President Donald Trump’s tax and spending cut bill targets organizations that both provide abortions and receive more than $800,000 a year in Medicaid reimbursements.

Planned Parenthood has argued the law violates the Constitution, while anti-abortion activists applauded the legislation.

The 1st Circuit Court of Appeals in Boston ruled that the law could go into effect in September while a lower court considered Planned Parenthood’s claims.

A three-judge panel of the appeals court was scheduled to preside over the hearing on Wednesday.

In a report released ahead of the hearing, Planned Parenthood said the legislation cost $45 million in September alone as clinics across the country paid for treatment for Medicaid patients out of pocket — a rate that the organization says is unsustainable.

Nearly half of Planned Parenthood’s patients rely on Medicaid for health care aside from abortions, which were already not covered by the federal insurance program that serves millions of low-income and disabled Americans.

Planned Parenthood Federation of America and its member organizations in Massachusetts and Utah, as well as a major medical provider in Maine, filed lawsuits against Health and Human Services Secretary Robert F. Kennedy Jr. in July.

The Maine provider has been forced to stop its primary care services while its lawsuit works its way through the courts.

In the meantime, seven states — California, Colorado, Massachusetts, New Jersey, New Mexico, New York, and Washington — have directed state funds to compensate for lost federal Medicaid reimbursements.

That has covered roughly $200 million of the $700 million that the organization spends annually on Medicaid patients, according to Planned Parenthood.

In light of the shortfall, some clinics will force Medicaid patients to pay out of pocket while others will close altogether, adding to the 20 Planned Parenthood-affiliated clinics that have closed since July and the 50 total that have closed since the start of Trump’s second term.

“The consequence is for patients who are going to be forced to make impossible choices between essential services,” Planned Parenthood President and CEO Alexis McGill Johnson said in an interview with The Associated Press.

Carol Tobias, president of the National Right to Life Committee, said Trump’s legislation is a step in the right direction.

“The consequence is for patients who are going to be forced to make impossible choices between essential services,” Planned Parenthood President and CEO Alexis McGill Johnson said in an interview with The Associated Press.

Even though federal tax dollars aren’t used for abortions directly, she said, taxpayers are contributing to abortion services even if they are morally or religiously opposed, since Medicaid reimbursements help organizations that provide them stay afloat.

“To be forced to pay for that is just very objectionable,” Tobias said.

She suggested Planned Parenthood could stop offering abortions if it wanted to keep providing medical care to vulnerable populations.

Planned Parenthood’s president has doubled down on the organization’s commitment to providing abortions.

“The government should not play a role in determining any pregnancy outcomes,” Johnson said.

Planned Parenthood is the country’s largest abortion provider, but abortions only constituted 4% of all medical services in 2024, according to the organization’s annual report.

Testing for sexually transmitted infections and contraception services make up about 80%.