Post-Election Overview: Key Changes in State Laws on Abortion and Reproductive Health Care

Election Season Overview: State Law Changes

This election season focused on amendments regarding reproductive health care. Here’s a summary of key changes and ongoing issues from recent state news.

Executive Summary

Abortion and Reproductive Health Care:

• Ten states had abortion measures on their ballots. Seven states voted to protect abortion in their constitutions.
• Courts in Georgia, North Dakota, and Ohio overruled state bans. Challenges brought stays on Georgia and North Dakota decisions.

Gender-Affirming Care:

• The U.S. Supreme Court scheduled oral arguments on gender-affirming care bans for minors in two major cases.
• A Florida case is stayed pending a rehearing in the Eleventh Circuit.
• A Maine court found the Defense Department unconstitutional for excluding gender-affirming surgery in its health plan.
• Texas initiated lawsuits against doctors regarding gender-affirming care coverage.

Pharmacy Issues:

• The U.S. Supreme Court requested input from the U.S. Solicitor General on a pharmacy benefit manager case.
• Texas Attorney General’s opinion on PBM regulations under ERISA is pending.
• Lawsuits filed against PBMs for high insulin costs.

Abortion Measures in States

• Seven states passed constitutional amendments to protect abortion rights.
• Arizona and Missouri ensure rights until fetal viability, conflicting with existing laws.
• Attempts in Florida and South Dakota to protect abortion access failed.
• Nebraska passed a restrictive 12-week abortion ban, failing to protect rights until viability.
• Colorado, Maryland, Montana, Nevada, and New York strengthened existing abortion protections.

Opponents in Arizona are considering legal actions against the new amendment. Legal challenges are increasing in other states.

Court Rulings on Abortion Bans

• In North Dakota, the court ruled against a near-total abortion ban, affirming rights until viability. The state appealed the ruling.
• Ohio overturned its six-week abortion ban, declaring it unconstitutional and unenforceable.

Ongoing Litigation

• The U.S. Supreme Court declined to review a Texas case regarding EMTALA’s application to pregnant patients.
• The Wisconsin Supreme Court heard arguments about an 1849 abortion law and its application to current state law.
• A renewed lawsuit in Texas challenges the FDA’s approval of Mifepristone, asking for new restrictions on its use.

Gender-Affirming Care Updates

• The U.S. Supreme Court will hear a case involving Kentucky and Tennessee’s gender-affirming care bans.
• Florida continues to face legal challenges over its prohibitions on gender-affirming care.
• Texas is suing doctors for providing hormone treatment to minors, leading to possible loss of medical licenses.

Pharmacy Benefit Manager (PBM) Developments

• The U.S. Supreme Court is gathering input for a case on PBMs and ERISA plans.
• Texas is pushing back against PBMs for insulin price inflation.

Insurance Mandates in States

California:

• New laws effective July 1, 2025, include more coverage for in vitro fertilization (IVF) and artificial intelligence use in medical necessity determinations.

Illinois:

• New mental health services laws and IVF coverage expansion begin in 2026.

Massachusetts:

• Similar to California, new insurance mandates were enacted.

Washington:

• Voters upheld the state’s long-term care insurance program, rejecting an optional measure.

Keep informed on these legal and regulatory changes as they impact employee health and welfare benefits.