Table of Contents
- Introduction
- Increasing Surveillance and Data Collection
- Banning Abortion Pills
- Defunding Abortion Clinics
- Health Insurance and Work Benefits for Abortion
- Limiting Access to Emergency Medical Care
- Prioritizing Religious Freedom Over Patient Health
- Forcing Anti-Abortion Views on the International Community
Introduction
Project 2025 provides a comprehensive plan to restrict access to abortion across the country, allow health care providers to refuse to provide life-saving health care, severely restrict the options for couples struggling with infertility, and weaponize U.S. foreign policy to enforce those same ideologically driven changes around the world.
The foreword encourages the next conservative president to remove all references to abortion, reproductive rights, and reproductive health in “every federal rule, agency regulation, contract, grant, regulation, and piece of legislation that exists.” Regardless of how the authors portray it in interviews or other articles, Project 2025 presents a radically anti-abortion, anti-democratic vision for America’s future.
While some states have been able to shield residents from the fallout following the Dobbs v Jackson decision, that won’t be possible anymore if Project 2025 is implemented. Nobody will be spared from the effects of Project 2025’s proposals. Even residents in the most progressive states will still find their reproductive rights curtailed and access to abortion limited.
Project 2025 calls for the next president to enact the strongest federal restrictions on abortion access that Congress will pass, while also using every power available to the executive branch to attack reproductive rights across the board. It is explicitly friendly to a federal abortion ban.
Military service members and veterans are uniquely vulnerable since the federal government controls military health care and Veterans Affairs. Brooks D. Tucker, author of the section on the Department of Veterans Affairs, simply instructs a conservative president to “Rescind all departmental clinical policy directives that are contrary to principles of conservative governance starting with abortion services.”
The authors want to restrict access to the abortion pill no matter where you live, including through enforcement of the Comstock Act, a 150-year-old law that would make it a crime to mail abortion pills.
Sections of the plan also propose policies and regulations that would make it easier for employers to avoid providing insurance coverage for contraception and abortion care, while simultaneously making it difficult or impossible for employers to provide such coverage when they want to.
On top of that, the authors use the language of “unborn children” and state that “life begins at conception” throughout the document. Similar language was recently used to justify wrongful death lawsuits against IVF providers in Alabama. They also go out of their way to attack surrogacy, another method used by couples who struggle to have children on their own.
Pregnant people living in anti-abortion states will find themselves with few remaining protections if Project 2025 is implemented. The authors argue that “no federal civil rights laws preempt state pro-life statutes.” States will be free to violate the civil rights of their residents under the next conservative president. The Department of Justice will not work to protect them.
Increasing Surveillance and Data Collection
Overview
- The CDC should require states to report all abortion procedures, including gestational age, reason, method, and the pregnant person’s home state.
- Medicaid money should be withheld from states that don’t comply.
- The author tries to draw distinctions between types of abortion that are not medically supported.
One of the first recommendations on abortion policy is a dramatic increase in federal government surveillance of abortion procedures through the Centers for Disease Control and Prevention (CDC).
Roger Severino, who authored the chapter on the Department of Health and Human Services (HHS), says the CDC should require that “every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method.”
Confusingly, Severino says that abortion should be defined as only procedures that “intentionally end an unborn child’s life,” adding that “standard ectopic pregnancy treatments should never be conflated with abortion.”
“Standard ectopic pregnancy treatments” intentionally terminate the pregnancy. That is the only treatment for an ectopic pregnancy.
Severino says that, if necessary, the CDC should threaten to cut funding, including Medicaid funding, to force states to comply with these new reporting requirements.
How the federal government should make use of the data is never explained, but given that Severino wants this data “because liberal states have now become sanctuaries for abortion tourism,” the goal may be to find ways to curtail interstate travel for abortion care.
Banning Abortion Pills
Overview
- Banning mifepristone is a high priority – Severino offers at least three ways to cut or eliminate access to the medication.
- Project 2025 calls on the FDA to reverse it’s approval of the medication by lying about the abortion pill’s safety.
- Project 2025 calls on the FDA to ignore research and reverse a 2016 update to regulations on the use of mifepristone.
- Project 2025 calls on the DOJ to enforce the Comstock Act, which was passed nearly 50 years before women could vote.
Project 2025 also provides instructions on how to cut access to mifepristone, a medication that can be used to terminate a pregnancy or as a treatment for Cushing’s Syndrome, arguing that “Abortion pills pose the single greatest threat to unborn children in a post-Roe world.”
Project 2025 calls on the Food and Drug Administration (FDA) to “reverse its approval of chemical abortion drugs because the politicized approval process was illegal from the start.”
To support the claim of illegality, Severino argues that the FDA failed to protect women and children from the potential harms of mifepristone in part because abortion pills are “by definition fatally unsafe for unborn children.”
Abortion pills are not dangerous to women. A 2018 study by the nonpartisan National Academies for Sciences, Engineering, and Medicine found that “The risks of medication abortion are similar in magnitude to the risks of taking commonly prescribed and over-the-counter medications such as antibiotics and NSAIDs.”
The FDA does not need to consider whether or not mifepristone is fatally unsafe for a fetus under U.S. law. Severino’s interpretation is based on legal recognition of fetal personhood from conception. While some states have passed or proposed legislation recognizing fetal personhood, federal law does not.
If mifepristone’s approval cannot be overturned, Project 2025 offers several other options to limit access.
First, Severino confusingly calls for the FDA to remove the “in-person dispensing requirement” to “eliminate dangerous tele-abortion and abortion-by-mail distribution.” We assume that he means they should require in-person dispensing.
Second, he calls on the FDA to return to the pre-2016 limit, which limited the use of mifepristone to the first 49 days of gestation.
The 2016 update was made in response to improved dosage and administration methods for mifepristone. The American College of Obstetricians and Gynecologists (ACOG) commended the change at the time, saying that the new 70-day limit was in line with 15 years of research and evidence proving the safety of mifepristone later in pregnancy.
Third, Severino proposes a new regulation requiring health care workers to “report abortion pill complications.”
This would require health care providers to ask invasive questions that may put the pregnant person at risk of criminal prosecution. Several women have been arrested and charged with crimes after telling nurses they took an abortion pill in recent years, including a woman in South Carolina and in Texas.
Finally, Project 2025 recommends that the next conservative president begin enforcing the Comstock Act, passed over 150 years ago, which makes it a crime to mail “[e]very article, instrument, substance, drug, medicine, or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.”
Both Severino and Gene Hamilton, who authored the chapter on the Department of Justice, recommend enforcing the law, which was passed in 1872 – the same year that Susan B. Anthony was arrested for illegally voting in a presidential election as part of the women’s suffrage movement. Women would not receive the right to vote until 1920.
We should not enforce a zombie law, passed before women could vote, that curtails women’s rights.
Defunding Abortion Clinics
Overview
- Severino provides plans to defund abortion clinics across the country.
- Project 2025 directs CMS to issue guidance allowing states to defund abortion clinics in their state Medicaid plans.
- Project 2025 recommends that CMS create a new regulation banning Medicaid funding to medical facilities that provide elective abortions.
- These plans would reduce access to preventative medical care across the country.
Project 2025 recommends defunding Planned Parenthood and any other organizations that offer abortion care.
According to Severino, this can be done by issuing “guidance reemphasizing that states are free to defund Planned Parenthood in their state Medicaid plans.“
Project 2025 also recommends that the Centers for Medicare and Medicaid Services (CMS) create a new regulation disqualifying “providers of elective abortion from the Medicaid program.” This language would disqualify hospitals, not just abortion clinics, if they provide elective abortions.
Roughly three percent of abortion procedures are performed in a hospital setting, most often because the pregnant person is experiencing an emergency or is at increased risk of serious complications. If hospitals no longer offered those services, pregnant people would be less safe.
Severino says the government should redirect those funds to organizations “that provide real health care for women.”
In reality, Planned Parenthood provides free or reduced cost gynecological exams, sexually transmitted illness testing, and birth control, among other health services.
Planned Parenthood has said that if they lose federal funding, they will cut access to these services rather than abortion care. This is because federal funding for Planned Parenthood is not – and cannot be – used for abortions. Cutting Medicaid funding to Planned Parenthood will reduce access to “real health care,” not increase it.
Health Insurance and Work Benefits for Abortion
Overview
- Under the proposed regulations, insurance companies would need to bill people twice if they offer abortion-related coverage.
- Project 2025 would make it easier for employers to request religious- or conscience-based exemptions to contraceptive coverage.
- Project 2025 would replace expert advisors with anti-abortion ideologues.
- Project 2025 lies about the morning- and week-after pills to remove ACA coverage of those medications.
- Project 2025 makes it more difficult or impossible for employers to offer abortion-related benefits if they want to.
When it comes to health insurance plans, Project 2025 is determined to have it both ways. On one hand, the proposed rules and regulations make it easier for organizations to claim faith- or conscience-based exemptions to providing contraception or abortion-related benefits. On the other, they make it difficult or impossible for employers who would like to offer those kinds of coverage, giving away the lie that their plans are designed to increase freedom of choice.
Making It Harder To Cover Abortion
Project 2025 instructs CMS to reinstate Trump-era regulations that would have required insurance companies to bill people twice if the insurance plan covers abortion care – once for the portion of the premium that covers abortion, and again for the rest of the monthly premium.
KFF found that the regulations would have made insurance more complicated and expensive, and almost certainly made it so fewer people had abortion care covered by their insurance.
Severino also argues that the contraceptive mandate should be rescinded and then re-implemented through the rulemaking process outlined in the Administrative Procedure Act (APA). There is no reason to rescind a rule if the plan is to immediately re-implement it unchanged.
Additionally, he says HHS should dissolve the advisory committee that currently oversees the contraceptive mandate, arguing that the expert committee members, who are drawn from ACOG, are “pro-abortion ideologues.” The advisory committee should be staffed with anti-abortion activists instead.
In the same section, Project 2025 argues that the ACA should stop covering both condoms and morning-after pills like Ella, incorrectly claiming that the morning-after pill is a “potential abortifacient.”
Abortifacients interfere with an established pregnancy. Studies have shown that morning-after pills like Plan B and Ella only prevent ovulation – they do not stop fertilized eggs from implanting in the uterine wall or dislodge those that have already implanted.
Jonathan Berry, in his chapter on the Department of Labor, calls on Congress to pass a law requiring that employers who provide employee benefits related to abortion must provide “equal or greater benefits” for pregnancy, childbirth, maternity, and adoption.
This would create extra barriers for employers who wish to provide insurance coverage or other benefits that support their employees who need abortions.
Berry also instructs the Department of Labor to issue guidance stating that the Employee Retirement Income Security Act (ERISA) does not preempt state laws restricting “abortion, surrogacy, or other anti-life ‘benefits.’”
ERISA is a federal law that preempts state laws to establish national minimum standards for “most voluntarily established retirement and health plans.”
Re-interpreting ERISA like this would make it impossible to offer abortion care benefits in hostile states, even if the employer wishes to do so.
Making It Easier To Claim An Exemption
At the same time, Severino writes that the Health Resources and Services Administration should restore Trump-era exemptions to contraceptive mandates in the Affordable Care Act (ACA).
Those exemptions, which removed access to free contraception that women had enjoyed for a decade, were upheld by the Supreme Court in 2020. While the Biden Administration rescinded the regulation, there is little doubt that another conservative president would implement those exemptions again, removing access to free contraception for tens of thousands of women once more.
Limiting Access to Emergency Medical Care
Overview
- Project 2025 calls on HHS and CMS to gut the Emergency Medical Treatment and Labor Act (EMTALA) so it doesn’t protect pregnant people experiencing a medical emergency in anti-abortion states.
Project 2025 also sets out methods to weaken access to abortion during medical emergencies.
Severino tells the next conservative president to rescind the 2022 HHS and CMS memo on the Emergency Medical Treatment and Labor Act (EMTALA) that said the law preempts any state laws.
EMTALA requires that hospitals provide “appropriate stabilizing care” to patients experiencing an emergency medical condition or, if they do not have the equipment or staff necessary to treat the patient, transfer them to a facility that can provide the care.
The 2022 memo specifically said that abortion can be appropriate stabilizing care if the pregnancy is the cause of the emergency, adding that EMTALA’s preemption of state law would be a defense against prosecution under a state’s anti-abortion laws.
Rescinding the 2022 memo would put pregnant people at risk across the country. Women like Amanda Zurawski, who went into sepsis while waiting for care in Texas, prove how dangerous delaying abortion care can be in emergency situations. A 2022 study found that pregnant people experiencing a medical emergency in Texas, which has some of the most restrictive laws on abortion, were twice as likely to suffer from severe complications like excessive bleeding or infection as people living in states where abortion was legal.
Prioritizing Religious Freedom Over Patient Health
Overview
- Project 2025 directs the Office of Civil Rights for HHS to issue regulations allowing doctors to refuse to care for patients who require abortion care.
- Project 2025 calls on the Health Resources and Services Administration to make sure medical students don’t have to learn how to provide abortion care.
Even in states where abortion remains legal, Project 2025 turns the Office for Civil Rights (OCR) into a tool to defend doctors who refuse to provide abortion care, prioritizing a twisted version of “religious freedom” over patient health.
Severino calls on the Office for Civil Rights in HHS to restore the Conscience and Religious Freedom Division (CRFD) he created when he was Director of the OCR for HHS. He continues by saying the next conservative administration should issue and finalize a draft rule he proposed in 2018.
The rule allows doctors and other medical care providers to refuse to perform abortions or assist with abortion care on religious grounds. Severino also instructs HHS to cut funding from institutions that don’t follow these “religious freedom” rules.
Doctors should not be allowed to let patients die based on personal objections to necessary medical care.
Severino directs the Health Resources and Services Administration to make sure students in “training programs for medical professionals—including doctors, nurses, and doulas” don’t have to learn how to perform or assist with abortion care.
Patients pursuing an elective abortion shouldn’t have to hunt for a doctor who has been trained in performing the procedure. Under-trained doctors also pose a health risk to patients experiencing a medical emergency related to their pregnancy.
Forcing Anti-Abortion Views on the International Community
Overview
- Project 2025 provides plans to force these radically anti-abortion policies on the international community, even if it damages the United State’s standing in international politics.
- Project 2025 directs the Office of Global Affairs to replace international staff with anti-abortion ideologues.
- Project 2025 calls on USAID to re-implement and expand the global gag rule, including by cutting U.S. funding to United Nations programs.
- Project 2025 directs the next conservative president to pull out of international organizations and agreements that support reproductive rights. This would necessarily involve exiting the United Nations and the World Health Organization, among others.
Project 2025 wants to push these radical anti-abortion policies on the rest of the world, even if that requires weakening the United States’ position as a global leader.
Severino writes that the Office of Global Affairs in HHS should promote anti-abortion policies around the world, adding that OGA staff who refuse to do so should be fired and replaced.
In his chapter on USAID, Max Primorac says USAID should re-implement and expand the global gag rule, which Planned Parenthood describes as preventing “foreign organizations receiving U.S. global health assistance from providing information, referrals, or services for legal abortion or advocating for access to abortion services in their country — even with their own money.” It should now apply to “all foreign assistance” instead of just health assistance.
This would mean blocking funding to the UNFPA, the United Nations sexual and reproductive health agency, and other international organizations.
Primorac also wants the U.S. to try to force the UN, the World Health Organization, and other international organizations to stop supporting reproductive rights, including access to abortion.
Kiron K. Skinner, writing about the Department of State, says that the US government “cannot and should not promote or fund abortion in international programs or multilateral agreements.” In order to make sure that doesn’t happen, Skinner calls for a review of “all multilateral agreements,” and those that promote LGBTQ+ or reproductive rights “must be halted and rolled back.”
Perhaps more concerningly, Skinner says that “The United States must return to treating international organizations as vehicles for promoting American interests—or take steps to extract itself from those organizations.”
It is extremely unlikely that the international community abandons its commitments to reproductive rights, meaning Project 2025 is all but calling for the next conservative president to exit the largest international organizations. Leaving the UN and WHO will only weaken the United States’ position in global politics.