Republicans targeted abortion providers. Some Mainers lost primary care

0:00Abortion is a matter for the states. that is the position that President Trump took when he was running for re-election in 2024. The Supreme Court, including three members he appointed, eliminated the constitutional right to an abortion in 2022. And there were questions about a future national ban. Trump said he wouldn't sign one. The states will determine by vote or legislation or perhaps both, and whatever they decide must be the law of the land, in this case, the law of the state. And he acknowledged in this video statement that it could mean a wide range of policies. Many states will be different.

0:37Many will have a different number of weeks or some will have more conservative than others. And that's what they will be. At the end of the day, this is all about the will of the people. But not everyone in his party agrees. Dobbs v. Jackson did not simply, quote, kick back the issue of abortion to the states. That's Republican Congressman Bob Onder of Missouri, co-chair of the Pro-Life Caucus, speaking on the third anniversary of the Dobbs decision. The wording in the court's opinion was very clear. The authority to regulate abortion is returned to the people and their elected representatives.

1:13Members of Congress and senators are elected representatives. And one of the measures Onder suggested was cutting off federal funding for Planned Parenthood. The law already banned federal dollars from paying for abortions, but Planned Parenthood provides other kinds of medical care, and the government has paid for some of it. From 2019 to 2021, Planned Parenthood received$1.5 billion, yes, that's billion with a B, from Medicaid chip and$3.3 million from Medicare. There is no reason we cannot immediately turn off Planned Parenthood's government cash flow. And that's what Republicans did. They included a provision in their one big, beautiful bill act that banned Medicaid payments to large health care providers that offer abortions.

1:59And Trump signed it into law this summer. Planned Parenthood called it a backdoor abortion ban. This is going to be devastating for the patients that Planned Parenthood serves. That's Alexis McGill Johnson, president of Planned Parenthood Federation of America. Planned Parenthood sued to block the law. That challenge is still playing out in court. The organization said the law put 200 clinics in jeopardy across the country. The majority of Planned Parenthood health centers that are at risk of closure are in medically underserved areas. They're in areas where there is primary care health shortage, right?

2:33They're in rural areas. Consider this. The Republicans' new funding restriction is aimed at abortion providers, but it is also cutting some patients off from their primary care. We'll look at how the law is playing out for a network of clinics in Maine.

2:51From NPR, I'm Juana Summers.

3:03It's Consider This from NPR. Abortion is legal in Maine, and abortion access is widely supported. Nearly three in four Mainers say it should be legal in all or most circumstances, according to a recent report from the Pew Research Center. But a network of clinics called Maine Family Planning is fighting for its survival because it provides abortions. That new provision in the big Republican budget law passed this summer would cut the network out of Medicaid. NPR's Selena Simmons-Duffin has been looking at the consequences of that. It was winter 2020, the first COVID winter in Oxford, Maine. Ashley Smith got a phone call from an ex-partner.

3:43Somebody that I haven't spoken to in a couple months is like, oh, hey, I hate to reach out and tell you this, but... They tested positive for a sexually transmitted infection called chlamydia. I just quickly did a Google search to see who was going to be in the area that I could just schedule an STI test. And that Google search led me to Maine Family Planning in Norway. Which was very close by, and they got her in quickly. Smith works in restaurants as a server. She doesn't have health insurance, so she came ready to pay cash. But the test was free. They made that process so easy and, like, so painless.

4:19From then on, that's where Smith went when she needed a doctor. Maine Family Planning has been around a long time, 50 years. They have 18 clinics all over the rural state, so there was still one nearby when she moved. She's gone there for pap smears, breast exams. She once went to get a physical to work at a summer camp. I was like, I know that you guys offer primary care. Can you basically just take my weight and tell them that my blood pressure is OK? She says most importantly, they diagnosed a chronic condition for her, premenstrual dysphoric disorder. She says getting that treated has improved her quality of life dramatically.

4:54It's night and day who I am. Clearly, she is a fan of Maine family planning, so much so that the 36-year-old has turned into an advocate. In March, she fought off nerves to testify in the state legislature at a committee hearing. I'm here because these nonprofit clinics are my only source of health care. The need for advocacy is because of recent actions by the federal government, and because in addition to cancer screenings and STI testing and all the rest, Maine Family Planning provides abortion care. After the Supreme Court overturned Roe v. Wade three years ago, 12 states banned abortion outright and more passed severe restrictions.

5:31States like Maine have moved in the other direction, to expand access. Now, the Republican-led federal government is moving to restrict abortion access in states where it's legal and protected, using federal funding as its lever. Hi, come on in. To be specific, Medicaid funding is now unavailable to Maine family planning clinics for any services. Vanessa Shields-Haas is the nurse practitioner at the clinic in Thomaston, Maine, a small town along the coast. This is our larger exam room. Here we do most of our yearly wellness visits. We do vulvar biopsies and vasectomies and intrauterine inseminations as well.

6:15Just like Ashley Smith, who needed a basic physical for her summer camp job, many of her reproductive health patients come in needing primary care, too. 70 % of Maine family planning patients only see them as their doctor. I can treat your tick bite or your bronchitis. I tell people if you cut your finger off or you're having a heart attack, I'm going to send you to the emergency room. But there's a lot of many other things that can be treated here. Clinics like this one were already prohibited from getting Medicaid reimbursement for abortion because of the Hyde Amendment, which passed in the 1970s.

6:48What's new now is a provision in the One Big Beautiful Bill Act, the congressional Republicans passed this summer, which blocks several health care organizations, including Planned Parenthood and Maine Family Planning, from receiving any Medicaid funding for any services for one year. So since July 4th, since the bill was passed, we haven't been reimbursed for visits for patients who use Medicaid as their insurance. And we've been seeing all of those patients for free. We haven't been turning them away. A lot of her patients do seasonal jobs. Half of Maine Family Planning's patients are on Medicaid.

7:26Maybe they're working at a hotel or they're waiting tables. They're serving lobster rolls to hungry tourists, starting oyster farms. These are entrepreneurs. These are people that are working really hard. Shields Haas tries to be there for them for whatever they need. She's acutely aware that there aren't enough doctors in this rural state. She calls the new law infuriating. Unfortunately, decision makers in Washington are having such a profound impact on what we can and can't do. Not being able to be reimbursed for the visits is, it's really crippling financially. The person tasked with troubleshooting that problem is George Hill, Maine Family Planning's president and CEO.

8:08He works about an hour's drive away at the organization's headquarters in Augusta. I've been in the field since 1987, so close to 40 years. Over those years, many presidential administrations have been hostile to their work, he says. This is, by volume and velocity, probably the worst that we have seen. Maine Family Planning filed a lawsuit to challenge the law that blocks them from getting Medicaid funding. In its response to the suit, the federal government said the provision furthers Congress's, quote, goal of reducing abortion and suggested Maine Family Planning could stop providing abortions to get its funding back.

8:45For now, while that lawsuit works its way through the courts, Maine Family Planning cannot receive Medicaid funding. That's$2 million, 20 % of their budget, gone. That's difficult. You have to make some difficult decisions. Either you generate more money, more revenue, or you cut costs. In the short term, they've had to cut some services. On November 1st, Maine Family Planning ended primary care services at three clinics in the far reaches of the state. Staff helped nearly 1 ,000 patients find new doctors. Hill hopes that decision will help preserve the rest of what they do. We have a mission, and our mission is to make sure that access to sexual and reproductive health care, the full range of sexual and reproductive health care, is available to as many patients as possible.

9:30They also received some additional funding from the state to help fill the gap. and he says they're exploring new ways to raise revenue. He quotes the late Democratic lawmaker Pat Schroeder. You can't roll up your sleeves and get to work if you're in your hands. We're going to keep doing what we're doing. We're not going to stop. That story came from NPR's Selena Semen-Stuffin reporting in Augusta, Maine. Additional reporting at the top of this episode came from NPR's Katie Riddle. This episode was produced by Connor Donovan and Ava Berger with audio engineering by Jimmy Keighley. It was edited by Diane Weber and Courtney Dorning.

10:07Our executive producer is Sammy Yenigan.

10:13It's Consider This from NPR. I'm Juana Summers.