“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,'” Justice Ketanji Brown Jackson wrote in her dissent. The Supreme Court’s 6–3 ruling this week has created shockwaves within the realm of reproductive health, and its effects are already resonating far beyond South Carolina.
This is what has just occurred The Court determined that states can exclude Medicaid money from Planned Parenthood, even for care not related to abortion like birth control, cancer screenings, and sexually transmitted infections testing. While federal law already prohibits Medicaid dollars from funding most abortions, this ruling targets the broad array of care that millions rely upon. In South Carolina, the impetus for this legal battle was Governor Henry McMaster’s 2018 directive to halt Medicaid payments to Planned Parenthood. He explained that, “Taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs,” and the Supreme Court has now recognized his prerogative to do so.
The ruling isn’t solely about a particular state. It’s the go-ahead for other states to follow suit, especially those already eager to defund Planned Parenthood. Texas, Arkansas, and Missouri have already done so, and others might soon be doing the same. At its core? The right of Medicaid patients to select their own qualified provider. Federal law for years promised patients they would be able to see “any qualified and willing provider,” but the Court decided that promise doesn’t obligate individuals to sue when the states refuse their choices. Justice Neil Gorsuch, writing in the majority opinion, felt the language of Medicaid “does not ‘clearly and unambiguously’ provide individuals the right to sue to enforce the ‘any qualified provider’ measure,” NPR reports.
For its backers, the consequences are dire. Paige Johnson, president and CEO of Planned Parenthood South Atlantic, called the decision “a grave injustice that strikes at the very bedrock of American freedom and promises to send South Carolina deeper into a health care crisis.” She pledged, “We will do everything in our power to ensure you can get the care you need at low or no cost to you. Know that we are still here for you, and we will never stop fighting for you to reclaim the rights and dignity you deserve,” as reported by Newsweek.
The decision comes in the midst of congressional negotiations on a federal budget that would eliminate Medicaid funding to Planned Parenthood nationwide. The coalition claims that doing so would shut down approximately 200 clinics many of them in states where abortion is still legal leaving huge segments of the country with minimal access to reproductive health care. In Massachusetts and California, respectively, Planned Parenthood clinics are already scrambling to raise emergency state funds, and executives predict that if federal Medicaid funding is cut, one-third of clinics would shut down and care deserts would expand, especially in rural areas. In Oregon, for example, Planned Parenthood is the main provider of reproductive health care and about 70 percent of its patients are on Medicaid.
In order to understand where this fight started, it helps to get to know the Hyde Amendment. Since 1977, it has been federal policy that prohibits abortion money from federal Medicaid, except under extraordinary circumstances. States can pay for it themselves to make it more available, but they don’t. The result? Medicaid patients in almost every state have never had full abortion coverage, and now even non-abortion care is at risk. As KFF describes it, this patchwork of coverage means that where you live will decide whether you are able to get the care that you need.
The Supreme Court decision also removes a vital legal avenue for patients. Litigation was typically the only device Medicaid beneficiaries had to guarantee their provider choice. Public health groups like the American Cancer Society argued that removing this option from the equation would restrict access to care for millions most notably in rural areas, where Planned Parenthood may be the only provider who will accept Medicaid. In South Carolina, that $90,000 in Medicaid funding Planned Parenthood receives is a tiny fraction of the state’s Medicaid budget, but to patients like Julie Edwards, who needs birth control to manage a life-threatening medical condition, it’s the difference between having care and having nothing.
The broader political climate is no less turbulent. The congressional budget backed by Trump would not only cut Medicaid funding but also eliminate funds for Title X, which subsidizes the clinics that provide free and low-cost family planning services. Title X cuts have already shuttered Utah and Michigan clinics, with more to follow.
As Destiny Lopez, co-president and CEO of the Guttmacher Institute, explained, “Stripping patients of their right to high-quality, affordable health care at the provider of their choosing is a dangerous violation of bodily autonomy and reproductive freedom,” Axios states.
As the dust is starting to settle, the decision has already changed the landscape of healthcare for millions of Medicaid patients, especially rural and underserved communities that have relied on Planned Parenthood for years for needed care.
