‘I’m afraid of no access’: Calls flood NC clinics as providers warn of a backdoor abortion ban

Cancer screenings, STI tests, and birth control are at stake.

At the clinic, questions started almost immediately.

The MyChart messages and phone calls piled up, each one tinged with the same urgency: “Can I still come? I’ve got an appointment next week and I’ve got Medicaid. What does this [bill] mean?”

Anne Logan Bass, clinical director of family planning at Planned Parenthood South Atlantic—which operates 14 clinics, including nine in North Carolina—has answered plenty of patient questions over the years. But this was different. Patients reaching out weren’t just confirming an appointment; they were trying to find out whether the care they’ve relied on for years—birth control refills, cancer screenings, STI tests—might vanish with little warning.

“People are fearful,” Bass said. “And we do what we can in the moment to let them know that we will do everything we can, for as long as we can, to help them and make sure that they have access to basic reproductive health care and life saving treatments.”

The cause for patients’ concern is a sweeping federal budget package, officially known as the One Big Beautiful Bill Act. Passed by a Republican-majority Congress and signed into law by President Trump in early July, the law blocks Medicaid reimbursements to clinics such as Planned Parenthood that provide abortion, even for non-abortion services.

It also bans abortion coverage in Affordable Care Act (ACA) marketplace plans—plans that around 44 million Americans use for their health insurance—pulling long-standing federal restrictions into new territory.

READ MORE: House GOP fast-tracks budget bill that would cut off Medicaid funding to Planned Parenthood

A widening ripple effect

While Republicans argue that the new restrictions make sure taxpayer dollars don’t support abortion providers, health care providers of all kinds warn that the big beautiful bill will cut off affordable care for thousands of North Carolinians—especially those in rural areas or living on low incomes.

Lexi White, director of state strategies at All* Above All, a national reproductive justice coalition, said the approach is deliberate.

“Even in states that have already had very restrictive abortion bans since the Dobbs decision, this bill is laying the groundwork for rollbacks to the most basic kinds of reproductive health care that are on a spectrum of care that impact folks over their reproductive lives,” White said.

She added that, in addition to cutting off reproductive health care for millions of women across the US, the bill acts as a “backdoor abortion ban” by removing abortion care coverage from ACA health insurance plans.

“And so to that effect, this is indeed a backdoor abortion ban, because it is exacerbating the impacts—especially in places like the South, where there are already restrictive abortion policies.”

White said she personally believes reproductive justice includes being able to pay for abortion aid through Medicaid.

“Pushing Medicaid care and coverage out of reach results in a heightened crisis for optimal maternal health outcomes that will continue to disproportionately and uniquely impact women who are already facing structural barriers as they navigate the full spectrum of reproductive health care,” she said. “But especially things like both abortion care and birth care.”

RELATED: Medicaid expansion is providing a lifeline to rural North Carolina

North Carolina’s Medicaid expansion, which took effect in December 2023, extended health insurance coverage to more than 650,000 residents. But the big beautiful bill now puts those residents at risk of losing their insurance. 

Even further out of reach

According to officials at Planned Parenthood South Atlantic, roughly 13% of their patients use Medicaid. And for many North Carolinians, Medicaid coverage alone isn’t enough to help them afford to end an unwanted pregnancy. Often, their first call isn’t to a clinc—it’s to an abortion fund. The largest in the state is the Carolina Abortion Fund.

Carolina Abortion Fund is a nonprofit that serves North and South Carolina abortion seekers, helping them bridge the financial gaps they may have for travel, lodging, or other issues related to accessing abortion care that are not covered by insurance. In 2024, the fund fielded nearly 3,900 calls for help and pledged almost $1 million in direct financial assistance to people in the Carolinas. On average, the group provided $430 toward each caller’s abortion cost, and distributed thousands more in gas cards, food, and rideshares to help people get to their appointments.

Losing that safety net, said Camille, director of policy at the Carolina Abortion Fund and an abortion doula, would be devastating. For privacy purposes, Camille asked that Cardinal & Pine exclude her last name from this story.

“I can only assume anyone who is interacting with an abortion fund probably is also someone who needs assistance,” Camille said. “Without question, they will be impacted by this, and the ways in which they’ll be impacted are varied.”

Camille added that those variations can range from patients having to travel further distances for health care due to abortion bans or reproductive care deserts, not being able to access a hospital that makes them feel safe from bias and stigma, and being forced into carrying their unplanned pregnancy to term.

A legal battle with high stakes

The big bill’s Medicaid restrictions are temporarily on hold because of an ongoing court battle. After it was signed into law, Planned Parenthood Federation of America, along with affiliates in Massachusetts and Utah, sued the Trump administration, arguing that the Medicaid provision was designed to punish them for providing and advocating for abortion access, despite Medicaid never covering abortions.

A federal judge granted a temporary restraining order on the bill in July, keeping Medicaid funds flowing for now. But the pause is temporary. If the legal pause is lifted, Planned Parenthood could lose reimbursement for providing essential services. Advocates say the threat to care is far from over.

For now, Medicaid patients can still walk into Planned Parenthood South Atlantic clinics for care. And in Bass’ clinic, the flood of messages asking about the bill hasn’t slowed.

“All we can do is just give them what reassurance we have,” Bass said. “And tell them that we will continue to fight this and we’ll do everything we can for our patients for as long as we can.”

But Camille worries the bigger danger is what comes next.

“I’m more concerned about what this bill represents than I am the bill itself,” she said. “I’m afraid of fascism. I’m afraid of no access. I’m afraid of the repetition of what that looks like for our communities.”