Supreme Court Just Allowed States to ‘Defund’ Planned Parenthood

The Supreme Court ruled on Thursday that states can kick Planned Parenthood out of their Medicaid programs, a decision that could have ripple effects across the country for all abortion providers, including independent clinics. The 6-3 opinion was written by Justice Neil Gorsuch, with all three liberals dissenting.

The decision comes as Congress is considering a budget reconciliation bill that would kick Planned Parenthood out of Medicaid nationwide. The budget bill passed the House in May, but the Senate has yet to vote on its version. If it passes that chamber, the House would have to approve the amended text before it goes to President Trump.

The technical question in Thursday’s case, Medina v. Planned Parenthood South Atlantic, was whether people with Medicaid can sue a state for blocking them from getting non-abortion care at a qualified provider who accepts their insurance. This all started when, in 2018, South Carolina Gov. Henry McMaster (R) signed an executive order directing the state health department to declare abortion providers as unqualified to participate in Medicaid because, he claimed, that “results in the subsidy of abortion.”

PPSAT and a Medicaid patient named Julie Edwards then sued South Carolina’s health department for violating her right to see any qualified provider under the Medicaid Act. They used what’s known as Section 1983 of the Civil Rights Act of 1871 to challenge state actions in federal court. The conservative supermajority said that they cannot sue over this state policy, effectively giving the green light to what conservatives call “defunding” Planned Parenthood.

But “defunding” is a misnomer—there’s no line item in budgets for Planned Parenthood. South Carolina is one of the many states that prohibit Medicaid funds from covering abortions in most circumstances. But as an approved Medicaid provider, the state reimburses Planned Parenthood for providing care, including birth control, STI testing and treatment, and cancer screenings to patients with that form of insurance.

Notably, South Carolina was represented in the case by Alliance Defending Freedom, a right-wing Christian legal organization that wrote the Mississippi abortion ban the Supreme Court used to overturn Roe v. Wade three years ago this week. ADF also represented the anti-abortion doctors who sued the FDA to try to remove the abortion drug mifepristone from the market. They were never going to stop at ending Roe.

Legal experts warned that, since the case is broadly about whether people can enforce their right to choose a Medicaid provider, a ruling for South Carolina could allow states to “defund” providers simply because they provide gender-affirming care, or even birth control. Justice Elena Kagan brought up this stunning possibility in the April arguments. Kagan said siding with South Carolina would effectively be “allowing states to do that and then giving individuals no ability to come back and say, ‘that’s wrong, I’m entitled to see my provider of choice regardless of what they think about contraception or abortion or gender transition treatment.'”

Justice Ketanji Brown Jackson wrote the dissent, joined by Kagan and Justice Sonia Sotomayor, where she blasted her conservative colleagues for upending both Medicaid law and gutting the portion of the 1871 Civil Rights Act that lets people sue their states. Jackson notes that the Reconstruction-era law was passed in the wake of “terrorist violence” following the Civil War and was intended to let citizens challenge actions that deprive them of their federal and Constitutional rights. “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,” Jackson writes.

“At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them,” she continued. “And, more concretely, it will strip those South Carolinians—and countless other Medicaid recipients around the country—of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable.'”