Background
In 2025, Congress enacted Section 71113 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 over eight hundred thousand dollars in Medicaid funding in fiscal year 2023. The statute also extends this funding restriction to affiliates, subsidiaries, and successors 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 First Circuit reviewed the case to determine if the law inflicted punishment.
The court’s reasoning
The court analyzed whether Section 71113 inflicted punishment under the Bill of Attainder Clause by examining historical meaning, the severity of burdens, and legislative intent. The court concluded that the statute does not impose punishment because it looks forward to establish new conditions on 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 permanent disabilities. Regarding the unconstitutional conditions claim, the court interpreted the term affiliates to mean entities under common corporate control, thereby avoiding the need to rule on whether the statute coerced a forfeiture of associational rights.
Section 71113 does not impose punishment on Appellees. It instead uses Congress’s taxing and spending power to put Appellees to a difficult choice: give up federal Medicaid funds and continue to provide abortion services or continue receiving such funds by abandoning the provision of abortion services.
Nos. 25-1698, 25-1755, slip op. at 27 (1st Cir. Dec. 12, 2025)
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.