Author: Grace Wright

HHS Probe Into States’ Medicaid Coverage of Abortion Care: Will Abortion Care Policies Truly be Left up to the States in the Wake of Dobbs?

In 2022, the Supreme Court, in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade, holding that abortion care is not a fundamental right under the Constitution. Therefore, access to abortion care is now left up to the states. However, the Trump Administration has also signaled that the current United States Department of Health and Human Services’ (HHS) priorities must protect the right of religious exercise and has expressed a goal to reevaluate programs to ensure enforcement of the Hyde Amendment, which prevents federal funds from being used for elective abortions. The Administration’s statements have created questions about whether future abortion care policies will actually be left to the states. 

On March 19, 2025, HHS’s Office of Civil Rights announced that it plans to investigate thirteen states, including California, Colorado, Illinois, Maine, Minnesota, New York, Maryland, and Massachusetts, for allegedly compelling health care providers to provide abortion care. While the full list of the states under investigation has not been released, the states included are those that mandate state-regulated health insurance plans to cover abortion care. The actions are being taken under the Weldon Amendment that prohibits states from discriminating against health care providers that refuse to cover abortion. The Biden Administration interpreted the amendment not to apply to healthcare sponsors, but this administration believes that interpretation is too limited. While the Trump Administration had previously rescinded civil rights guidance issued by the Biden Administration that largely sought to protect abortion access, this investigation has escalated efforts to limit abortion care. 

Maryland Governor Wes Moore and Massachusetts Governor Maura Healey have publicly responded to the letters they received from HHS and both made clear that their priorities are to continue ensuring access to reproductive health care in their states. While it remains unclear what the outcome of these investigations will be, they indicate a potential threat to states that have decided to continue ensuring access to abortion. Reproductive health care advocates have expressed a concern that this investigation indicates that the Trump Administration does not truly intend to “leave abortion to the states” and that further federal interference with states that have protected abortion access post-Dobbs may be imminent. In addition, concerns have arisen that the investigations do not have weight under law, as they did not arise out of any complaints of the states, and advocates have expressed fear that they have merely arisen to advance the Administration’s political agenda, rather than out of a genuine concern of violation of the law. For citizens, abortion care post-Dobbs has been uncertain, with access largely depending on geography and an increase in travel for abortion access. This investigation indicates the potential that the Trump Administration plans to take action to further limit abortion access, particularly meaning that low-income citizens with less ability to travel may experience further difficulty in access. 

The Trump Administration Issues Inconsistent Guidance Regarding Acetaminophen and Autism

The current presidential administration has placed significant focus on addressing a cited increase in the rate of autism diagnoses. Late last month, President Trump, alongside the Health Secretary, Robert F. Kennedy Jr., issued new health guidance and announced in a press conference that there is evidence of a link between the use of acetaminophen during pregnancy and neurological effects, specifically autism and attention-deficit/hyperactivity disorder (ADHD), in children post-birth. The announcement was coupled with a notice from the U.S. Food and Drug Administration (FDA) that it plans to initiate a process for a label change on acetaminophen products to inform consumers of the link, as well as a letter issued by the FDA to physicians about the potential link. The FDA’s letter specifies that “a causal relationship has not been established” between use of the medication and autism, while also asserting that clinicians may want to suggest pregnant people reduce their use of the medication. The issuance of sweeping advice from the Trump Administration in light of these inconsistencies is unsettling from a public health perspective because acetaminophen remains the recommended drug for fever reduction in pregnant people. The guidance to minimize acetaminophen use could be harmful for pregnant people because it may lead them to endure unnecessary pain and fever, which are dangerous for the pregnant person and the fetus.

In addition, mixed messages have created confusion in the legal context because of the announcement’s reliance on a study that was previously found inadmissible by a judge. In 2022, a group of families sued the maker of Tylenol, an acetaminophen product, for failure to warn consumers of the risk that prenatal exposure to the medication may create a heightened risk of autism. One of the experts used to support the families’ proposition was Andrea Baccarelli, MD, PhD, who was also cited in the Trump Administration’s recent announcement. The judge rejected this expert, as well as all of the families’ other experts, in an order in 2023, stating that the experts had “cherry-picked” data in their analyses. The case was subsequently dismissed in 2024, and the dismissal is currently on appeal.

In light of the executive branch’s reliance on one of the same experts as the families, the plaintiffs’ attorney has filed a letter with the court in support of their appeal, noting that the expert had been relied upon in the conclusions of a recent White House briefing. The lawyer notes the separation of power concerns that would arise if the ruling that this expert’s opinions are inadmissible in court is affirmed, while the opinions are simultaneously cited as valid by the executive branch. On the other hand, the attorney for Tylenol in the same lawsuit has also filed his own letter referencing the advice put out by the Trump administration as support of the defendant’s position that they have not failed to include any warning of a link to autism on their products. The defendant’s lawyer cites the language in the FDA’s letter to doctors stating that there is no causal relationship between the drug and autism. In light of each of letters, the judge has pushed back oral argument on this appeal that was set to occur on October 6, 2025 to November 17, 2025.

The use of the Trump administration’s guidance in this litigation to both support and disprove a link between Tylenol and autism emphasizes the confusion the new health guidance has created. What does this mean going forward? In the immediate future, the guidance may create fear among pregnant people about treating their pain and fever during pregnancy. If moving forward, the guidance does successfully ignite litigation aimed at a requirement to label acetaminophen products as not recommended during pregnancy, it could lead to an increase in pregnant people leaving pain and fever untreated during pregnancy, potentially putting them in danger of other complications.