Overview
Reproductive health was dealt a significant blow on June 18, 2025, when a federal judge in the Northern District of Texas issued a ruling invalidating the final HIPAA Rule to Support Reproductive Health Care Privacy. The judgment is a major setback not only for reproductive health privacy but also health equity.
Reproductive health was dealt a significant blow on June 18, 2025, when a federal judge in the Northern District of Texas issued a ruling invalidating the final HIPAA Rule to Support Reproductive Health Care Privacy (the Rule). The invalidation, or “vacatur,” has nationwide application, and means, at least as of the time of this writing, that HIPAA-regulated entities are no longer required to comply with the Rule.
The judgment is a major setback not only for reproductive health privacy but also health equity. As discussed in a recent Network factsheet, 13 states now have total abortion bans and at least three states seek to criminalize abortion. The three other cases seeking to invalidate the Rule were brought by 17 states with total or near total abortion bans, suggesting these states do not wish to be stymied by a Rule that prohibits using protected health information (PHI) to investigate or prosecute persons merely for the act of seeking, obtaining or providing reproductive health care. The threat of criminalization will undoubtedly have a detrimental impact on access to care. What’s more, people of color are criminalized far more than white people, suggesting people of color will suffer a greater negative impact by the decision to invalidate the Rule.
The Rule, implemented by the Biden Administration, had generally prohibited the disclosure of information about reproductive health care to conduct investigations or impose liability on individuals for the mere act of seeking, obtaining or facilitating reproductive health care. In certain cases, such as requests for PHI from law enforcement, it required an attestation from the requester stating that PHI was not being requested for prohibited purposes. It further defined person as a “human being born alive” and public health as population-level activities that do not include conducting investigations or imposing liability on persons merely for seeking, obtaining or providing reproductive health care.
The case involved a Texas physician, Dr. Carmen Purl, and her business entity, who sued HHS. It was one of four cases across the country challenging the validity of the Rule. The other three—in Texas, Missouri and Tennessee—are still pending.
At the heart of the opinion, the court held the Rule must be vacated, or overturned, because it limits potential child abuse reporting and unlawfully redefines person and public health. The court also held the Rule exceeded HHS’s authority and violated the major questions doctrine, a rule requiring clear congressional authorization in cases in which an agency would otherwise be making major policy decisions itself. On this point, the court reasoned “harnessing HIPAA to create special protections for politically favored medical procedures is a matter of ‘great political significance’” and it impedes an area of state law.
One of the troubling aspects of this case is the procedural history. Since the new administration took over, HHS has expressly not addressed the merits of the case because the new administration has not yet articulated its position on the Rule and it is but one among many priorities. Nevertheless, the court denied a motion to intervene in the case filed by the City of Milwaukee, Wisconsin, the City of Columbus, Ohio and the organization Doctors for America, who do in fact address the merits of the case, holding the proposed intervenors had failed to show how HHS’s representation was inadequate. Five days before the judgment, the proposed intervenors filed notice that they are appealing the denial of their motion to intervene at the U.S. Court of Appeals for the Fifth Circuit. Nevertheless, the district court issued judgment, vacating the rule and dismissing the case in its entirety with prejudice—meaning, it cannot be refiled.
While HHS has a right to appeal the judgment, it is not likely to do so, given other administration policy decisions around abortion, including revocation last month of President-Biden-era guidance to provide emergency abortions where necessary to stabilize a patient’s medical condition.
This post was written by Stephen Murphy, J.D., Director, Network for Public Health Law—Mid-States Region.
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