In 2025, the landscape of reproductive health care is more complex than ever. With rapid policy change at both the federal and state levels and widening state-level disparities around family planning, nurse practitioners and patients alike are navigating new and evolving barriers to care.
The massive budget reconciliation bill, titled the “One Big Beautiful Bill” Act (OBBBA or H.R.1), passed narrowly by a vote of 51-50 on July 4, 2025. The most significant cuts were levied on Medicaid, the backbone of reproductive health access for millions. The program is slated for hundreds of billions of dollars in cuts, with the Congressional Budget Office estimating that nearly 12 million people will lose insurance coverage in the next decade. Even patients enrolled in private health insurance could feel the sting of the bill, as expiring tax credits threaten to raise premiums on ACA Marketplace plans.
The OBBBA is far from the only piece of legislation to impact reproductive health services recently, adding to an already-complex web of legal decisions and federal policies passed within the year. Join NP 411 as we dive into some of the most pressing developments affecting reproductive health today.
Policy Impacts on Sexual Health and Family Planning
Since entering office in January, the Department of Government Efficiency (DOGE) under the Trump administration have slashed numerous health programs receiving federal grant funding. Title X grants, which have historically funded family planning services including contraception, STI screening, and preventative care for low-income patients, were largely scrapped. Additionally, CDC programs aimed at STI research, surveillance, and prevention have found themselves on the funding chopping block. While the “Make America Healthy Again” initiative launched by the HHS’ Robert F. Kennedy, Jr. vows to investigate and stop chronic disease, the steep reduction in federal funding for critical sexual health programs could be a step backwards for public health.
Add to this the OBBBA, which significantly slashed Medicaid programs with reproductive care directly in the crosshairs. Since the Hyde Amendment of 1976, federal law already prohibits Medicaid from covering abortions except in cases of rape, incest, or life-endangering complications.
However, the OBBBA goes further by fully preventing Medicaid dollars from flowing to providers that perform abortions, even if those clinics also offer services unrelated to abortion. This narrow definition includes all Planned Parenthood clinics but also numerous other small family planning clinics, which may be forced to close or narrow their offerings. With many rural hospitals also at risk of closure due to the OBBBA’s cuts to Medicaid, many patients will find that they have far fewer options to turn to for sexual health services.
All of this comes in addition to new legal decisions like Medina v. Planned Parenthood South Atlantic, in which the Supreme Court ruled that individuals cannot sue the state over the Medicaid Act’s “free choice of provider” provision, which allows Medicaid beneficiaries to choose a qualified provider for a service. These policy changes could introduce more hurdles and more variability to accessing reproductive care and sexual health services.
This funding squeeze places heavier regulatory burdens on NPs in addition to mounting legal and ethical pressure. For NPs working in the realms of women’s health, federally qualified health centers (FQHC), primary care, sexual health (and those in other specialties who may experience ripple effects from new policies), this means adapting to fewer referral options, fewer subsidized resources, and greater disparities in patient outcomes.
Post-Roe Abortion Policy: Still in Flux
It’s been over three years since the Supreme Court ruling in Dobbs v. Jackson overturned constitutional protections on abortion granted by Roe v. Wade. In the years following this decision, access to abortion is determined by where a patient lives. Most states have some sort of gestational limit in place. Twelve states have banned abortion entirely or, in the most extreme cases, have made it a criminal offense to receive an abortion as a patient or to practice abortion as a provider. The diagram below from KFF outlines abortion restrictions by state.
Providers have raised legal and ethical concerns about the impacts of such fragmentary care on patients, as well as on their own practice. To this end, there have been high-profile legal battles between practitioners in states without abortion bans who have provided abortions to women in states where abortion is criminalized. While some states have enacted “shield laws” to protect providers in these situations, this practice is far from institutionalized. This patchwork makes continuity of care particularly difficult for patients who must travel across state lines or seek remote telehealth services to end a pregnancy, while also presenting a slew of legal risks for providers.
Contraceptives in 2025
Birth control is a mainstay of sexual health, with the CDC reporting that from 2015-2017 over 65% of women were using a contraceptive of some type. The FDA approval of over-the-counter Opill (a progestin-only birth control pill) in 2023 signaled a promising turn in favor of OTC birth control options. However, since insurers aren’t always required to cover OTC contraceptives or nonprescription methods like condoms, sponges, and spermicides, they remain out-of-reach for many due to out-of-pocket costs.
At the same time, prescription-only forms of birth control, like IUDs, injections, and implants have become harder to obtain for some patients since expanded exemption criteria for contraceptive coverage introduced by the first Trump administration was upheld by the Supreme Court in 2020.
Demand for reversible contraceptives is demonstrably high, and there’s likewise been an increasing interest in permanent sterilization options since the Dobbs ruling. A study published in JAMA found that tubal ligation procedures increased in every state following the ruling, signaling widespread concern about the state of reproductive health policy in the Post-Roe era.
Telehealth prescribing of birth control remains popular but may be limited by new state-level restrictions or reimbursement rollbacks. Nurse practitioners offering contraceptive care are likely preparing to troubleshoot coverage changes, affordability concerns, and continuity of use.
For patients trying to navigate sexual health, reproductive care, and the complex web of policies impacting access, NPs remain one of the most trusted, accessible points of contact to the medical world. As the barriers to care grow, counseling around the options available to patients has never been more important.
