The US supreme court has paved the way for South Carolina to kick Planned Parenthood out of its Medicaid program over its status as an abortion provider, a decision that could embolden red states across the country to effectively “defund” the reproductive healthcare organization.
The case, Medina v Planned Parenthood South Atlantic, centers around a 2018 executive order from South Carolina’s governor, Henry McMaster, that blocked clinics that provide abortions from receiving Medicaid reimbursements. “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 said at the time, even though the reimbursements could not be used for abortions. Abortions are also now banned in South Carolina after six weeks of pregnancy.
Planned Parenthood South Atlantic, a Planned Parenthood affiliate that operates two clinics in South Carolina, and Julie Edwards, a patient who sought birth control, sued over McMaster’s order, arguing that it flew in the face of a federal provision known as the “free choice of provider” clause. That provision guarantees that people insured by Medicaid, the government health insurance program for people with low income or other eligibilities, can freely choose their own providers as long as they accept the program and are qualified to provide care. Lower courts have repeatedly sided with Planned Parenthood South Atlantic and Edwards, keeping McMaster’s order from taking effect.
The case in front of the supreme court did not directly deal with the question of whether South Carolina could legally remove Planned Parenthood from Medicaid. Instead, the justices were asked to weigh in on a highly technical question: Do Medicaid beneficiaries have the right to sue if they believe their right to a free choice of provider has been violated?
South Carolina, which was represented in the case by the powerful rightwing organization Alliance Defending Freedom, argued that beneficiaries could not sue and that the free choice of provider clause lacked “clear rights-creating language”, as ADF senior counsel John Bursch put it in oral arguments.
These technicalities cloaked the potentially sweeping consequences of the case. If people can’t sue when they believe a state is violating Medicaid, it is far harder to stop states from discriminating against controversial care, such as abortion, Nicole Huberfeld, a health law professor at Boston University’s School of Public Health, told the Guardian ahead of oral arguments.
The South Carolina case was also part of a longstanding effort by anti-abortion activists, including ADF, to “defund” Planned Parenthood by cutting it out of Medicaid. Of the 2.4 million people treated at Planned Parenthood each year, almost half use Medicaid.
