Yet anti-abortion activists remain frustrated, in some cases even more so than before Roe was overturned.

Why? Because despite the new legal restrictions, abortions have not stopped taking place, not even in states with complete bans. In fact, the number of abortions has not dropped at all, according to the latest statistics.

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Liz Murrill, Louisiana’s attorney general, said at a Senate Health, Education, Labor, and Pensions Committee hearing this month.

That’s due in large part to the easier availability of medication abortion, which uses a combination of the drugs mifepristone and misoprostol, and particularly to the pills’ availability via mail after a telehealth visit with a licensed health professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could be dispensed only directly, and only by a medical professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the requirement for an in-person visit — a change the second Trump administration has not undone.

While the percentage of abortions using medication had been growing every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person dispensing requirement supercharged its use. More than 60% of all abortions were done using medication rather than a procedure in 2023, the most recent year for which statistics are available. More than a quarter of all abortions that year were managed via telehealth.

Separately, President Donald Trump’s FDA in October approved a second generic version of mifepristone, angering abortion opponents. FDA officials said at the time that they had no choice — that as long as the original drug remains approved, federal law requires them to OK copies that are “bioequivalent” to the approved drug.

It’s clear that reining in, if not canceling, the approval of pregnancy-terminating medication is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “America’s New Public Health Crisis,” referencing their growing use in ending pregnancies as well as claims of safety concerns — such as the risk a woman could be given the drugs unknowingly or suffer serious complications. Decades of research and experience show medication abortion is safe and complications are rare.

Another group, Students for Life, has been trying to make the case that the biological waste from the use of mifepristone is contaminating the nation’s water supply, though environmental scientists refute that claim.

Yet the groups are most frustrated not with supporters of abortion rights but with the Trump administration. The object of most of their ire is the FDA, which they say is dragging its feet on a promised review of the abortion pill and the Biden administration’s loosened requirements around its availability.

President Joe Biden’s covid-era policy allowing abortion drugs to be sent via mail ”should’ve been rescinded on day one of the administration,” SBA Pro-Life America’s president, Marjorie Dannenfelser, said in a recent statement. Instead, almost a year later, she continued, “pro-life states are being completely undermined in their ability to enforce the laws that they passed.”

Lawmakers who oppose abortion access are also pressing the administration. “At an absolute minimum, the previous in-person safeguards must be restored immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see abortion pill availability curtailed.

Sen. Jim Banks (R-Ind.) said at the hearing that he hoped “the rumors are false” that “the agency is intentionally slow-walking its study on mifepristone’s health risks.”

The White House and spokespeople at the Department of Health and Human Services have denied the review is being purposely delayed.

“The FDA’s scientific review process is thorough and takes the time necessary to ensure decisions are grounded in gold-standard science,” HHS spokesperson Emily Hilliard said in an emailed response to KFF Health News. “Dr. Makary is upholding that standard as part of the Department’s commitment to rigorous, evidence-based review.” That’s a reference to Marty Makary, the FDA commissioner.

Revoking abortion pill access may not be as easy as advocates hoped when Trump moved back into the White House. While the president delivered on many of the goals of his anti-abortion backers during his first term, especially the confirmation of Supreme Court justices who made overturning Roe possible, he has been far less doctrinaire in his second go-round.

Earlier this month, Trump unnerved some of his supporters by advising House Republicans that lawmakers “have to be a little flexible” on the Hyde Amendment to appeal to voters, referring to a decades-old appropriations rule that bans most federal abortion funding and that some Republicans have been pushing to enforce more broadly.

And while the anniversary of Trump’s inauguration has many analysts noting how much of the Heritage Foundation’s Project 2025 blueprint has been realized, the most headline-grabbing portions on reproductive health have yet to be enacted. The Trump administration has not, for example, revoked the approval of mifepristone for pregnancy termination, nor has it invoked the 1873 Comstock Act, which could effectively ban abortion nationwide by stopping not just the mailing of abortion pills but also anything else used in providing abortions.

Still, abortion opponents have decades of practice at remaining hopeful — and playing a long game.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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Roy, a co-founder and the chair of the Foundation for Research on Equal Opportunity, said health care affordability has become a more salient issue for the GOP under President Donald Trump, with more people from working-class backgrounds voting Republican.

Before Trump, he said, the party’s support was more concentrated among those covered by employer-sponsored insurance or Medicare, the public program for those who are 65 or older or have disabilities — voters less likely to be concerned about affording medical care.

An abbreviated version of this interview aired on What the Health? Episode 423: “The GOP Circles the Wagons on ACA.”

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Affordable Care Act tax credits are at the heart of one of the longest government shutdowns in U.S. history. The impact is starting to be felt by families and federal employees. Food assistance programs could run out of money at the end of the month. And federal health agencies such as the Centers for Disease Control and Prevention have faced layoffs.

KFF Health News chief Washington correspondent Julie Rovner appeared on WAMU’s Oct. 22 “Health Hub” to discuss the possible compromises that could reopen the government.

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While few details were made public when the program was announced on Sept. 30, Rovner explains that consumers who are enrolled in health plans through their employers or government programs may save more money on drugs using their insurance or drugmakers’ patient discount programs.

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Federal funding ran out at midnight on Oct. 1, after Congress failed to pass even a stopgap budget while negotiations continued.

Now the question is how long the deadlock will last, with Democrats pitted against Republicans and a presidential administration that has broken with constitutional norms and regularly used political intimidation and primary threats to achieve its ends. Because Republicans hold only a slim majority in the Senate, any deal will need to attract at least a few Democratic votes.

Ramifications from a shutdown on public health systems and health programs will be felt far beyond Washington, D.C., halting almost all of the federal government’s nonessential functions, including many operations related to public health.

Even on Sept. 30, as the clock ticked toward midnight, President Donald Trump renewed threats about mass firings of federal workers if Democrats didn’t acquiesce to GOP demands. Some people worry that such workforce reductions would further enable the administration to undermine federal government operations and reduce the budget impasse to what’s been described as three-dimensional chess or a game of chicken.

Such threats to fire, rather than temporarily suspend, federal workers are “unprecedented,” said G. William Hoagland of the Bipartisan Policy Center. The lack of negotiations between Capitol Hill Republicans and Democrats in advance of the shutdown is also unprecedented in his experience, said Hoagland, a longtime GOP Senate Budget Committee aide.

The stalemate centers largely on health coverage, with Democrats and Republicans clashing over the Affordable Care Act and Medicaid cuts. For Americans with ACA marketplace plans, government subsidies cap the percentage of household income they must pay toward premiums. Lawmakers expanded the subsidies in 2021 and extended that additional help through the end of 2025, and the looming expiration of those expanded subsidies would increase costs and reduce eligibility for assistance for millions of enrollees.

Democrats want a further extension of the subsidies, but many GOP lawmakers are resistant to extending them as is and say that debate must wait until after a budget deal to keep the federal government afloat. Antagonism has grown, with the parties in a pitched battle to convince voters the other party is to blame for the government’s closure.

Said Senate Minority Leader Chuck Schumer on the Senate floor Sept. 30: “Republicans have chosen the losing side of the health care debate, because they’re trying to take away people’s health care; they’re going to let people’s premiums rise.”

But Senate Majority Leader John Thune accused Democrats of attempting to “take government funding hostage.”

The longer a shutdown lasts, the more impacts could be felt. For example, some community health centers would be at risk of closure as their federal funding dries up.

Long-term projects by the Federal Emergency Management Agency to reduce damage from future natural disasters will stop, for example. Rescue services at national parks that stay open will be limited. And at the National Institutes of Health, many new patients awaiting access to experimental treatments may not be admitted to its clinical center.

Entitlement programs such as Medicaid and Medicare will continue, as will operations at the Indian Health Service. But disease surveillance, support from the Centers for Disease Control and Prevention to local and state health departments, and funding for health programs will all be hampered, based on federal health agencies’ contingency plans.

The Department of Health and Human Services is expected to furlough about 40% of its workforce, which has already been downsized by about 20,000 positions under the Trump administration. Across the federal government, roughly 750,000 employees will be furloughed, according to an estimate released Sept. 30 by the Congressional Budget Office, a nonpartisan agency that calculates the cost of legislation. While furloughed employees won’t be working, eventually they will get back pay, totaling about $400 million daily, the CBO estimated.

At HHS, research is expected to pause on the links between drug prices and the Inflation Reduction Act, the major law enacted under former President Joe Biden to boost the economy. Despite reports that Food and Drug Administration Commissioner Marty Makary said the FDA would basically be untouched, the agency won’t accept new drug applications and food safety efforts will be reduced. Federal oversight of a program that helps hospitals save lives and evacuate individuals in environmental crises is expected to stop.

Fewer federal staff will be available to provide help to Medicaid and Medicare enrollees. CDC responses to inquiries about public health matters will be suspended. And the work of a federal vaccine injury program is also anticipated to stop.

Congressional Democrats insist the ACA subsidies must be renewed now because enrollment for the Obama-era health program opens on Nov. 1. Without the extended subsidies, health insurers are warning of double-digit premium hikes for millions of enrollees.

House Democratic Leader Hakeem Jeffries has argued that a “Republican-caused health care crisis” is hanging over Americans as a result of Trump’s new tax-and-spending bill, which adds restrictions to Medicaid that are expected to kick millions off the program. Republicans have also advanced mass layoffs and funding cuts at the nation’s health department and caused widespread confusion over access to some vaccines.

“We’re not going to simply go along to get along with a Republican bill that continues to gut the health care of everyday Americans,” Jeffries told reporters Sept. 29. “These people have been trying to repeal and displace people off the Affordable Care Act since 2010.”

Republicans, meanwhile, have blasted Democrats for holding up funding over the subsidies and say any deal will require concessions.

“If there were some extension of the existing policy, I think it would have to come with some reforms,” Thune, the Senate Republican leader, said Sept. 26.

Such a deal may involve changes to a policy that caps what consumers have to pay for ACA marketplace plans at 8.5% of their income, no matter how much they earn. It could also alter their ability to obtain plans with no premiums, an option that became more widely available because of the beefed-up subsidies.

Adding restrictions to the ACA subsidies is likely to decrease enrollment in the program, which saw declines during the first Trump administration and did not reach 20 million for the first time until last year, a milestone reached in large part due to the subsidies.

Several Republicans have expressed interest in extending the subsidies, including a group of GOP representatives who proposed legislation to do so last month.

Democrats may be betting that the timing of the shutdown will put pressure on their Republican colleagues to come to the negotiation table on the ACA subsidies.

Within days of the government’s closure, ACA enrollees are expected to get notices from their health insurers advising them of steeper premiums. Insurers have said the expiring subsidies have forced those large premium hikes because the healthiest and youngest people are more likely to opt out of coverage when prices go up.

The White House, meanwhile, ramped up its pressure campaign on Democrats. White House press secretary Karoline Leavitt insisted Sept. 29 that Trump wants to keep the government open.

“Our most vulnerable in our society and our country will be impacted by a government shutdown,” she said.

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With only a few exceptions, the budget reconciliation process — which allows the political party in control to pass a bill with only 51 votes in the Senate, rather than the usual 60 — is how nearly every major piece of health legislation has passed Congress since the 1980s.

But using reconciliation to constrict rather than expand health coverage, as the GOP is attempting now? That is unusual.

One of the best-known programs born via reconciliation is the “COBRA” health insurance continuation, which allows people who leave jobs with employer-provided insurance to keep it for a time, as long as they pay the full premium.

That is one of dozens of health provisions tucked into COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985. Also included was the Emergency Medical Treatment and Active Labor Act, which requires hospitals that take Medicare to treat or transfer patients with medical emergencies, regardless of their insurance status — a law that’s become a focus of abortion opponents as they seek to limit access to the procedure.

The 1989 reconciliation bill created a new system for paying doctors who treat Medicare patients, as well as a new federal agency to study the cost, quality, and effectiveness of health care, today known as the Agency for Healthcare Research and Quality.

Children’s health has been a popular add-on over the years, including the gradual expansion of Medicaid coverage to more children based on family income. The 1993 reconciliation bill created the Vaccines for Children program, which ensures the availability and affordability of vaccines nationwide for uninsured and underinsured kids. The 1997 reconciliation bill created the Children’s Health Insurance Program, which today provides insurance to more than 7 million children.

In fact, the list of major health bills of the past 50 years not passed using budget reconciliation is short. For instance, the 2003 Medicare Modernization Act, which added a prescription drug benefit to the program for the first time, attracted just enough bipartisan support to pass on its own.

The biggest health care law of recent decades — the Affordable Care Act — didn’t start out as a reconciliation bill, but it ended up using the process to clear its final hurdles.

After initial passage of the bill in December 2009, a special election cost Democrats their 60th seat in the Senate — and with it, the supermajority they needed to pass the bill without Republican votes. In the end, the two chambers used a separate reconciliation measure, the Health Care and Education Reconciliation Act of 2010, to negotiate a compromise that included the ACA.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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Health programs including Medicaid, Affordable Care Act subsidies, and food assistance are facing cuts in the budget reconciliation bill making its way through Congress. If passed as written, the “One Big Beautiful Bill” could dramatically reduce health care access for millions of Americans. And even those who don’t rely on these programs could see local hospitals close.  

KFF Health News chief Washington correspondent Julie Rovner appeared on WAMU’s “Health Hub” on June 18 to answer listeners’ questions and break down how the bill could reshape U.S. health care. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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And indeed, abortion opponents held their breath when, during Trump’s first few days in office, his piles of executive orders did not include any on abortion. 

But he has more than made up for it since, having gone further in his first two weeks in office to restrict abortion than any president since Roe v. Wade was decided in 1973. 

As was widely expected, Trump has reinstated the “Mexico City Policy,” an order issued by every GOP president since it was adopted by former President Ronald Reagan in 1984. It bars funding to international aid organizations that “perform or actively promote” abortion. 

He also issued a similar-sounding order seeking to end “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs. It in fact goes further to restrict abortion than previous presidents in the modern era. 

Trump’s order, and a memo from the Department of Health and Human Services following up on it, says that the basis for this policy is the Hyde Amendment, which was named for the late GOP congressman and anti-abortion crusader Henry Hyde. That measure has barred federal funding of most abortions since Congress first passed it in the late 1970s. 

In its current iteration (it has changed several times over the years), the Hyde Amendment says that no HHS funding “shall be expended for health benefits coverage that includes coverage of abortion.” 

But Hyde bars only payment. Unlike the Mexico City Policy, it says nothing about “promoting” abortion. 

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that grantee providers give patients with unintended pregnancies “nondirective” counseling about all their options, including abortion, and be referred for abortions if they request it. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term. 

With Roe now in the rearview mirror, the Trump administration could take even more dramatic action to restrict abortion at the federal level, including by canceling FDA approval of the abortion pill mifepristone. His anti-abortion backers are expecting he will. So are those who support abortion rights. 

“We said they were coming for us,” said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. “And they are.” 

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Their concerns mounted after Trump named Robert F. Kennedy Jr., a longtime supporter of abortion rights, to lead the Department of Health and Human Services — and then as he signed a slew of Day 1 executive orders that said nothing about abortion.

As it turns out, they had nothing to worry about. In its first two weeks, the Trump administration went further to restrict abortion than any president since the original Roe decision in 1973.

Hours after Trump and Vice President JD Vance spoke to abortion opponents gathered in Washington for the annual March for Life, the president issued a memorandum reinstating what’s known as the Mexico City Policy, which bars funding to international aid organizations that “perform or actively promote” abortion — an action taken by every modern Republican president.

But Trump also did something new, signing an executive order ending “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs — effectively ordering government agencies to halt funding to programs that can be construed to “promote” abortion, such as family planning counseling.

Dorothy Fink, the acting secretary of Health and Human Services, followed up with a memo early last week ordering the department to “reevaluate all programs, regulations, and guidance to ensure Federal taxpayer dollars are not being used to pay for or promote elective abortion, consistent with the Hyde Amendment.”

The emphasis on the word “promote” is mine, because that’s not what the Hyde Amendment says. It is true that the amendment — which has been included in every HHS spending bill since the 1970s — prohibits the use of federal dollars to pay for abortions except in cases of rape or incest or to save the mother’s life.

But it bars only payment. As the current HHS appropriation says, none of the funding “shall be expended for health benefits coverage that includes coverage of abortion.”

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that patients with unintended pregnancies be given “nondirective” counseling about all their options, including abortion. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term.

So, what is the upshot of Trump’s order?

For one thing, it directly overturned two of Biden’s executive orders. One was intended to strengthen medical privacy protections for people seeking abortion care and enforce a 1994 law criminalizing harassment of people attempting to enter clinics that provide abortions. The other sought to ensure women with pregnancy complications have access to emergency abortions in hospitals that accept Medicare even in states with abortion bans. The latter policy is making its way through federal court.

Trump’s order is also leading government agencies to reverse other key Biden administration policies implemented after the fall of Roe v. Wade. They include a 2022 Department of Defense policy explicitly allowing service members and their dependents to travel out of states with abortion bans to access the procedure and providing travel allowances for those trips. (The Pentagon officially followed through on that change on Jan. 30, just a few days after Defense Secretary Pete Hegseth took over the job: Service members are no longer allowed leave or travel allowances for such trips.) The order is also likely to reverse a policy allowing the Department of Veterans Affairs to provide abortions in some cases, as well as to provide abortion counseling.

But it could also have more wide-ranging effects.

“This executive order could affect other major policies related to access to reproductive health care,” former Biden administration official Katie Keith wrote in the policy journal Health Affairs. These include protections for medication abortion, emergency medical care for women experiencing pregnancy complications, and even in vitro fertilization.

“These and similar changes would, if and when adopted, make it even more challenging for women and their families to access reproductive health care, especially in the more than 20 states with abortion bans,” she wrote.

Anti-abortion groups praised the new administration — not just for the executive orders, but also for pardoning activists convicted of violating a law that protects physical access to abortion clinics.

“One after another, President Trump’s great pro-life victories are being restored and this is just the beginning,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.

Abortion rights groups, meanwhile, were not surprised by the actions or even their timing, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. The association represents grantees of Title X, which has been a longtime target of abortion opponents.

“We said we didn’t think it would be a Day 1 thing,” Coleman said in an interview. “But we said they were coming for us, and they are.”

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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