Republicans targeted abortion providers. Some Mainers lost primary care

Summary

Consider This from NPR

Episode Title: Republicans targeted abortion providers. Some Mainers lost primary care
Date: November 17, 2025
Host: Juana Summers
Main Reporter: Selena Simmons-Duffin

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Episode Overview

This episode examines how a new federal law, aimed at restricting funding for abortion providers, is affecting access to primary care in Maine—where abortion remains legal and widely supported. The focus is on Maine Family Planning, a network of clinics now cut off from Medicaid funding due to their provision of abortion services. The story highlights how the law, intended to target abortion, is also endangering basic healthcare access in underserved parts of the state.

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Key Discussion Points & Insights

1. Shifting National Politics Around Abortion

• President Trump and many Republicans assert that abortion should be a state decision. However, not all in his party agree:

  • "Dobbs v. Jackson did not simply, quote, kick back the issue of abortion to the states. The authority to regulate abortion is returned to the people and their elected representatives. Members of Congress and senators are elected representatives."
    — Rep. Bob Onder [01:04]

• Newly passed Republican legislation, “One Big Beautiful Bill,” bans Medicaid payments to large providers offering abortions, signed into law in summer 2025. Planned Parenthood called it a "backdoor abortion ban."

  • "There is no reason we cannot immediately turn off Planned Parenthood's government cash flow."
    — Rep. Bob Onder [01:31]

2. Local Impact in Maine

• Abortion is legal and supported by most Mainers, yet Maine Family Planning clinics are losing Medicaid funding.
  • "A network of clinics called Maine Family Planning is fighting for its survival because it provides abortions. That new provision ... would cut the network out of Medicaid."
    — Juana Summers [03:55]

3. First-Hand Patient Stories

• Ashley Smith’s experience shows clinics fill crucial gaps in basic healthcare, especially for uninsured and low-income Mainers:
  • "They made that process so easy and...painless. From then on, that's where I went when I needed a doctor."
    — Ashley Smith [05:03]
  • "These nonprofit clinics are my only source of health care." (Testifying at legislature)
    — Ashley Smith [05:58]

4. Clinic Operations and Community Role

• Maine Family Planning offers broad services: primary care, STI screenings, annual wellness, vasectomies, and more.

  • "We do most of our yearly wellness visits. We do vulvar biopsies and vasectomies and intrauterine inseminations as well."
    — Nurse practitioner Vanessa Shields Haas [06:51]

• 70% of their patients rely solely on the clinics for healthcare. Half are on Medicaid.

  • "Maybe they're working at a hotel...serving lobster rolls...starting oyster farms. These are entrepreneurs. These are people that are working really hard."
    — Shields Haas [08:16]

• Since the law’s passage, clinics aren’t reimbursed for Medicaid patients:

  • "Since July 4, since the bill was passed, we haven't been reimbursed for visits. Patients who use Medicaid as their insurance...we've been seeing all of those patients for free. We haven't been turning them away."
    — Shields Haas [07:54]

5. The Reality of Funding Cuts

• George Hill, president/CEO of Maine Family Planning, explains the dire consequences:

  • "This is, by volume and velocity, probably the worst that we have seen."
    — George Hill [09:12]

• The new law removes $2 million, or 20% of the clinics' budget.

  • "You have to make some difficult decisions. Either you generate more money, more revenue, or you cut costs."
    — George Hill [09:45]

• November 1: Primary care ended at three clinics, affecting nearly 1,000 patients.

  • "Our mission is to make sure that access to sexual and reproductive health care, the full range...is available to as many patients as possible."
    — George Hill [10:09]

• The state is helping fill some funding gaps, and the clinics are seeking new revenue streams. Commitment to mission remains:

  • "You can't roll up your sleeves and get to work if you're wringing your hands. We're going to keep doing what we're doing. We're not going to stop."
    — George Hill (quoting Pat Schroeder) [10:30]

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Notable Quotes & Memorable Moments

• "At the end of the day, this is all about the will of the people."
  — Donald Trump (quoted by George Hill) [00:35]

• "These nonprofit clinics are my only source of health care."
  — Ashley Smith [05:58]

• "Not being able to be reimbursed for the visits...is really crippling financially."
  — Vanessa Shields Haas [08:37]

• "You can't roll up your sleeves and get to work if you're wringing your hands. We're going to keep doing what we're doing. We're not going to stop."
  — George Hill [10:30]

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Timestamps for Important Segments

• 00:00–02:33: National abortion policy debate; introduction of new federal law
• 03:55–05:44: Local landscape in Maine, patient testimony (Ashley Smith)
• 06:37–08:10: Clinic services, staff perspectives (Vanessa Shields Haas)
• 08:51–10:38: Funding crisis, leadership response (George Hill), service cuts, call for resilience

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Summary Table

| Time | Content | |-----------|----------------------------------------------| | 00:00–02:33 | Federal debate, Republican policy split, law summary | | 03:55–06:01 | Impact in Maine, patient stories | | 06:37–08:10 | Clinic perspective, Medicaid cut effects | | 08:51–10:38 | Leadership response, service cuts, mission | | 10:38–end | Additional credits/reporting |

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Episode Tone

The episode is urgent yet empathetic, highlighting the real-life stakes for patients and providers in Maine. The voices of those affected—patients, clinicians, leadership—are prominent, ensuring the story is personal and direct while grounded in policy implications.

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For those who haven’t listened:
This episode gives a concise yet powerful account of how national abortion politics have immediate, sometimes unintended local consequences, affecting not just abortion access but general primary care for vulnerable communities in Maine.

Transcript

[Juana Summers]

Abortion is a matter for the states. That is the position that President Trump took when he was running for reelection in 2024. The Supreme Court, including three members he appointed, eliminated the constitutional right to an abortion in 2022. And there were questions about a future national ban. Trump said he wouldn't sign one.

[George Hill]

The states will determine by vote or legislation, or perhaps both. And whatever they decide must be the law of the land, in this case the law of the state.

[Juana Summers]

And he acknowledged in this video statement that it could mean a wide range of policies.

[George Hill]

Many states will be different, many will have a different number of weeks, or some will have more conservative than others, and that's what they will be. At the end of the day, this is all about the will of the people.

[Juana Summers]

But not everyone in his party agrees.

[Bob Onder]

Dobbs v. Jackson did not simply, quote, kick back the issue of abortion to the states.

[Juana Summers]

That's Republican Congressman Bob Onder of Missouri, co chair of the Pro Life Caucus, speaking on the third anniversary of the Dobbs decision.

[Bob Onder]

The wording in the court's opinion was very clear. The authority to regulate abortion is returned to the people and their elected representatives. Members of Congress and senators are elected representatives.

[Juana Summers]

And one of the measures Onder suggested was cutting off federal funding for Planned Parenthood. The law already banned federal dollars from paying for abortions, but Planned Parenthood provides other kinds of medical and the government has paid for some of it.

[Bob Onder]

From 2019 to 2021, Planned Parenthood received one and a half billion dollars. Yes, that's billion with a B from Medicaid CHIP and 3.3 million from Medicare. There is no reason we cannot immediately turn off Planned Parenthood's government cash flow.

[Juana Summers]

And that's what Republicans did. They included a provision in their One Big Beautiful Bill act that banned Medicaid payments to large health care providers that offer abortions. And Trump signed it into law this summer. Planned Parenthood called it a backdoor abortion ban. This is going to be devastating for.

[Selena Simmons Duffin]

The patients that Planned Parenthood serves.

[Juana Summers]

That's Alexis McGill Johnson, president of Planned Parenthood Federation of America. Planned Parenthood sued to block the law. That challenge is still playing out in court. The organization said the law put 200 clinics in jeopardy across the country. The majority of Planned Parenthood health centers that are at risk of closure are in medically underserved areas. They're in areas where there is primary care health shortage.

[Ashley Smith]

Right.

[Juana Summers]

They're in rural areas. Consider this. The Republicans new funding restriction is aimed at abortion providers, but it is also cutting some patients off from their primary care we'll look at how the law is playing out for a network of clinics in Maine. From NPR, I'm Juana Summers.

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[Bob Onder]

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[Selena Simmons Duffin]

Again.

[Bob Onder]

You can hear them by signing up for NPR plus, along with lots of other bonus content. Just go to plus.npr.org foreign.

[Juana Summers]

Abortion is legal in Maine, and abortion access is widely supported. Nearly three in four Mainers say it should be legal in all or most circumstances, according to a recent report from the Pew Research Center. But a network of clinics called Maine Family Planning is fighting for its survival because it provides abortions. That new provision in the big Republican budget law passed this summer would cut the network out of Medicaid. NPR's Selena Simmons Duffin has been looking at the consequences of that.

[Selena Simmons Duffin]

It was winter 2020, the first Covid winter in Oxford, Maine. Ashley Smith got a phone call from an ex partner.

[Ashley Smith]

Somebody that I haven't spoken to in a couple months is like, ooh, hey, hate to reach out and tell you.

[Selena Simmons Duffin]

This, but they tested positive for a sexually transmitted infection called chlamydia.

[Ashley Smith]

I just quickly did a Google search to see who was going to be in the area that I could just schedule an STI test. And that Google search led me to main Family planning in Norway, which was very close by.

[Selena Simmons Duffin]

And they got her in quickly. Smith works in restaurants as a server. She doesn't have health insurance, so she came ready to pay cash, but the test was free.

[Ashley Smith]

They made that process so easy and.

[Selena Simmons Duffin]

Like so painless from then on. That's where Smith went when she needed a doctor. Maine family planning has been around a long time, 50 years. They have 18 clinics all over the rural state, so there was still one nearby when she moved. She's gone there for pap smears, breast exams. She once went to get a physical to work at a summer camp.

[Ashley Smith]

I was like, I know that you guys offer primary care. Can you basically just take my weight and tell them that my blood pressure.

[Selena Simmons Duffin]

Is okay, she says. Most importantly, they diagnosed a chronic condition for her premenstrual dysphoric disorder. She says getting that treated has improved her quality of life dramatically.

[Ashley Smith]

It's night and day who I am.

[Selena Simmons Duffin]

Clearly, she is a fan of Maine family planning, so much so that the 36 year old has turned into an advocate. In March, she fought off nerves to testify in the state legislature at a committee hearing.

[Ashley Smith]

I'm here because these nonprofit clinics are my only source of health care.

[Selena Simmons Duffin]

The need for advocacy is because of recent actions by the federal government and because in addition to cancer screenings and STI testing and all the rest of the Maine family planning provides abortion care. After the Supreme Court overturned roe v. Wade Three years ago, 12 states banned abortion outright and more past severe restrictions, states like Maine have moved in the other direction to expand access. Now the Republican led federal government is moving to restrict abortion access in states where it's legal and protected, using federal funding as its lever.

[Vanessa Shields Haas]

Hey, come on in.

[Selena Simmons Duffin]

To be specific, Medicaid funding is now unavailable to Maine family planning clinics for any services. Vanessa Shields Haas is the nurse practitioner at the clinic in Thomaston, Maine, a small town along the coast.

[Vanessa Shields Haas]

This is our larger exam room here. We do most of our yearly wellness visits. We do vulvar biopsies and vasectomies and intrauterine inseminations as well.

[Selena Simmons Duffin]

For people just like Ashley Smith, who needed a basic physical for her summer camp job, many of her reproductive health patients come in needing primary care too. 70% of Maine family planning patients only see them as their doctor.

[Vanessa Shields Haas]

I can treat your tick bite or your bronchitis. I tell people if you cut your finger off or you're having a heart attack, I'm going to send you to the emergency room. But there's a lot of many other things that can be treated here.

[Selena Simmons Duffin]

Clinics like this one were already prohibited from getting Medicaid reimbursement for abortion because of the Hyde Amendment, which passed in the 1970s. What's new now is a provision in the One Big Beautiful Bill act the Congressional Republicans passed this summer, which blocks several healthcare organizations, including Planned Parenthood and Main Family Planning, from receiving any Medicaid funding for any services for one year.

[Vanessa Shields Haas]

So since July 4, since the bill was passed, we haven't been reimbursed for visits, patients who use Medicaid as their insurance. And we've been seeing all of those patients for free. We haven't been turning them away.

[Selena Simmons Duffin]

A lot of her patients do seasonal jobs. Half of Maine Family planning's patients are on Medicaid.

[Vanessa Shields Haas]

Maybe they're working at a hotel or they're waiting tables. They're serving lobster rolls to hungry tourists starting oyster farms. These are entrepreneurs. These are people that are working really hard.

[Selena Simmons Duffin]

Schieles Haas tries to be there for them for whatever they need. She's acutely aware that there aren't enough doctors in this rural state. She calls the new law infuriating.

[Vanessa Shields Haas]

Unfortunately, decision makers in Washington are having such a profound impact on what we can and can't do. Not being able to be reimbursed for the visits is it's really crippling financially.

[Selena Simmons Duffin]

The person tasked with troubleshooting that problem is George Hill, Maine Family Planning's president and CEO. He works about an hour's drive away at the organization's headquarters in Augusta.

[George Hill]

I've been in the field since 1987, so close to 40 years.

[Selena Simmons Duffin]

Over those years, many presidential administrations have been hostile to their work, he says.

[George Hill]

This is by volume and velocity, probably the worst that we have seen.

[Selena Simmons Duffin]

Maine Family Planning filed a lawsuit to challenge the law that blocks them from getting Medicaid funding. In its response to the suit, the federal government said the provision furthers Congress's, quote, goal of reducing abortion and suggested Maine Family Planning could stop providing abortions to get its funding back. For now, while that lawsuit works its way through the courts, Maine Family Planning cannot receive Medicaid funding. That's $2 million, 20% of their budget gone.

[George Hill]

That's difficult. You have to make some difficult decisions. Either you generate more money, more revenue, or you cut costs.

[Selena Simmons Duffin]

In the short term, they've had to cut some services. On November 1, Maine Family Planning ended primary care services at three clinics in the far reaches of the state. Staff helped nearly 1,000 patients find new doctors. Hill hopes that decision will help preserve the rest of what they do.

[George Hill]

We have a mission, and our mission is to make sure that access to sexual and reproductive health care, the full range of sexual and reproductive health care, is available to as many patients as possible.

[Selena Simmons Duffin]

They also received some additional funding from the state to help fill the gap, and he says they're exploring new ways to raise revenue. He quotes the late Democratic lawmaker Pat Schroeder.

[George Hill]

You can't roll up your sleeves and get to work if you're wringing your hands. We're going to keep doing what we're doing. We're not going to stop.

[Juana Summers]

That story came from NPR's Selena Semenstuffen, reporting in Augusta, Maine. Additional reporting at the top of this episode came from NPR'S Katie Riddle. This episode was produced by Connor Donovan and Eva Berger, with audio engineering by Jimmy Keeley. It was edited by Diane Weber and Courtney Dorning. Our executive producer is Sami Yenigun. It's Consider this from npr. I'm Juana Summers.

[George Hill]

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