Have you ever watched a referee call a penalty after the game clock hit zero and the score was already final? That’s exactly what it feels like watching certain federal judges handle President Trump’s second-term agenda. One judge in Boston seems particularly determined to keep the whistle in her mouth long after Congress has spoken.
Another Day, Another Injunction from Boston
Last week, District Judge Indira Talwani dropped a fresh 45-page opinion that effectively orders states to continue routing Medicaid money to Planned Parenthood — even though Congress passed, and the President signed, explicit language barring it in the massive reconciliation bill known informally as the “Big Beautiful Bill.”
This isn’t her first rodeo. Judge Talwani previously tried to block the same defunding effort on “bill of attainder” grounds (a theory that didn’t survive appeal). Undeterred, she’s back with a new legal theory: the prohibition is supposedly too “vague” for states to understand.
Let that sink in for a second.
What Congress Actually Wrote
The relevant section of the law — Section 71113 — is about as clear as legislative language ever gets. It says no federal Medicaid dollars can go to any “prohibited entity” for one year starting July 4, 2025. A prohibited entity is defined as any provider that:
- Performed abortions after October 1, 2025 (with the usual life-of-mother, rape, incest exceptions), and
- Received more than $800,000 in Medicaid payments in the prior fiscal year.
Everyone in Washington knows this language targets one organization and one organization only. But it’s written in general terms — the way Congress normally writes when it wants to avoid the “bill of attainder” problem the judge flagged last time.
The Centers for Medicare and Medicaid Services (CMS) even sent guidance to every state explaining exactly how to implement it. No guesswork required.
The Judge’s New Theory: “Unclear Notice”
Judge Talwani’s latest argument is that the statute “does not furnish states with clear notice” of what they’re supposed to do. She claims the criteria are ambiguous and that states might accidentally keep paying prohibited entities.
With respect, that feels like a stretch big enough to pull a muscle.
“The elected Branches determined that taxpayer funds should not be used to subsidize certain entities that practice abortion — conduct that many Americans find morally abhorrent.”
— U.S. Department of Justice brief
The DOJ’s blunt language captures what most observers already understood: Congress used its undisputed Spending Clause authority to say, “If you do elective abortions and take a lot of Medicaid money, you don’t get federal dollars for a year.” Perfectly legal, perfectly common (see Title X rules, Hyde Amendment, etc.).
Why This Particular Judge Keeps Stepping In
Judge Talwani has developed a reputation during the second Trump administration for being one of the most aggressive district judges issuing nationwide relief. She’s the same court that previously tried to block deportations of certain parolees and has repeatedly ruled against administration priorities.
Look, every judge has a judicial philosophy. Some lean toward deference to the political branches on spending and immigration. Others don’t. But when the pattern here is hard to ignore.
In my experience covering these battles, when a single district judge becomes the go-to venue for emergency relief against an entire administration, higher courts eventually push back — hard. We saw it with the travel-ban litigation in 2017, with DACA, with the border wall. History suggests the First Circuit (and probably the Supreme Court) will have something to say.
The Real-World Impact
While the legal ping-pong plays out, Planned Parenthood is closing dozens of clinics and laying off staff. They’ve been upfront that losing roughly $700 million in annual federal reimbursements (mostly Medicaid for non-abortion services) creates an existential crisis.
Supporters argue women in underserved areas will lose basic health screenings. Critics counter that community health centers vastly outnumber Planned Parenthood locations and stand ready to absorb patients — and they don’t perform abortions.
Both sides have data. Both sides have passion. But only one side got to write the law.
The Bigger Constitutional Question
Here’s the part that keeps me up at night: if a single unelected district judge can suspend a clear appropriations rider passed by both houses of Congress and signed by the President — on vagueness grounds that feel manufactured — what can’t they suspend?
Congress controls the power of the purse. Always has. When courts start second-guessing the clarity of funding conditions, they’re not just interpreting statutes. They’re rewriting budget priorities the voters elected a government to set.
Perhaps the most interesting aspect is how quietly these rulings fly under the radar compared to the travel-ban days. Maybe because abortion funding hits different cultural nerves, or maybe because the administrative state has simply grown used to judicial veto power.
Where This Goes Next
The First Circuit has already shown skepticism toward Judge Talwani’s earlier attainder theory (they stayed her prior injunction pending appeal). Most court watchers I talk to expect the same thing to happen again — quickly.
If the Supreme Court eventually takes it up, the question could become: does the Spending Clause give Congress essentially unlimited authority to attach conditions to federal dollars, or can district judges veto those conditions whenever they seem “unfair”?
My money’s on Congress. And on the American people who just sent a pretty clear message in November about the direction they want the country to take.
But until the higher courts speak, one judge in Boston will keep writing checks that Congress explicitly refused to cash. And that, more than anything about abortion or women’s health, is the real story here.
Stay tuned. These cases move fast, and the next ruling could drop any day.
