Background
In 2025, Congress enacted Section seven one one one three of the Reconciliation Act, which withholds Medicaid funding for one year from non-profit organizations that are essential community providers, provide abortion services, and received more than eight hundred thousand dollars in Medicaid funding in fiscal year two thousand and twenty-three. The statute also extends this funding restriction to the affiliates, subsidiaries, and clinics of such entities. Planned Parenthood Federation of America and two of its members sued, arguing the law was an unconstitutional bill of attainder, an unconstitutional condition on their right of association, and a violation of equal protection. The district court granted a preliminary injunction, but the government appealed to the First Circuit.
The court’s reasoning
The court analyzed whether Section seven one one one three inflicted punishment under the Bill of Attainder Clause. It concluded that the statute does not impose punishment because it looks forward to establish conditions on the receipt of appropriated funds rather than penalizing past conduct. The court noted that the statute leaves open the possibility for providers to qualify for funds by halting abortion services, distinguishing it from historical bills of attainder that imposed non-contingent disabilities. Regarding the unconstitutional conditions claim, the court interpreted the term affiliates to mean entities under common corporate control, such as subsidiaries or parent corporations, rather than independent members of the same association. This narrow construction meant the statute did not coerce the plaintiffs to disassociate from their national organization to retain funding.
What it means going forward
The decision allows the federal government to proceed with withholding Medicaid funding from qualifying Planned Parenthood members and their controlled affiliates for one year, subject to the statutory criteria.