At a time when Planned Parenthood, the nation’s largest provider of reproductive health care, faces unprecedented threats to its very survival on multiple fronts, the Supreme Court added another one on Thursday.
In a 6-3 decision, the court ruled that if states decide to unilaterally cut off Medicaid funding to a healthcare provider—in this case Planned Parenthood—patients cannot sue to stop them.
Justice Neil Gorsuch authored the decision in the case, known as Medina v. Planned Parenthood South Atlantic. In his opinion, he wrote that the Medicaid provision that protects patients’ ability to choose their doctor lacks the “rights-creating language” needed for patients to bring federal lawsuits when a state restricts their choice.
In a dissent, Justice Ketanji Brown Jackson wrote that the decision would gut the landmark Reconstruction-era civil rights law giving ordinary citizens the ability to sue in federal court when their rights are violated. “South Carolina asks us to hollow out that provision so that the State can evade liability for violating the rights of its Medicaid recipients to choose their own doctors,” she wrote.
The case began in 2018, when South Carolina Republican Gov. Henry McMaster disqualified the regional Planned Parenthood affiliate from receiving Medicaid reimbursements for the extensive non-abortion services it offers, such as birth control, sexually transmitted infection treatment, and screening for cervical and breast cancer. (Medicaid already doesn’t cover abortion, except in cases of rape, incest, or when the patient’s life is in danger. Nonetheless, many conservative states impose restrictions on their Medicaid programs that make it nearly impossible to access the procedure even under those circumstances.)
As I reported in April, there was no dispute that McMaster’s decision was motivated by anti-abortion politics, rather than genuine concerns over patient safety or medical qualifications:
Everyone seemed to agree that in 2018, when [McMaster] suddenly declared that the state would no longer consider Planned Parenthood South Atlantic a “qualified provider” for Medicaid purposes, it had nothing to do with medicine and everything to do with politics. “The payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life,” McMaster reasoned in his executive order, as he effectively cut access to birth control and basic health screenings for his state’s poorest residents in an attempt to financially punish Planned Parenthood.
Congress amended the federal Medicaid law in 1967 to ensure that patients would have the “free choice” to see any “qualified” provider who takes Medicaid. The whole point of that provision was to stop states from artificially restricting patients’ options. So, in response to McMaster’s order, Planned Parenthood South Atlantic and one of its Medicaid patients, Julie Edwards, sued the state, arguing that it had violated patients’ right to choose their provider.
By the time the case reached the Supreme Court, it had become a technical dispute over whether patients like Edwards even had the right to file such lawsuits, or if the federal government was alone in enforcing the free-choice-of-provider provision. During oral argument, Justice Sonia Sotomayor pointed out that the federal government’s only power to enforce the provision would be to pull Medicaid funding from noncompliant states—an extremely unlikely scenario.
As a result, with today’s decision, the Court has removed one of the only practical ways to stop a state from punishing doctors it doesn’t like by kicking them out of Medicaid program.
“Today’s decision is a direct attack on reproductive health care, and it is a dangerous green light for politicians to target any providers they don’t like,” said Jennifer Driver, Senior Director of Reproductive Rights at State Innovation Exchange, in a statement. “By allowing South Carolina politicians to block people enrolled in Medicaid from accessing care at Planned Parenthood, the Court has opened the door for extremist lawmakers across the country to do the same.”
The ruling is a victory for the powerful conservative Christian legal group, Alliance Defending Freedom, which represented the state of South Carolina in an increasingly common arrangement. ADF has long worked to obliterate abortion rights and is one of the forces behind the fall of Roe v. Wade and legal attacks on the abortion pill, as well as major anti-LGBTQ laws and Supreme Court cases.
Thursday’s decision could pave the way for states beyond South Carolina to block Medicaid reimbursements to Planned Parenthood—or any other disfavored medical provider. As a result, it threatens access to care for Medicaid patients who rely on Planned Parenthood.
Meanwhile, Congress is considering separate moves to “defund” Planned Parenthood—and gut Medicaid entirely. Trump’s proposed budget, currently under consideration in the Senate, would block Medicaid reimbursements to nonprofits that offer reproductive health care if they also provide abortion. That policy change could force nearly 200 of Planned Parenthood’s approximately 600 health centers to close, the organization says. It’s part of the GOP’s proposed $723 billion in cuts to Medicaid—cuts projected to leave nearly 11 million people without health insurance, according to the Congressional Budget Office.
The Trump administration is also attacking another federal funding stream for Planned Parenthood and similar clinics. Title X provides grants to health centers so they can offer free or reduced-cost family planning services to low-income and uninsured people. As of last year, 49 percent of patient visits at Planned Parenthood health centers were paid for by Medicaid or Title X funding. In April, Trump announced it would withhold tens of millions in Title X grants to Planned Parenthood, affecting 297 clinics in 34 states and Washington, DC. And his budget proposes eliminating Title X entirely.
“They know so much of our patient base is on Medicaid or needs Title X to pay for their care,” Planned Parenthood of Michigan chief external affairs officer Ashlea Phenicie told NBC News in early June. “They know that cutting this off will allow them to cut off access to abortion and they are willing to make that trade.”
