State Impacts of the One Big Beautiful Bill Act of 2025
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Key Takeaways:

  • Three years after Dobbs, reproductive health policy continues evolving rapidly through state legislative responses, ballot measures, and interstate legal battles, demonstrating the ongoing national debate over abortion access and restrictions.
  • Ballot measures remain a powerful policy driver even in off-election years, with Missouri successfully advancing a measure to overturn voter-enacted protections while Montana failed to achieve the two-thirds vote needed for fetal personhood legislation.
  • Interstate conflicts over abortion medications are intensifying as Republican attorneys general pursue cases against out-of-state providers while blue states enact shield laws allowing healthcare facilities rather than individual clinicians to appear on prescription labels.
  • Emergency abortion policies are diverging along partisan lines, with red states clarifying medical emergency exceptions under existing bans while blue states codify federal EMTALA protections into state law following Trump administration guidance changes.


June marked 3 years since Roe v. Wade was overturned and states took control over reproductive health policy. In the first year after the Dobbs decision, we saw a flurry of state activity with several red states enacting abortion bans, while blue states worked to protect access. Last year, reproductive health policy was defined by ballot measures with seven states approving constitutional protections for reproductive health. All the while, the judicial systems at the state and federal levels have considered the legality of abortion restrictions and protections. In 2025, the national debate over reproductive health policy remained active with state legislatures advancing new measures and responding to developments. 


Ballot Measures Continue Driving Policy Despite Off-Election Year

Even though it is not a major election year, ballot measures continued to be a driver of reproductive health policy. Lawmakers in Missouri and Montana attempted to overturn voter-enacted abortion protections with ballot measures of their own. Missouri was successful, and a ballot measure is set to go before voters in 2026, or sooner if Governor Mike Kehoe (R) calls a special election. Meanwhile, in Montana, lawmakers failed to gain the two-thirds vote necessary to put a measure to establish fetal personhood on the ballot. 

Interstate Legal Battles Over Abortion Medications Intensify

Abortion medications continue to be a highly contentious debate within reproductive health policy. Republican attorneys general in Texas and Louisiana are pursuing civil and criminal cases against a New York doctor who mailed abortion pills to patients in their states. In response, New York, Colorado, Maine, Massachusetts, and Vermont enacted similar measures to allow abortion medication prescription labels to list the health care facility instead of the prescribing clinician, a move intended to protect providers. The ongoing lawsuits could have a significant impact on reproductive health policy as they challenge shield laws, which seek to protect abortion providers and patients from out-of-state actions. Meanwhile, Louisiana enacted further restrictions on abortion medications, and lawmakers in Texas continue to debate additional restrictions as part of their current special session. 

Emergency Abortion Policies Split Along Partisan Lines

Emergency abortions have also been a point of interest this session. Since strict abortion bans have gone into place, exceptions for medical emergencies have been the subject of litigation as abortion advocates have contended they are vague and dangerous.

This year, Arkansas, Kentucky, Tennessee, and Texas enacted bills to clarify the circumstances under which abortions may be performed under their bans. On the other hand, following the U.S. Supreme Court’s dismissal of a case concerning the federal Emergency Medical Treatment and Active Labor Act (EMTALA) last year and the Trump Administration’s rescission of EMTALA abortion guidance, blue states have moved to codify related federal protections into state law. Colorado, New York, Washington, Massachusetts, and Connecticut all enacted similar legislation to require hospitals to provide necessary stabilizing care, including emergency abortions, to patients with emergency medical conditions. 


What's Next?

Legislative activity from this session demonstrates the rapidly evolving nature of reproductive health policy. Even as courts weigh in and voters shape outcomes, state legislatures have acted quickly to respond. In addition to state-level dynamics, developments at the federal level, including restrictions on funding of abortion providers and potential FDA review of abortion medications, could further shape the reproductive health landscape and prompt new state responses in the coming year. 


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This article appeared in our Morning MultiState newsletter on August 12, 2025. For more timely insights like this, be sure to sign up for our Morning MultiState weekly morning tipsheet. We created Morning MultiState with state government affairs professionals in mind — sign up to receive the latest from our experts in your inbox every Tuesday morning. Click here to sign up.