Members of the American College of Obstetricians and Gynecologists meet with a member of Congress during the organization’s Congressional Leadership Conference in March. (Courtesy of ACOG)
There are periods of Hannah Lord’s life when her full-time job is doctors’ appointments.
Lord, 30, has seen gastroenterologists, physical therapists, psychiatrists, cardiologists and more in Maine to manage a rare connective tissue disorder that is also tied to the premenstrual dysphoric disorder she experiences during her monthly cycle. The premenstrual condition causes depressive symptoms, fatigue, brain fog, and suicidal thoughts, and Lord has dealt with it since she first started having periods. She’s also a single mom to a 12-year-old boy, who is seeing specialists about similar gastrointestinal symptoms that he may have inherited from Lord.
Because of those struggles, Lord had to give up her job as a doula, and she has had health insurance to cover her myriad appointments because of MaineCare, the state Medicaid program. But that coverage is now at risk, as congressional Republicans work to pass a budget bill that would cut federal support for Medicaid, the program that provides health insurance to millions of low-income Americans, by $625 billion over the next 10 years. The total Medicaid budget in 2023 was $880 billion, according to KFF.
Lord is one of millions who could lose access to sexual and reproductive health care if the budget bill in Congress makes it to Republican President Donald Trump’s desk. Clinic workers, physicians and researchers say they are fighting to make their voices heard on Capitol Hill, in some unprecedented ways for at least one organization.
As of Monday afternoon, the budget bill had cleared another procedural hurdle on its way to the U.S. House floor, after opposition from four far-right Republicans who have said the cuts aren’t deep enough to bring down the national deficit and the Medicaid work requirements should begin sooner than 2029. Republicans hold a slim majority in the House, and need almost every one of their 220 members to vote in favor for it to pass.
The savings from cuts will partially help pay for an extension of the tax cuts passed by Congress in 2017 during the first Trump administration, which largely benefited the most wealthy Americans. Republicans categorize the cuts as “reforms” and say it is an effort to remedy waste, fraud and abuse within the system.
States Newsroom reported Florida Republican Rep. Laurel Lee argued during a U.S. House Energy and Commerce Committee hearing last Wednesday that the changes to Medicaid are common sense improvements, like “restoring work requirements for able-bodied adults without dependents, modernizing systems to prevent fraud and abuse, and ending misdirected payments to those who are deceased or who are not eligible for the program.”
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“These reforms are not about taking something away; they are about protecting the integrity of the program so that the people we represent — those who truly need this support — can count on it to be there, now and in the future,” Lee said.
Data from the Guttmacher Institute, a research and policy organization for reproductive health and rights, shows more than 21% of all U.S. women of reproductive age were insured through Medicaid in 2023. Those numbers are higher among women of color, with 31% of Black women and 28% of Hispanic women using Medicaid. It also covers 4 out of every 10 births nationwide.
Lord has more appointments and treatments scheduled in the future, and she feels a sense of urgency to complete them sooner as threats to the program continue.
“If I didn’t have MaineCare, (the surgery) would be thousands of dollars and I would never get it done,” she said. “Am I going to be able to afford medications that I’m on now in the future? I think about that.”
The budget bill also includes provisions that would effectively strip all Planned Parenthood clinics, which served 33% of the 4.7 million contraceptive clients who used safety-net family planning centers in 2020, of federal funding through a combination of Title X family planning and Medicaid funding cuts. The U.S. Health and Human Services agency already froze Title X funding to a number of clinics in April, causing some affected to consider closing their facilities. The National Family Planning and Reproductive Health Association and the American Civil Liberties Union have sued the Trump administration over that action.
Members of the American College of Obstetricians and Gynecologists gather outside the U.S. Capitol in March during the organization’s Congressional Leadership Conference. (Courtesy of ACOG)
The effort to defund Planned Parenthood is one heavily promoted by anti-abortion activists, even though federal funding cannot be used to pay for abortion procedures. The federal funds instead help cover services such as cancer screenings, birth control and IUDs, and treatment for sexually transmitted infections and diseases for those who can’t afford them.
Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, said Medicaid and Title X are lifelines of health insurance for millions of people and policies that would remove them from Medicaid are cruel and unnecessary.
“This is a manufactured crisis because Congress wants to pass a massive tax cut for wealthy individuals, so they’re doing it on the backs of everyday working people,” Friedrich-Karnik said.
The loss of those funds would also affect independent clinics, such as Maine Family Planning, where Lord has received her reproductive health care. Olivia Pennington, director of advocacy for the clinic, said it receives nearly $2 million in Medicaid reimbursements every year and has already been underfunded for the past decade.
“It’s incredibly unjust that the federal administration would attempt to block people’s access to lifesaving health care,” Pennington said.
ACOG asks public, not just its members, to call Congress
The threats to reproductive health care funding have prompted at least one organization to take action in a way it hasn’t in the past.
The American College of Obstetricians and Gynecologists spent $20,000 on a new ad campaign advocating against the cuts, and for the first time includes a call to action in those ads, which are running in targeted congressional districts across 27 states. The ad highlights some of the health services covered by Medicaid and directs viewers to contact their member of Congress. While ACOG frequently encourages its own 60,000-some members to take that action, engaging the broader public to do so in a digital campaign is new.
“There’s such a bombardment of information that it’s really important that if we’re going to engage the public in this fight — because it really is a fight — that we need to meet people where they are and think through ways to reach folks that are outside the typical population, which is our members,” said Rachel Tetlow, vice president of government and political affairs for ACOG.
Rachel Tetlow, American College of Obstetricians and Gynecologists vice president of government and political affairs (Courtesy of ACOG)
Tetlow said the efforts have already had an effect, as proposals that would have created even deeper cuts to Medicaid were dropped in recent weeks and it has been difficult for Republican members to find consensus on some topics.
“Comparing this time last year to this year, we’ve seen nearly triple the actions taken by our members in reaching out to their members of Congress,” Tetlow said. “Medicaid is the biggest driver of that.”
One of those active members is Dr. Clayton Alfonso, who is an associate professor at Duke University and practicing OB-GYN as well as ACOG’s legislative chairman in North Carolina. Alfonso said if the federal support for Medicaid changes, North Carolina has a type of trigger law that will end Medicaid expansion. That would end coverage for about 660,000 people, he said.
Alfonso already went to Washington, D.C., in March with other physicians from his state, and in the time since, he has emailed his representatives on both sides of the aisle but has not received a response.
“A lot of our (medical) residents here at Duke have also done some phone call trees and left messages and things like that,” he said. “As much as we keep trying to talk on a federal level, we haven’t had much luck.”
But even without responses, he hopes their messages are breaking through. And he said he is seeing people engage in a stronger way than in the past, because recent events are driving them to action.
“We’re watching the institutions that we’ve not seen waver through different administrations now all of a sudden be completely gutted,” he said, citing firings at the Centers for Disease Control and Prevention, the National Institutes of Health and other agencies, as well as the discontinuation of vaccine programs and others.
Alfonso said the issue is important to him because he sees it as a part of human dignity to receive health care and not be bankrupted by it. Stripping people of their insurance will only further separate them from the rest of society, he said, and create deeper health inequities.
Lord, who has friends who are still doulas in rural areas of Maine, said she’s seen a stronger level of engagement among her advocacy groups as well.
“There’s kind of a passion, or a fire, that this lit up in all of us,” Lord said. “We’re not going to give up easily.”
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