When Senate Republicans voted on Tuesday to pass President Trump’s spending bill, abortion opponents came one step closer to stripping Planned Parenthood of federal funding — a move that could jeopardize abortion access for patients even in states where abortion is legal.

The bill imposes a one-year ban on state Medicaid payments to any health care nonprofit that offers abortions and received more than $800,000 in federal funding in 2023. The restriction jeopardizes Planned Parenthood’s ability to keep operating in some states.

While federal law already prohibits federal Medicaid dollars from paying for abortions, the bill would affect the stream of federal money that covers other services, and thus helps keep clinics open. Though not all individual Planned Parenthood locations provide abortions, the legislative language could knock them out of Medicaid if they are part of a regional network that does offer the procedures.

Planned Parenthood affiliates — each an independently run nonprofit that operates clinics across a geographic region — are in the unusual position of being both an abortion provider and an operator of clinics. The facilities provide a wide range of other medical services for more than two million Americans who cannot afford health care anywhere else.

“This bill threatens to close nearly 200 Planned Parenthood health centers and will create devastating gaps in our health care infrastructure,” Alexis McGill Johnson, the chief executive of Planned Parenthood Federation of America, the national umbrella organization, said in a statement.

The bill most deeply affects Planned Parenthood clinics in blue states, including California, Oregon, Washington and Illinois, where abortion is still legal and where there are also large numbers of patients who are eligible for Medicaid reimbursements for other health care.