From clinics to crisis: Pennsylvania women will feel the pain of Medicaid cuts

In Pennsylvania, about one in every five women of reproductive age is enrolled in Medicaid. Dozens of family planning clinics throughout the state could lose their Medicaid funding if Trump’s “big, beautiful bill” passes, leaving thousands of women without reproductive health care options.

Autumn Gravier knows better than many that life can change in an instant. Hers did.

In 2023, the Harrisburg resident took her father to the hospital when he wasn’t feeling well. Doctors found a baseball-size tumor in his brain—which turned out to be an aggressive form of brain cancer. He was given a year to live.

Gravier was a single mother, but she quit her job to care for her father. The scariest part of that, she said, was losing her health insurance.

“I had to get on Medicaid,” Gravier said. “Because of Medicaid I was able to take care of my dad for 14 months. I was able to be by his bedside. I was able to be there when he took his last breath. I would not have been able to do that without Medicaid.”

Gravier, who only stayed on Medicaid while caring for her father, said it allowed her to continue receiving health care not only for her chronic illnesses, but also for her reproductive health.

Now, a Republican-backed bill making its way through the federal government could change all of that. If it passes, people like Gravier won’t be able to use Medicaid for their health care needs.

Last week, the US House narrowly passed a budget reconciliation bill—a type of legislation Congress uses to fast-track major changes to federal spending and tax policy. Republicans used the process to advance a broad proposal that aims to extend President Donald Trump’s 2017 tax cuts, which primarily benefited corporations and the wealthiest Americans, and make at least $1.5 trillion in cuts to key programs like Medicaid. 

Tucked inside the bill’s pages are major changes to how Medicaid operates—including a provision that would block Medicaid patients from receiving care at many rural family planning clinics and Planned Parenthoods, the nation’s largest provider of reproductive health services. It also adds work requirements to Medicaid eligibility that would disqualify many from receiving health insurance.

Dr. Libby Wetterer sees Medicaid patients all the time through her work with Planned Parenthood of Southeastern Pennsylvania. The family medicine physician provides the full array of reproductive health care and family planning services to many whose only option for health insurance is Medicaid. And for some of them, their only option for care is at a Planned Parenthood clinic. 

“Not every doctor takes Medicaid, and not every doctor that takes Medicaid offers reproductive health care,” Wetterer said. “Health care is a human right. All Pennsylvanians deserve access to health care regardless of income. Adding restrictions to Medicaid coverage and restricting Planned Parenthood from participating in Medicaid will threaten the health of millions of Pennsylvanians.”

How will Medicaid cuts affect Pennsylvania?

In Pennsylvania, close to 3 million adults and children are on Medicaid. About one in every five women of reproductive age are enrolled in Medicaid. Over 45,000 births every year, or 34% of births in the state, are covered by Medicaid.

If the reconciliation bill passes—it still needs to be approved by the US Senate—at least 310,000 Pennsylvanians will lose their Medicaid coverage, said Dr. Val Arkoosh, secretary of the state’s Department of Health and Human Services.

Additionally, the bill would also have a detrimental effect on the health care infrastructure in the state, Arkoosh said. The bill aims to take Title XIX funding—federal Medicaid funding—away from family planning clinics that “provide for abortions.”

Experts say that’s odd wording, since Medicaid already doesn’t cover abortions. The bill, then, would prevent all other care—including annual wellness exams, breast exams, cancer screenings, and so on—at any facility that in some way deals with abortions that are entirely unrelated to the care being received by Medicaid users.

“That language is very vague,” Arkoosh said. “It could be interpreted to mean providing abortions, or it could mean helping someone to get an abortion, or maybe referring them if they don’t do abortions at that particular clinic.”

Because the language is open to interpretation, Arkoosh said, it could impact not only Planned Parenthood clinics, but all of the family planning and reproductive health care clinics across the state. 

Pennsylvania has 66 family planning clinics that serve about 90,000 Pennsylvanians every year. Women go to these clinics, Arkoosh said, not just for contraception and possibly abortion care, but for mammograms, screening exams, annual checkups and much more. 

Planned Parenthood, which also provides the full gamut of reproductive health care in addition to abortions, has a little more than a dozen clinics in the state that serve about 20,000 women on Medicaid. If the reconciliation bill passes, more than 200 clinics across the country will be forced to go, Planned Parenthood said.

“This program touches every aspect of our lives and our communities,” Arkoosh said. “In a rural setting, sometimes the family planning clinic is the only place that somebody has access to. A significant number of individuals could lose access to vital health care services.

“The loss of these vital health care services would likely mean that we see more people using our already crowded emergency departments because they wouldn’t be able to make a doctor’s appointment if they didn’t have insurance, and our hospitals would see an increase in uncompensated care from folks that are not insured.”

The program was vital to Gravier, who only needed it for a little while so that she could give her father the end of life care he needed and deserved.

The program is also vital to so many of Wetterer’s patients. 

“One of the reasons I became a family physician was so that I could provide everyone with all their options and also take care of their children,” Wetterer said. “That means providing prenatal care, delivering babies, providing abortion care, contraception, and also pediatric and family-centered care.

“Restrictions to Medicaid will increase infant and maternal mortality. Access to the full spectrum of reproductive health care is vital to achieving reproductive justice in Pennsylvania. We should be expanding access, not cutting it. Everyone, no matter what their income, race, gender or zip code is, deserves the right to make their own decisions about their own health care.”

Jessica Sass contributed to this story.