Republicans inserted nationwide abortion restrictions into their budget bill

“Every single chance they get, Republicans are putting restrictions into federal law"

Oct 20, 2025

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In October 2023, rePro-Truth reported on new pressure campaign against abortion training by opponents of reproductive health, rights, and justice, and detailed the deceptive tactics being used by to exploit the OB-GYN shortage in the U.S. to chip away at access to abortion training in furtherance of their goal: ensuring that “no abortions or abortion training happen at all.”1 rePro-Truth advised readers:

“The anti-abortion movement is both litigious and legislatively aggressive. As such, we can expect to see more than just propaganda and pressure campaigns in the future. Watch for legislation and litigation. Watch for religious freedom/conscience claims.”

rePro-Truth warned readers to “expect to see efforts to chip away at institutional autonomy and authority.” Just five months later, in March 2024, rePro-Truth reported that Republicans in Missouri had introduced legislation attacking institutional autonomy by outright banning medical schools from both providing abortion training to medical students and residents and from working with any out of state medical schools, clinics, or other facilities to provide abortion training to Missouri medical students and residents.

Just three months later, in July 2024, Congressional Republicans leading the House Appropriations subcommittee on Labor, Health and Human Services, and Education unveiled a budget language that would “block funding for any hospital that trains doctors to perform or assist with abortions if the hospital ‘provides or requires such training for any participant in such program without the participant first voluntarily electing to opt in to undergo such training,’” (see image below).2

2024 anti-abortion budget language, House Appropriations subcommittee on Labor, Health and Human Services, and Education

As rePro-Truth warned readers back in October 2023, “will likely see attempts to use funding to attack access to abortion training, such as making government funding conditional on adherence to anti-abortion demands,” and that we could “expect to see efforts to carry out the goals detailed in Project 2025.” One of the anti-abortion goals laid out in Project 2025's Mandate for Leadership is to “Communicate to medical schools that any abortion-related training must be on an opt-in rather than opt-out basis” (see the image below). Withholding funding from medical schools that don't change their training requirements to an opt-in process certainly gets the message across.

Project 2025's Mandate for Leadership document details abortion opponents’ goals for attacking abortion training, accreditation institutions that set training requirements, and the institutions and programs that provide training.

Now, opponents of reproductive health, rights, and justice in Congress are at it yet again. Notus reports that, “Hidden in a House GOP funding bill is a new rider that would ban federal funding from going to hospitals that follow abortion training requirements for residents and fellows from the Accreditation Council for Graduate Medical Education. Since 1996, the accreditation body has required residency programs in obstetrics and gynecology to offer abortion training, with an option for residents to opt out if they had moral or religious objections” (emphasis added)3

“Abortion, or evacuating the uterus, is a core procedure for OB-GYN. It’s also used for management of miscarriages and complications of pregnancy like infection and bleeding.”4 That's why “it’s a technique that has to be learned,” explains Dr. John Combes of the Accreditation Council for Graduate Medical Education (ACGME).5

While “medical schools’ curriculums vary,” the ACGME “requires OB/GYN residency programs to provide access to abortion training… It’s a key component of an OB/GYN’s training, even for doctors who have no plans of becoming abortion providers,”6 because “an OB/GYN must be able to evacuate a uterus — whether the skill is used to care for a patient who has had an incomplete miscarriage, to remove polyps for cancer diagnosis or assist someone who wants to terminate an unwanted pregnancy.”7

In a statement attacking the institutional autonomy, authority, and integrity of the Accreditation Council for Graduate Medical Education (ACGME), Rep. Greg Murphy, co-chair of the Republican party's Doctors Caucus, said, “This is where the problem with accrediting boards has occurred. A lot of them have gone unchecked in their authority. They’re pushing political opinions in medicine.”8

Althoughthe ACGME requires residency programs to provide abortion training, “residents with moral or religious objections are allowed to opt out.”9

Congress “prohibits entities that receive federal funds from discriminating against health care workers who refuse to undergo abortion training as part of the 1996 Coats-Snowe Amendment, which was proposed after the Accreditation Council for Graduate Medical Education began to require abortion training for OB-GYN residency programs. In direct response to the Coats-Snowe Amendment, the accreditation body amended its requirements to allow residents to opt out” (emphasis added).10

The ACGME’s opt-out system “has proven to strike the appropriate balance between ensuring comprehensive training is the standard while respecting the fact that some residents may have objections,” says Rachel Gandell Tetlow, vice president of government and political affairs for the American College of Obstetricians and Gynecologists.11 However, as Notus reports,

“The opt-out option was not enough for anti-abortion advocates, who have long sought to limit access to abortion training.
“Instead, they want trainees to have to opt-in — with the goal of forcing the accrediting body to rethink how OB-GYNs are trained.”12

As rePro-Truth reported, opponents of reproductive health, rights, and justice have been amping up their pressure campaign against abortion training and accreditation requirements through the use of histrionic and fundamemtally nonsensical claims that allowing medical students and residents to opt-out of learning how to perform abortions is, somehow, a form of discrimination that “persecutes,” “targets,” and “coerces” medical students and residents.

Speaking about the anti-abortion rider in Republicans’ latest funding bill, Susan Bane, vice-chair for the board of directors of the American Association of Pro-Life OB-GYNs (AAPLOG), said that allowing anti-choice students and residents to opt out of learning to perform abortions “really violates conscious protection rights when you think about the coercive nature of it” (emphasis added )13

The AAPLOG is an anti-abortion lobbying group “that uses its members’ medical certifications to push false information regarding abortion and birth control. Since most of its claims fall outside what is accepted by the medical and scientific communities, AAPLOG has accused other medical professionals of using ‘politically correct’ research” as a way to discredit them.14

Bane lamented, “There’s been a normalization of abortion as health care” (abortion is healthcare), and told Notus that the AAPLOG started meeting with Congressional Republicans “a few years ago” to pass legislation to force the majority of medical students and residents to opt-in to abortion training, instead of allowing an opt-out option for the minority of anti-abortion students and residents who fo not wish to learn how to perform abortions.15

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Opt-in training programs are a recognized barrier to obtaining abortion training.1617 Opt-in abortion training requires residents to arrange their own off-site training for abortion care, and “residents [have] described that having to opt-in, particularly at an off-site location, was challenging given limited elective time” (emphasis added).18 As the American College of Obstetricians and Gynecologists notes, “The nature of opt-in training places the burden to create a clinical experience on the residents and establishes a culture of marginalization for abortion provision and those who wish to obtain training” (emphasis added).19 Opt-out programs, on the other hand, “allocate time for abortion training in residents’ schedules.”20

“Where [abortion] training is routinely integrated,” that is, in opt-out programs, “residents report higher self-assessed competence in procedural and counseling skills than those in programs with opt-in… Residents in opt-in programs report similar clinical experience to those programs where abortion training is not available.”21 “When compared with residents in programs with opt-in training, residents in programs with routine training were significantly more likely to receive instruction in all modalities of abortion provision.”22

Furthermore, “opt-in training does not require a formalized curriculum,” whereas opt-out abortion is built into the curriculum” (emphasis added).23

“Studies have shown that access to abortion training led to more clinical experience, with some residents who have opted out of the training saying they wanted additional training to treat pregnancy complications.”24 Research also shows that “providing access to an abortion rotation for residents,” including those who do not plan to work in abortion care, “gives them the opportunity to improve their skills in family planning, therapeutic abortion and miscarriage management.”25

The language in the 2025 budget bill is identical to the 2024 budget bill, which “would make it so that hospitals or ‘any other program of training in the health professions’ would lose access to federal money if they provide abortion training ‘without the participant first voluntarily electing to opt in to undergo such training’” (emphasis added).26

2025 Republican anti-abortion budget language

One physician told Notus, “I’m not familiar with any medical specialty where a core competency is allowed to be marginalized in this way,” adding that “this change will end up leading to fewer providers who are able to manage some incredibly common and life-threatening conditions, as well as providers who want to make sure that their patients are able to end a pregnancy when they don’t want to be pregnant” (emphasis added).27

Rep. Teresa Leger Fernández repined, “Every single chance they get, Republicans are putting restrictions into federal law to limit access…”28

What's most important to remember is that this budget rider is not actually about opt-in versus opt-out abortion training.

It's about the anti-abortion movement's goal to eliminate abortion and abortion training altogether via death by a thousand cuts: incrementally chipping away at access to abortion and abortion training. It's about changing the standard of care.

As reproductive health journalist Sofia Resnic reported in July 2024, a small but influential group of opponents of reproductive health, rights, and justice “have spent [] years trying to change the reproductive health care standards in state and federal health policy, in a way that is potentially dangerous.”29

Last year, anti-choice activists with the anti-abortion organization Charlotte Lozier Institute — the non-profit arm of anti-abortion lobbying group SBA Pro-Life America — and who are “behind retracted studies claiming abortion drugs are dangerous,” released new anti-abortion policy recommendations.30 The recommendations, which contradict national standards of care, say that, “when pregnancy termination is necessary, doctors should opt for procedures considered by the wider reproductive health community to carry bigger health risks, such as cesarean sections, rather than less invasive [and far safer] abortion procedures.”31 (I highly recommend you read Resnic's full article.)

The anti-abortion movement seeks the total elimination of abortion. Hindering medical students and residents from accessing abortion training is part of that plan. Every move they make is in furtherance of that goal. Never forget that.

rePro-Truth

Republicans inserted nationwide abortion restrictions into their budget bill

“Every single chance they get, Republicans are putting restrictions into federal law"

What's most important to remember is that this budget rider is not actually about opt-in versus opt-out abortion training.

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