The Supreme Court has dealt another blow to abortion access. It decided that states can ban Planned Parenthood from receiving Medicaid reimbursements because it provides abortions. Women between the ages of 19 to 44 account for nearly two-thirds of Medicaid beneficiaries. Prior to this decision, they were able to access reproductive health care services such as contraception, screenings for sexually transmitted infections and pregnancy testing in any state because of Medicaid and other federal programs.

The entire Medicaid system is next on the chopping block now that the Senate has passed tax cuts for the mega-rich in President Donald Trump’s One Big Beautiful Bill Act. The majority of Americans oppose Medicaid cuts because it helps the most vulnerable among us — individuals with limited incomes, middle-class older adults and those with disabilities — through a joint federal and state program that provides free or low-cost health care coverage for 71 million Americans.

As researchers concerned with health care access for pregnant people, we interviewed 189 women over the last year to better understand barriers to abortion access since the Supreme Court overruled Roe v. Wade in 2022. Most of the women we interviewed live in conditions of sustained financial instability and, like most abortion seekers nationwide, already have children. These women are reliant on Medicaid or other forms of state assistance, such as the federal supplemental nutrition program for women, infants and children, known as WIC; school lunches; and housing vouchers. Our study confirms that Medicaid plays a critical role in guaranteeing access to reproductive health care and other essential services crucial to women’s ability to sustain their families.

Ten states that have tried to ban or restrict abortion also never expanded Medicaid under the Affordable Care Act. That means it’s harder to get birth control in these states, and when women experience unwanted pregnancies, they can’t get abortions. Maria, one of our study participants, faced this exact dilemma. Maria is a dental hygienist and a single mother of three. She explained: “I’ve looked into getting birth control (at a clinic with a sliding scale) … but … it’s still too high of a cost for me.” When she found out she was pregnant, she said, “I honestly knew I could not afford to have a fourth child. I’m already tight as is.”

If Congress passes the bill, more women will face the same catch-22. Maria ended up using abortion pills she received in the mail.

When the federal government restricts social assistance programs, women won’t be able to support the children they already have. Therefore, getting abortions for unwanted pregnancies isn’t exactly a “choice,” as sociologist Katrina Kimport explains. As Eva, a 22-year-old Latina single mom from Indiana, summarized, “If you aren’t going to provide certain health care benefits or … food stamps or … housing, you shouldn’t have a say on if somebody should have a baby.”

Abortion bans have reverberating effects. Pregnant people living in states with bans are twice as likely to die during childbirth as in states without bans. The risk is greatest for Black women — they are three times more likely to die during childbirth. Further, OB/GYNs don’t want to train or practice in states with abortion bans, where their decisions around reproductive health care would be constantly under state surveillance. As a result, women in ban states already experience reduced reproductive health care access.

Now that the bill has passed, women in all states will likely face reproductive risks because cuts also affect women living in states where abortion is legal. Illinois has used Medicaid to effect immediate decreases in direct patient costs and increases in abortion care by removing federal restrictions for abortion coverage and raising Medicaid reimbursement rates for abortion services by 20%. Medicaid coverage for abortions improves outcomes by allowing people to seek medical care earlier in pregnancy. Early access to abortion is positively associated with improved physical and mental health outcomes. When abortion care is not covered by Medicaid, people wait longer to get an appointment for care, and their pregnancies are more advanced and abortions more complicated and expensive.

The bill would erase these state-led gains for women’s reproductive health care while increasing federal spending. Barring Planned Parenthood from participating in Medicaid at a national level because it happens to provide abortions will raise federal spending by $300 million, the result of decreased contraception provision and a corollary increase in Medicaid-funded births. We know this because Texas implemented a similar plan in 2013 with these results.

Our leaders should be working to increase access to health care, not rationing it out to only those who can afford it.

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Claire Decoteau is professor of sociology and Kim D. Ricardo is the Lucy Sprague professor in public interest at the University of Illinois at Chicago. Both are Society of Family Planning grantees.

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