Supreme Court Just Allowed States to ‘Defund’ Planned Parenthood

The ruling allows states to kick any healthcare provider out of Medicaid just because they offer abortions, and opens the door to banning clinics for providing birth control and gender affirming care.

AbortionPolitics
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.'”

The ruling won’t take effect in South Carolina until the justices issue what’s known as a judgment, which typically takes several weeks. Then the state would need to petition a judge to lift an order blocking the policy.

In a statement, Planned Parenthood South Atlantic president and CEO Paige Johnson called the ruling “a grave injustice” that allows governors like McMaster to “weaponize anti-abortion sentiment to deprive communities with low incomes of basic health care.” She noted that the court declined to take this case two times—including shortly after Justice Ruth Bader Ginsburg’s death—before it finally agreed to hear it in December, weeks after Trump won a second term in office.

Johnson said PPSAT will continue to see South Carolina patients enrolled in Medicaid—but that would mean either eating the cost of their care, charging these low-income patients some of their bill, or a combination of both. “To our patients, we will do everything in our power to ensure you can get the care you need at low or no cost to you,” she said. On a Thursday press call, PPSAT chief medical officer Dr. Katherine Farris was more direct: “We are working hard not to turn people away, but the reality is we may not be able to do that for long.”

The president and CEO of Planned Parenthood Federation of America, Alexis McGill Johnson, said in a statement that the court “once again sided with politicians who believe they know better than you, who want to block you from seeing your trusted health care provider.” McGill Johnson connected the ruling to the federal efforts to attack the organization. “Right now, lawmakers in Congress are trying to ‘defund’ Planned Parenthood as part of their long-term goal to shut down Planned Parenthood and ban abortion nationwide,” she said.

Planned Parenthood has called the federal bill a “backdoor abortion ban” because it could lead to nearly 200 clinics shutting down—and it said 90% of the closures would be in states where abortion is legal. After the ruling on Thursday, the anti-abortion group Live Action implied on Twitter that severely restricting abortion access via “defunding” is their goal.

Jennifer Driver, Senior Director of Reproductive Rights at State Innovation Exchange, said in a statement that the ruling allows politicians to target any healthcare provider they don’t like, and it will harm people who are already vulnerable. “This isn’t just about one provider or one state—it’s about dismantling the already fragile network of reproductive health care available to millions of people, especially those who are low-income, Black, Brown, rural, and marginalized,” Driver said. “The Court sent a chilling message that if you rely on publicly funded care, the personal beliefs of politicians—not yours—will determine who you can see, what care you can get, and whether your health and autonomy matter.”

The April hearing did not suggest that this would be the outcome, as multiple justices appeared to agree that a 2023 precedent would require ruling against South Carolina. As I wrote, “After more than 90 minutes of arguments, it sounded like Justices Amy Coney Barrett, John Roberts, and maybe Brett Kavanaugh could side with the three liberal appointees.”

Today is a good reminder that we cannot trust these Justices any further than we can throw them.


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