What The Hell America!

Will the Supreme Court do the right thing and ensure that Medicaid patients can continue to choose Planned Parenthood as their healthcare provider?

The U.S. Supreme Court heard oral arguments on April 2 in the case of Medina v. Planned Parenthood South Atlantic (PPSAT). This case involves a challenge to South Carolina’s effort to prevent Medicaid recipients from obtaining reproductive healthcare at the state’s Planned Parenthood clinics.

The actual legal issue before the Court is a narrow one: Can a Medicaid patient sue a state (known as a private right of action) to enforce Medicaid’s “free-choice of provider” provision? This provision says that a state must allow Medicaid patients to seek care from “any institution … or person … qualified to perform the service or services required” (emphasis added). Although the legal question is a narrow one, a win for the state would have devastating consequences for patients who obtain their reproductive healthcare at Planned Parenthood clinics in South Carolina and beyond.

According to a policy analysis from the Guttmacher Institute, “Other states could follow suit, especially those that have tried to defund Planned Parenthood or otherwise cut it out of public programs.” Additionally, a win for the state could “embolden the U.S. Department of Health and Human Services (HHS) to … encourag[e] states to target Planned Parenthood.”

Of course, this is the point. Antiabortion activists and politicians “have been on a years-long crusade against Planned Parenthood,” with the ultimate goal of defunding it—this would block patients who depend on public healthcare funds from getting their care at Planned Parenthood health centers.” In the meantime, the Trump administration is certainly doing its part to dismantle Planned Parenthood with its recent announcement of a freeze of close to $35 million in federal Title X funding effective April 1— a move straight out of Project 2025’s playbook.

One need only to look at the services provided by PPSAT to get a sense of the drastic impact that a win for the state would have on the reproductive health of Medicaid patients. Although Medicaid does not pay for abortions except in very narrow circumstances—due to the draconian Hyde Amendment—it is a crucial source of funding for other kinds of healthcare.  For example, the available care at PPSAT includes “physical exams; cancer screenings; contraception; pregnancy testing and counseling; and screening for conditions such as diabetes, depression, anemia, cholesterol, thyroid disorders, and high blood pressure.”

Equally important in terms of the rights at stake in this case, according to the Planned Parenthood Action Fund:

• Approximately one in five women of reproductive age across the United States use Medicaid to access no-cost, essential healthcare. That’s 16.75 million women ages 19 to 49.
• Medicaid is also the largest payer of reproductive healthcare coverage, paying for 75 percent of all public funds spent on family planning services like birth control. 
• Due to systemic barriers, 31 percent of Black women and 27 percent of Hispanic women ages 15 to 44 are enrolled in Medicaid, compared to 16 percent of white women.
• Nearly half of Planned Parenthood’s patients get their healthcare through Medicaid. 

Zeroing in on South Carolina, the Guttmacher policy analysis reports that:

• Sixty-three percent of Medicaid recipients in South Carolina are women.
• Twenty percent of all women of reproductive age in South Carolina are enrolled in Medicaid.
• Nearly three in five South Carolinians (58 percent) enrolled in Medicaid identify as non-white.

This case began in 2018 when South Carolina Gov. Henry McMaster (R) issued two executive orders “designed to withdraw state funding from any organization that provides abortions.” As a result, the state’s Department of Health and Human Services terminated PPSAT’s participation in Medicaid “solely because it performed abortions outside of the Medicaid Program.” In short, this move was motivated purely by antiabortion animus and not because PPSAT was professionally unqualified to provide medical care.

In response, PPSAT and Medicaid patient Julie Edwards, who wished to continue receiving her reproductive healthcare from Planned Parenthood, sued the state. They argued that the decision to terminate PPSAT’s participation in Medicaid violated the statute’s free choice of provider provision which gives Medicaid beneficiaries, such as Edwards, a legally enforceable right to choose their own healthcare provider.

At oral argument, the state’s attorney John Burch of the Alliance Defending Freedom, which has been described as a Christian right-wing organization, argued that the Medicaid statute does not include any “clear rights giving language” which would entitle a recipient to sue the state for depriving them of their choice of provider. This would remain true even if, as in the present case, the provider was deemed “unqualified … chiefly because they’re the nation’s largest abortion provider.”  

Pushing back, Nicole Saharsky, attorney for PPSAT, argued that the state’s position defeated the very purpose behind the free choice of provider provision, which Congress added to the Medicaid statute because states were artificially limiting the providers in Medicaid. And that’s the same thing that the state is doing now. And Congress made this an individual right because it recognized that when the state does that, it hurts individual patients.

She further stressed that “if a provider is medically qualified, the state can’t take the provider out of Medicaid for a different reason because that was the problem that Congress was addressing in the first place.” 

Saharsky also powerfully captured the equity considerations animating the adoption of this provision. As she stated, Congress enacted it to ensure that Medicaid recipients, like other individuals, could make deeply personal choices about where to obtain medical care without states “restricting beneficiaries to certain providers.”

In short, the adoption of the state’s position would nullify the very purpose of the free choice of provider provision through its obliteration of the “individual dignity and … autonomy interests” of Medicaid recipients that Congress intended to protect.

It is hard to predict how the Court will ultimately rule in the case—although there is certainly some hope that at least two out of the three so-called “swing” justices, namely Barrett, Kavanaugh and Barrett will join the powerful and staunch trio of Kagan, Jackson and Sotomayor to ensure that the “dignity and autonomy” interests of Medicaid patients are protected.