopic pregnancy which is also life-threatening, doctors need that clear guidance that yes, EMTALA applied,' said Autumn Katz, associate director of U.S. litigation at the Center for Reproductive Rights. A federal investigation into Thurman's case found that the Texas hospital violated EMTALA, according to a recent letter from the CMS. 'I finally got some justice,' Thurman said in a statement. 'I hope this decision will do some good in encouraging hospitals to help women in situations like mine.' Hospitals that violate EMTALA are subject to heavy fines and, in some extreme cases, risk losing a portion of their Medicare and Medicaid hospital funding, according to the National Institutes of Health. Former President Biden leaned on the law to preserve access to emergency abortion across the country, leading to a legal fight with Idaho, which has a strict abortion ban. The Supreme Court last year dismissed the case, declining to rule on the merits of a politically charged case. The rescinding of these guidelines also means hospitals that violate the law will likely not be investigated as often as they were under previous administrations, according to Shah. That lack of punitive risk means that hospitals could be incentivized to deny life-saving care for patients. 'The standard of EMTALA is pretty high,' said Katherine Hempstead, senior policy adviser at Robert Wood Johnson Foundation. 'This kind of takes that layer of reassurance away, and it will make a lot of providers feel very vulnerable.'
