The Department of Health and Human Services announced Tuesday that it is launching investigations into 13 states for allegedly violating a federal health refusal clause and pressuring healthcare entities to provide or perform abortion services.

HHS officials said the department's Office for Civil Rights will investigate whether California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont and Washington violated the Weldon Amendment, an appropriations provision enacted in 2005 that prohibits states receiving federal funds from discriminating against healthcare providers who refuse to refer or provide abortions.

What the Left Is Saying

Democratic lawmakers and abortion rights advocates in the affected states have criticized the investigations as an overreach of federal authority. The 13 states under investigation have all passed laws protecting access to abortion or expanding insurance coverage for the procedure.

State attorneys general from several of the targeted states have indicated they will contest the investigations. Illinois Governor JB Pritzker, whose state was issued a notice of violation in January, has called the action 'a politically motivated attack on women's healthcare.'

Progressive groups have noted that the Biden administration in 2021 interpreted the Weldon Amendment more narrowly, finding that churches and religious organizations did not fall under the definition of 'healthcare entity.' The administration at that time withdrew a notice of violation issued to California by the Trump administration.

Abortion rights advocates argue that the current investigations represent a reversal of the previous administration's more nuanced approach and threaten to undermine state-level healthcare protections. The National Women's Law Center called the investigations 'an attempt to weaponize federal law to gut state abortion protections.'

What the Right Is Saying

Conservative lawmakers and anti-abortion advocacy groups have praised the investigations as a necessary enforcement of existing federal law. The Weldon Amendment has been included in federal appropriations bills since 2005, but advocates argue it was rarely enforced.

Family Research Council President Tony Perkins said in a statement that healthcare professionals 'should not be forced to choose between their conscience and their livelihood.' The organization has long advocated for stronger enforcement of conscience protections in healthcare.

Senator James Lankford (R-Okla.) said the investigations 'finally hold states accountable for coercing healthcare providers into providing abortions against their deeply held beliefs.' Senate Minority Leader Mitch McConnell called the action 'a critical step in protecting the religious liberty of healthcare professionals.'

HHS officials on a press call described the provision as necessary 'because of concern over the fact that state and local governments were coercing health care entities... both providers as well as health plans and health insurance companies, into covering or providing abortion, despite religious or conscious objections to those requirements.'

What the Numbers Show

The Weldon Amendment was first enacted as part of the FY2005 Labor, Health and Human Services, and Education appropriations bill. It has been included in every such spending bill since.

The 13 states under investigation represent a mix of geographic regions: four New England states (Maine, Massachusetts, Vermont, and Delaware), three West Coast/Pacific Northwest states (California, Oregon, and Washington), four Mid-Atlantic/Midwest states (Illinois, Minnesota, Maryland, and New Jersey), plus Colorado and New York.

States will have 20 days to respond to letters sent by HHS's Office for Civil Rights. The department noted these investigations were not prompted by formal complaints, with an official stating this was 'largely, I think, because the prior administration closed complaints.'

In January 2026, the OCR announced plans to promote compliance with the Weldon Amendment and issued a notice of violation to Illinois. The current investigations expand this enforcement to 12 additional states.

The Bottom Line

The HHS investigations represent a significant escalation in federal enforcement of conscience protections for healthcare providers. The 13 states under investigation have all enacted policies that expand abortion access or insurance coverage, which the department argues may violate the Weldon Amendment.

The legal interpretation of who qualifies as a 'healthcare entity' under the Weldon Amendment remains contested. The Biden administration's 2021 narrow interpretation excluded churches and religious organizations, while the current administration says it 'disavows' that reading.

The outcome of these investigations could affect how states structure their abortion coverage requirements and insurance mandates. Healthcare providers in the targeted states should monitor developments, as non-compliance could result in loss of federal funding. The 20-day response window for states begins immediately.