Author: Emily Van Court

A Year in Review: The Dissolution of USAID

It has now been just over one year since the dissolution of the United States Agency for International Development (USAID), one of the first agencies affected by the Trump Administration’s government efficiency cuts. USAID, prior to absorption into the State Department, was the United States’ foremost agency for humanitarian aid, and a key implementation partner to multiple global public health campaigns, such as vaccination and AIDS relief programming. Two decades of USAID services, specifically targeting low and middle-income countries (LMIC), were associated with a 15% reduction in age-standardized all-cause mortality, with those numbers higher when looking at a reduction in mortality from HIV/AIDs, malaria, and nutritional deficiencies.

In the year since USAID’s dissolution, the cessation of humanitarian aid has spread beyond the U.S., with multiple European countries rolling back their international development funding, leading to what is now known as the “Great Aid Recession.” For the first year following the funding cuts, multiple non-profits tracked the fallout in terms of human casualties, most notably the Impact Counter Dashboard, which has since retired in early 2026.  At the one-year mark, the Impact Counter Dashboard estimated a mortality count of 781,343 deaths directly attributed to the funding cuts, with millions more estimated from the spread of diseases such as malaria, which were previously on the road to eradication in certain regions. Another study conducted by The Lancet Global Health projected that USAID funding cuts to global health programs could result in an additional 22.6 million deaths by 2030, should an alternative not be found.

Just as the global health impact is not slowing any time soon, neither is the legal fallout from the Trump Administration’s decision to abruptly dissolve the agency. In the immediate aftermath of the closure, hundreds of lawsuits were filed by affiliated NGOs fighting against the funding freeze, most notably the case of Department of State v. Aids Vaccine Advocacy Coalition. In this case, the Supreme Court, in a narrow 5-4 decision, barred the Administration from withholding $2 billion, allotted by Congress for humanitarian aid, from USAID contractors. A similar case, Global Health Council v. Trump, also consisted of several non-profits seeking an injunction barring the implementation of an Executive Order that would cut their funding from USAID prior to their contracts being fulfilled. However, this case is still ongoing, despite an initial injunction filed by the D.C. District Court based on the decision in Department of State v. Aids Vaccine Advocacy Coalition. Multiple USAID partners are still fighting funding freezes with the hopes of retaining their programs and impact.

Another slew of lawsuits against the Administration came from the USAID workers themselves. One such case is American Foreign Service Association v. Trump, in which a representative of USAID workers argued that the reduction in force and subsequent funding cuts violated the Civil Service Reform Act. The arguments in front of the DC Circuit Court of Appeals are due to be heard on April 23, 2026. Another case, Greene v. USAID, consists of three former USAID employees fighting the force reduction on the grounds that their jobs were unlawfully terminated because their duties involved DEI-related compliance. This case was filed in February 2026, and is scheduled to be heard by the D.C. District court later this year.

In the midst of both worsening global health challenges and unending legal battles throughout the last year, health advocates and humanitarian organizations have been waiting to see what the Trump Administration will implement in place of USAID. According to the 2025 America First Global Health Strategy, the Administration plans to move away from federal partnerships with NGOs and towards providing direct funding to target nations. The Administration did not act on the plan until March 19, 2026, when they released an executive order, announcing the signing of a five-year bilateral health cooperation agreement between the United States and Angola. It remains to be seen whether the Administration’s new strategy can match the reach and efficacy of USAID.

EMTALA in the Age of Rising Abortion Bans

Following the decision in Dobbs v. Jackson Women’s Health Organization in 2022, abortion bans have been popping up in states across the country. Many states have qualified their bans with exceptions based on the gestational age of the pregnancy, assault, or medical necessity. However, for 12 states, the exceptions, if present at all, are narrow, creating near-total abortion bans. This has widespread implications not just for patients, but for medical providers who traditionally provide abortions or greater obstetrics care.

One specific class of providers has found itself in the middle of a clash between state and federal law due to these bans. Emergency medical providers are not just bound by state law, but by the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA is a federal act passed in 1986 as a response to a problematic practice of “patient dumping,” where hospitals refuse to treat low-income patients or patients from marginalized communities and transfer them to other hospitals. The primary requirement of the act is that any patient who arrives at an emergency room in a hospital that receives Medicare funding must be screened and stabilized before being transferred or released. The majority of guidance on EMTALA has left the medical decision-making aspect of stabilization and treatment up to the discretion of medical providers within the scope of their capabilities and the current standards of care.

The issue arises in cases where an abortion is determined to be medically necessary for the stabilization of a patient by a provider in an emergency setting. Pregnancy complications are the fifth most common reason that women between 18 and 65 visit the emergency room, with 84% of women visiting the emergency room at some point during their pregnancy. Due to the breadth of procedures that fall under the clinical term “abortion,” many medical procedures required for emergency obstetrics care fall under the abortion umbrella. Often, these procedures are life-saving and needed for even the most basic stabilization of a pregnant patient, such as in the case of ectopic pregnancy.

A few cases reflecting this conflict have made their way to the Supreme Court, hoping to receive a concrete answer as to whether emergency abortion procedures would remain protected. The most recent of these is Idaho v. United States, where the DOJ contended that Idaho’s near-total abortion ban would have to yield to federal law in terms of the provision of necessary stabilizing treatment. However, SCOTUS dismissed the complaint in 2024 without a specific ruling on the interaction between EMTALA and abortion bans, finding that the writ of certiorari was improvidently granted.

Despite this dismissal, the Supreme Court has another chance to hear arguments concerning the interaction between EMTALA and abortion bans due to a recent lawsuit where Texas sued the DOJ in an attempt to force ER compliance with the state’s strict abortion ban. The Fifth Circuit Court of Appeals sided with the state, allowing for the abortion ban to prevail over EMTALA obligations. The DOJ, under President Biden, filed for a review of the decision in 2024, but after the change in administration, it remains to be seen whether the DOJ will continue to pursue the complaint or whether SCOTUS will hear the case.

Without a clear ruling from federal courts, the conflict between the duties of providers under EMTALA and state-based bans leaves providers wary of legal repercussions, no matter which actions they take. Guidance from the Center for Medicare & Medicaid Services, as given in 2022, stated that providers would be protected under EMTALA for the provision of medically necessary abortions for the stabilization of emergent patients. However, that guidance was rescinded under President Trump as of June 3rd, 2025, and subsequent communication from the HHS on June 13th, 2025, was unclear. The lack of clear information and rising legal consequences of providing abortions in certain states have thrust providers and patients alike back into a state of uncertainty and fear.