A US federal appellate court panel on Wednesday heard oral arguments in a case to determine whether Congress may strip Planned Parenthood and its affiliates of its Medicaid funding.

The case challenges the “Defund Provision” of Trump’s “One Big Beautiful Bill Act,” which excluded Planned Parenthood-affiliate organizations from federal funding. Before the US Court of Appeals for the First Circuit, plaintiffs argued that the provision specifically targeted these organizations, violating the First and Fifth amendments as well as the Bill of Attainder and Equal Protection clauses of the Constitution.

Planned Parenthood attorney Alan Schoenfeld argued that, because the provision appears to single out affiliate-organizations, equal protection requires the court to review other alleged constitutional violations under a more strict lens:

Heightened scrutiny applies because the Defund Provision infringes Planned Parenthood’s fundamental First Amendment right of association. Because the Defund Provision “applies to affiliates of an entity that provide[s] abortion, no Member can escape the law’s burden simply by ending its own abortion services. Instead, a Member must also disaffiliate from any Member that continues to provide abortion, which requires disassociating from [Planned Parenthood]”… That compulsion curtails Members’ associational expression.

Often, courts will permit laws that infringe on individual rights so long as the government provides a rational explanation for their enactment. Laws that infringe on these rights and violate equal protection can receive heightened scrutiny, and laws that infringe on fundamental rights may be subject to “strict scrutiny.” Plaintiffs not only argued that the Defund Provision crumples under higher scrutiny, but that the government could not establish a rational explanation for the provision under a lower review standard.

Panel judges quickly picked up on the scrutiny aspect of the case, questioning positions taken by Justice Department attorney Eric McArthur:

It seems like this law, one, is quite under-inclusive, one because there are all sorts of abortion-providing entities that are not covered. Two, if this affiliate version becomes broader, it seems to me that it’s over-inclusive in that it will prevent funding from groups that are not providing abortions, certain Planned Parenthood entities.

The language at issue turns on the word “affiliates” in Section 71113 of the Act. According to Planned Parenthood, the term “affiliates” swallows and punishes non-abortion providers “if they merely ‘affiliate’ with [Planned Parenthood] despite the lack of any evident link between such affiliation and ‘subsidizing abortion.'” Laws that are excessively over- or under-inclusive typically fail heightened and strict scrutiny because there are less restrictive means through which the government may accomplish its goals.

The Hyde Amendment prohibits federal funding from subsidizing individuals who use their health insurance to cover abortion care. However, nearly half of Planned Parenthood’s patients rely on Medicaid for healthcare aside from abortions. In response to the One Big Beautiful Bill Act, several states have directed state funds to compensate for lost Medicaid reimbursements.

Looking at the issue from a public health perspective, Schoenfeld said that the “only fact in the record is that when you defund Planned Parenthood members from providing non-abortion care, the result is an increase in abortions.”

Planned Parenthood filed its initial complaint in July. It is not yet known when the First Circuit will render its decision.