Recent comments by Republican vice-presidential nominee JD Vance that a second Trump administration would eliminate federal funding for Planned Parenthood underscore the reality that despite the campaign’s emphasis on making abortion largely a state issue, a second Donald Trump administration would have many policy levers at its disposal.

While greeted as news, Vance’s comments merely echo actions taken by the Trump administration, which in 2019 finalized a Department of Health and Human Services regulation or rule that prohibited federal family-planning funds, known as Title X funds, from going to organizations that refer to or provide abortions. This move led Planned Parenthood to stop participating in the grant program, realizing — even if for a brief time — a long-stated pro-life goal.

Even with Trump and the 2024 Republican platform emphasizing “that power has been given to the States and to a vote of the People” in determining abortion laws, severing the federal government from abortion policy will be most unlikely, given the myriad of federal policies and regulations that impact abortion directly or indirectly, including recent actions taken by the Biden administration, which includes Vice President Kamala Harris, the Democratic presidential nominee.

Trump spoke of abortion when he was interviewed Oct. 17 by EWTN News’ Raymond Arroyo

“I am like Ronald Reagan before me. The exceptions are very important to me, and that’s the life of the mother, rape and incest. ... I’m very proud of what we did. Everybody wanted it to be back in the states where it belongs. The states are voting, and, frankly, some of the votes are very liberal by comparison to what people may have thought. But it’s now back in the states.”

The federal government’s ongoing role in setting abortion policy has been apparent throughout the current Biden administration, which, especially since the Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization, has sought to aggressively use executive branch actions, including federal regulations, to drive access to abortion.

The Food and Drug Administration (FDA) has loosened restrictions on prescribing abortion pills, the Centers for Medicare & Medicaid Services (CMS) has advocated aggressively that a long-standing federal law known as EMTALA that governs the provision of emergency health-care services pertains to emergency abortion services, and the Department of Health and Human Services (HHS) rewrote regulations pertaining to privacy of medical information (HIPAA) to prevent release of information to law enforcement pertaining to patients seeking abortions in states where the procedure is legal.

Most recently, the Biden administration issued a proposed rule to require health insurers to cover non-prescription or over-the-counter (OTC) contraceptives. Vice President Harris lauded the proposal, which she described in a statement as “the largest expansion of contraception coverage in more than a decade.”

A Harris administration would be expected to continue using the federal regulatory process to drive abortion and related policies, though as the American Civil Liberties Union (ACLU) has noted, “the Biden Harris Administration has used nearly ever executive tool available” to do so.

A second Trump administration would have recourse to these same processes and could use them to both reverse Biden administration policies and to promote its own agenda, just like it did with the family-planning rule mentioned above and other issues.

And while the Trump campaign has distanced itself from the recommendations included in the Heritage Foundation’s “Project 2025” blueprint, it’s worth noting that the document’s chapter on HHS — authored by Roger Severino, who headed the HHS Office of Civil Rights during the Trump administration — speaks to many executive branch actions that can be taken by a future administration to advance pro-life goals.

Day One Actions

Upon taking office, a new administration can take several immediate actions, including by freezing any actions taken by the proceeding administration that have not yet been finalized.

A new administration can also issue new directives reversing certain actions of the prior administration.

Few policies exemplify this back-and-forth than the Mexico City Policy that prohibited U.S. foreign-aid funds from going to organizations that provide or support access to abortion, a policy initiated by then-President Ronald Reagan 40 years ago. Presidents Clinton, Obama and Biden rescinded that policy, while Presidents George W. Bush and Trump reinstated it, making the Mexico City Policy the federal regulatory equivalent to watching a tennis match at center court.

Trump spoke about the Mexico City Policy to Arroyo too.

“[W]e’re going to be giving that a very good, serious look: in other words, how that compares and competes with the states. But we’ll be giving that a very serious look.”

A new administration could also issue directives that would lead to more significant changes, including through the rewriting of federal rules or regulations such as those that govern family-planning programs. But unlike actions that can be reversed immediately upon taking office, revising regulations is a lengthy process that often consumes months, if not years.

This is because of the time needed to rewrite at times lengthy and complex regulations, make the proposed changes publicly accessible during a comment period that is typically 60 days, review and respond to thousands or tens of thousands of public comments received and, ultimately, issue a final rule.

Shaping Allocation of Funding

A core power of any administration is the ability to direct vast federal resources to shape its policy priorities. For example, in September, the Biden administration announced a $9-million round of grant funding to states focused on educating women about various health-care services, including contraception and family planning. A Harris administration would be anticipated to continue such an approach, and a Trump administration would similarly have the ability to shape such funding directives.

As noted above, a second Trump administration could again prohibit any federal family-planning dollars from going to organizations that provide or refer for abortions. The administration could also shape family-planning policy so funds could go to a range of providers, including those that focus on abstinence or the use of natural family planning.

But because the family-planning program is governed by a federal rule, making sweeping changes would take many months, if not longer.

Access to Abortion

Long-standing laws, always subject to attack, have limited direct federal support for abortion. The most notable of these is referred to as the Hyde Amendment, named after former U.S. Rep. Henry Hyde, R-Ill., which prohibits the use of federal funds to pay for abortions within most federal health programs, such as Medicaid, except for cases involving rape, incest or the life of the mother. Unlike rules and regulations described above, the Hyde Amendment has been included by Congress in annual appropriations or federal spending laws, meaning an administration cannot act unilaterally to reverse or limit the policy.

Despite Hyde, the Biden administration has expanded direct federal support for abortion in other domains of the federal government. These policies include regulations allowing the Department of Veterans Affairs to provide abortion services in limited cases as well as a Department of Defense policy to facilitate service member access to abortions, including use of federal funds to travel to obtain abortion, as well as other services such as assisted reproductive technologies. A Trump administration could undo or seriously amend these policies.

A second Trump administration FDA could also restore long-standing limitations on access to abortion drugs that were scuttled by the Biden administration to facilitate easier access, such as by restoring what is known as the “in-person dispensing requirement.”

A Trump FDA could also revisit changes made in late 2022 to emergency contraception drug labels that removed language on the drug’s potential effects on embryo implantation. The National Catholic Bioethics Center criticized this action, noting that the FDA “did not fully address a well-known concern that (emergency contraception) can prevent pregnancy even after it falls to prevent ovulation.”

Harris has never publicly endorsed any restriction on abortion. She also opposes the Hyde Amendment, which prohibits federal funding for abortion in most cases. If passed by a future Congress and signed by a future president Kamala Harris, the Women’s Health Protection Act would eradicate all existing state restrictions on abortion, at any stage of pregnancy.

Conscience Protections

A final important domain of federal policy pertaining to abortion is protection of health-care-provider conscience rights. Like the Mexico City and Title X actions, this topic, too, has been subject to significant changes from administration to administration.

Federal conscience regulations are rooted in various federal laws and seek to protect health providers from being required to participate in abortions, protect medical students from having to train in abortions, and prevent discrimination against entities that do not perform, pay for or refer for abortions.

While the underlying laws have not been changed, the conscience rules have shifted significantly going back to late in the administration of President George W. Bush. The regulations finalized during the Trump administration were ultimately blocked in federal court, and the regulations finalized during the Biden administration reverted to the narrower scope of the rules dating to the Obama administration.

The crux of this issue comes down to scope of protections as well as the level to which the federal government, notably the Office of Civil Rights within HHS, will investigate and prioritize complaints and take actions against offenders. This can be especially tricky in cases in which an offender is a governmental entity and the penalty is loss of federal funding.

A second Trump administration may well pursue a revised regulation and more aggressive responses to complaints received. Such actions would be relevant to Catholic and other faith-based providers concerned about being forced to participate in abortion, particularly providers located in states with liberal abortion laws on their books.

In his interview with Arroyo, Trump said that he would seriously consider religious exemptions for those not wanting to participate in IVF, which is against Catholic teaching. He also stated that he supports religious liberty, “a stance that I’ve taken from the beginning, and I’ll keep it. I wouldn’t change it for anything.”

On the other hand, in 2019, Harris expressed support for the Do No Harm Act, which would have ended religious-liberty exemptions for certain government mandates, including for health-insurance coverage. It would have scaled back the protections in the Religious Freedom Restoration Act so the government could force religious employers to include coverage for abortion and transgender surgeries in their health plans, as CNA reported. The CNA report also explained that Democratic lawmakers introduced the legislation to push back against the Little Sisters of the Poor, a Catholic community of religious sisters who were suing the federal government over a mandate that their health-insurance plan cover abortion. The sisters ultimately prevailed at the Supreme Court.

Nick Manetto writes from Herndon, Virginia. CNA contributed to this report. Some portions were taken from the Register’s 2024 Voter’s Guide and this Register editorial.