A year ago, abortion opponents were celebrating one of their biggest victories under the Trump administration: Planned Parenthood, the movement’s arch-villain, had been temporarily kicked out of Medicaid, one of the nation’s largest health insurance programs.

Planned Parenthood was calling the policy an existential threat — warning that hundreds of health centers could shut down, leaving countless Americans without a reliable option for birth control, cancer screenings or testing for sexually transmitted infections.

But a year later, abortion opponents’ biggest win has expired and has little chance of being renewed any time soon, and Planned Parenthood’s most dire predictions did not come to pass. The ban ended July 3, and Americans insured through Medicaid can once again use that coverage at a Planned Parenthood affiliate.

More than a dozen blue states, including California and New York, stepped in during the defunding, providing hundreds of millions of dollars to support Planned Parenthood clinics. As a result, only about two dozen of the nation’s nearly 600 Planned Parenthood clinics shut their doors in the year the organization lost federal funding. 

On Thursday, Planned Parenthood announced a $47 million midterm spending plan in an effort to target congressional Republicans who voted last year in favor of the defunding.

And anti-abortion activists are learning that in an election year, it’s harder to persuade their Republican allies on Capitol Hill to cut funds for the nation’s largest provider of reproductive health care. 

“At the time people were hungry for something that they could spin as a political win for the pro-life cause, and it wasn’t like it was nothing — but it was kind of the lowest-hanging fruit,” said Patrick Brown, a fellow at the conservative think tank the Ethics and Public Policy Center. “I can’t say I’m terribly surprised that even that low-hanging fruit is not able to be plucked again.”

Abortion opponents are calling on Congress to renew Planned Parenthood’s “defunding,” which prohibited the use of federal Medicaid funds to reimburse the organization’s clinics for non-abortion reproductive health services. Medicaid, which covers low-income people, is mostly bankrolled by the federal government, but individual states also contribute a portion of funding.

But with the November elections mere months away, and the GOP already facing tough odds to retain control of Congress, the chances of another defund are slim. 

“Everybody knew at the time there was no way this was going to get extended heading into an election year,” Brown added.

Polling has shown that most adults — including most independents and almost half of all Republicans — oppose policies that would stop Medicaid from covering non-abortion services provided at Planned Parenthood clinics. Already, federal funds do not cover abortions done at Planned Parenthood, meaning the federal “defund” did not directly affect access to abortion but did cut off coverage of preventive services like Pap smears and contraception.

“We are doing everything we can to make sure people are aware this care is popular, that it’s something people want,” said Stephanie Ogorzalek, the vice president of research and policy at Planned Parenthood Action Fund, the organization’s political wing.

Congressional Republicans have indicated that they face long odds in getting enough support for another tax-and-spending bill before the elections. That type of legislation, which only requires 51 votes in the Senate, would be the likeliest vehicle to renew cuts to Planned Parenthood. 

Medicaid is one of the largest single sources of revenue for Planned Parenthood clinics, which often operate on shoestring budgets. 

The organization has pointed to other data that it says suggests larger consequences, even if most clinics stayed open. 

Between October 2025 and April 2026, Planned Parenthood recorded 250,000 fewer visits than in the same period a year earlier. The number of breast exam visits at Planned Parenthood clinics declined by 20 percent; visits for intrauterine devices, or IUDs, fell by 26 percent. 

It’s not clear how many patients received medical care somewhere else and how many may have skipped those visits altogether. Planned Parenthood’s data showed that most clinics that closed were in places that had few if any other options for basic reproductive health care.

“A lot of people are likely going without this care if they can’t find care elsewhere to go,” said Brittni Frederiksen, associate director for women’s health policy at KFF, a nonpartisan health policy, polling and journalism organization. “I’m sure a number of these people have gone to Planned Parenthood for years. This is their preferred source of care. This is where they know they can get quality sexual and reproductive health care.”

She suggested the consequences of the federal defunding might be more concentrated in particular states, pointing to Louisiana, which now has no Planned Parenthood clinics left, and Iowa, where a clinic is set to close at the end of July, leaving one remaining in the entire state.

Planned Parenthood Central Northern States, which operates clinics in Iowa, Minnesota, Nebraska and South Dakota, shut down eight clinics last year in anticipation of the federal defund policy, said CEO Ruth Richardson. 

This month’s closure in Iowa, which she attributed to the financial strain caused by losing Medicaid revenue, will leave 14 Planned Parenthood health centers across those four states, down from 23 at the beginning of 2025. In Iowa alone, she said, Planned Parenthood saw its volume of Medicaid-insured patients fall almost by half.

“Those lost patients were people not getting access to cancer screenings or primary care,” she said. “We’re really an irreplaceable provider.”

Iowa is one of the three states in the country where cancer rates are climbing; doctors say treatment for rural patients is often delayed because it’s so difficult to get screened.

Even without federal action, some conservative states may move to defund Planned Parenthood on their own, said Laurie Sobel, another associate director for women’s health policy at KFF. She pointed to a Supreme Court case decided in June 2025 in which the court allowed South Carolina to bar Planned Parenthood from receiving Medicaid funds.

That ruling took effect weeks before Congress voted to cut Planned Parenthood out of the program altogether. 

Now, with the federal ban lapsed, conservative-led states could use the court ruling as fuel to enact their own defundings — without incurring the same political risk as members of Congress, where Republicans hold a slim majority and where several members are in districts Kamala Harris won in 2024.

“What I’m anticipating is we’re going to see a new wave of states banning Planned Parenthood from their Medicaid programs,” Sobel said. “I think there are states that even if it’s not very meaningful, even if Planned Parenthood is not a big provider in their state, I think it’s symbolic for some states to take whatever action they can.”