The U.S. Court of Appeals for the First Circuit has vacated preliminary injunctions that had previously blocked the enforcement of a 2025 law designed to withhold Medicaid funding from certain abortion providers, primarily affecting Planned Parenthood affiliates. The appellate court disagreed with the district court’s finding that the Planned Parenthood plaintiffs were likely to succeed on their constitutional challenges, specifically those related to bills of attainder, unconstitutional conditions, and equal protection.
The law in question, Section 71113 of a 2025 Reconciliation Act, targets non-profit entities that function as essential community providers, primarily offer family planning services, provide abortion services, and received over $800,000 in Medicaid funding in fiscal year 2023. Crucially, the law also applies these restrictions to the “affiliates, subsidiaries, successors, and clinics” of any entity meeting these four criteria, even if the affiliate itself doesn’t meet all four.
The plaintiffs—Planned Parenthood Federation of America (PPFA), Planned Parenthood League of Massachusetts (a “Qualifying Member”), and Planned Parenthood Association of Utah (a “Non-Qualifying Member”)—argued that the law singled them out for unconstitutional punishment and coerced them into abandoning their association with the national organization or other members to retain Medicaid eligibility.
Bill of Attainder Claim Fails Under Retrospective Test
The First Circuit first tackled the claim that Section 71113 constitutes an unconstitutional bill of attainder. This clause prohibits Congress from enacting laws that inflict punishment without a judicial trial. To prove this, the plaintiffs needed to show the law inflicts punishment, targets an identifiable group, and does so without a trial.
The appellate court focused its analysis on whether the statute inflicts “punishment.” While acknowledging the district court found the law imposed severe burdens—forcing a choice between providing abortions or receiving Medicaid funds—the First Circuit disagreed with classifying this as punishment in the historical sense.
The court emphasized that traditional bills of attainder targeted past conduct through severe, non-contingent disabilities (like imprisonment or barring individuals from professions). In contrast, Section 71113 is prospective; it establishes new conditions for receiving future government funds.
Judge Gelpí, writing for the panel, noted that the statute does not impose a fine or penalty for past actions. Instead, it presents a choice: stop providing abortions to continue receiving Medicaid funds or keep providing abortions and forgo those funds. The court likened this to conditioning benefits, stating that the “mere denial of a noncontractual government benefit” is generally not considered historical punishment. Because the plaintiffs could avoid the funding loss by altering future conduct (stopping abortion services), the court found they were unlikely to succeed on this claim.
Interpreting “Affiliates” Narrowly Avoids Constitutional Conflict
Next, the court addressed the plaintiffs’ argument that Section 71113 imposed an unconstitutional condition on the right of association, particularly for Non-Qualifying Members. The district court had accepted that the vague application of the term “affiliates” might coerce these members into disaffiliating from abortion-providing members to maintain funding eligibility.
The First Circuit took a different interpretive path, relying on the principle of constitutional avoidance. Since the government’s articulation of “affiliate” was inconsistent—ranging from corporate control to shared medical standards—the court decided to adopt the most legally settled meaning.
The court turned to standard legal dictionaries, defining “affiliate” in the context of other federal statutes as involving corporate control, ownership, or the power to direct management, rather than just shared mission or values. By reading “affiliates” narrowly to mean relationships based on concrete organizational control, the court concluded that the funding condition was unlikely to hinge on protected expressive activity.
“These considerations support applying the corporate-control definition,” the opinion stated. Under this narrow reading, the link between a Non-Qualifying Member and a Qualifying Member is less likely to be deemed an “affiliate” relationship requiring disaffiliation based on speech or association. Therefore, the unconstitutional conditions claim was deemed unlikely to succeed.
Equal Protection Reviewed Under Rational Basis, Not Strict Scrutiny
The final major challenge involved the Equal Protection component of the Fifth Amendment, which the district court reviewed under strict scrutiny because it believed the law infringed on the fundamental right of association.
However, the First Circuit’s decision to interpret “affiliates” based on corporate control—rather than expressive association—removed the basis for applying strict scrutiny. If no fundamental right is implicated by the statutory classification, the court applies the highly deferential rational basis review.
Under rational basis review, the law must only be rationally related to a legitimate governmental interest, and the challenger bears the heavy burden of proving it is arbitrary or irrational. The government argued that Section 71113 targeted providers who received significant Medicaid funding and were likely to perform a “disproportionate number” of abortions, aiming to reduce the subsidization of abortion.
The appellate court found this justification sufficient. It noted that Congress is permitted to legislate incrementally, addressing the “phase of the problem which seems most acute.” The court dismissed arguments that the law was underinclusive (by missing other abortion providers) or that the $800,000 threshold was an arbitrary proxy, stating that courts cannot second-guess the wisdom of legislative policy choices under this standard.
Concluding that plausible reasons existed for treating these highly funded entities differently, the First Circuit found the plaintiffs unlikely to prevail on their equal protection claim.
In summary, the First Circuit vacated the preliminary injunctions, ruling that the plaintiffs were unlikely to succeed on any of their constitutional challenges against Section 71113. The case was remanded for further proceedings consistent with the appellate court’s narrow interpretation of the statute’s reach.