Pa. abortion providers, legal experts look at what’s ahead for reproductive rights under a second Trump term

From Philly and the Pa. suburbs to South Jersey and Delaware, what would you like WHYY News to cover? Let us know!

Following President-elect Donald Trump’s win last week for a second term in the White House, local health care providers and legal experts are waiting to see what access to abortion and reproductive care might look like under his presidency — again.

There is one thing that Penn State Health OB-GYN Sarah Horvath said she wants to make clear about health care access right now: “Nothing has changed in 2024.”

Abortion today is legal in Pennsylvania, Delaware and New Jersey. Experts say it is likely to remain legal here under Trump, who has stated that the health procedure should be regulated at the state level following the end of widespread access under Roe v. Wade, which was overturned in 2022.

Last month, Trump stated that he would veto a federal abortion ban should Congress pass a bill, in a post on X, formerly known as Twitter, and his social media platform, Truth Social.

However, his administration could implement policies around federal funding, insurance and surveillance that could affect access to reproductive health services here in the commonwealth and elsewhere.

“I think it’s all going to get a little bit more difficult to access in ways that maybe we don’t know yet,” said Horvath, an associate professor at Penn State Health – Hershey.

Federal funding and insurance coverage

While she won’t speculate on what exactly will happen over the next four years, Horvath said she can draw from Trump’s first term in office to see what actions his administration may take again.

Last time, that included restrictions on the Title X national family planning program, which is a network of clinics and organizations that get money to provide contraception and services like STD testing, annual gynecologic exams and prenatal care at reduced cost.

Title X federal funds cannot be used for abortion care and never have since the program started in 1970.

In 2019, the Trump administration introduced a domestic “gag rule” that prohibited participating clinics and organizations from counseling on or making referrals for abortion, which caused several states and all Planned Parenthood sites to withdraw from the program and its funding.

“It didn’t mean fewer abortions, it meant less funding for things like pap smears, less funding for things like breast exams, less funding for other preventive care,” Horvath said. “And less funding for contraception, which we know from research is the thing that prevents abortions.”

The Biden administration reversed the gag rule, but if Trump reinstates it, Horvath predicts that many clinics will once again be cut off from funding and suffer financially if they cannot make it up in private donations and fundraising.

“Access decreases and inequities really deepen in who can and cannot access the preventive health care that they need,” she said.

Another issue health providers and experts are watching is insurance coverage for birth control.

The Affordable Care Act requires employers and health insurance plans to cover hormonal birth control, but the Trump administration in 2017 expanded exceptions for employers and companies with religious or moral objections.

“So I anticipate that, again, it will be more difficult for people to access and pay for their contraceptive care,” Horvath said.

Legal challenges and court cases

Law experts like Rachel Rebouché, the Kean Family Dean at Temple University Beasley School of Law, have been following several ongoing legal cases as they wind through trial and appellate courts.

Among them is Moyle v. United States, which the Supreme Court dismissed earlier this year and sent back down to a lower court. The ongoing case examines state abortion bans that lack a health exception — meaning abortion is banned even when a woman’s health is threatened, like in cases of late-term miscarriage or complications.

In order to get an emergency abortion in these states, a woman must be at risk of death. But the U.S. Department of Justice argued that this violates EMTALA, a federal law that requires hospital emergency departments to provide patients with stabilizing treatment, no matter what the condition.

“The Biden administration’s DOJ really defended the federal law,” Rebouché said. “And we don’t know what will happen, but I’d be curious to see if the Trump administration defends that view in the way that Biden did.”

Rebouché said she’s also watching for another legal challenge to the abortion medication mifepristone, an Food and Drug Administration–approved drug used in a majority of abortions across the country.

The Supreme Court dismissed a related case earlier this year because plaintiffs failed to show they had been directly harmed by the drug or its FDA approval status. But Rebouché said this has left the door open for others to try again.