The U.S. Supreme Court has ruled that states can chose to cut Planned Parenthood from its roster of Medicare providers, in a case that centered around the right of recipients of state-funded care through Medicaid to chose their own provider.
The court – in a 6-3 ruling, dividing on ideological lines – overturned a lower court’s decision which had prevented South Carolina from removing the local Planned Parenthood affiliate from the Medicare roster because the organization provides abortions. In South Carolina, abortion is prohibited after six weeks of pregnancy, but it was argued that Planned Parenthood should be removed from publicly-funded options for non-abortion services.
Republican governor of South Carolina, Henry McMaster, said that: “Taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs.”
The decision to end Planned Parenthood participation in the public healthcare scheme was challenged by the South Carolina Planned Parenthood affiliate and Medicaid patient Julie Edwards who argued that the federal Medicaid law guarantees patients the right to choose their healthcare provider – being entitled to “any qualified and willing provider”. However, McMaster’s order deemed any abortion provider unqualified to provide other publicly-funded services.
Two previous rulings in the lower courts – including the 4th U.S. Circuit Court of Appeals – had favoured Planned Parenthood, finding that Ms Edwards had the right to freely choose a qualified medical provider – but at the Supreme Court the South Carolina Department of Health and Human Services argued that the Medicaid provision did not meet the “high bar for recognizing private rights.”
The Supreme Court majority decision – Justice Neil Gorsuch – held that the “any qualified provider” provision “does not create the kind of clear and unambiguous right required under the Supreme Court’s cases to allow private lawsuits alleging violations of the provision,” according to Scotus Blog analysis – meaning that Ms Edwards, in effect , does not have standing to challenge the decision of South Carolina to exclude Planned Parenthood from Medicaid.
In an opinion by Gorsuch, the court emphasized that although federal civil rights laws allow private actors to sue government officials who violate their constitutional rights and their rights under federal law, federal laws “do not confer ‘rights’ enforceable” under civil rights laws “as a matter of course.” This is especially true, Gorsuch continued, for laws – such as the Medicaid Act – that Congress passes using its spending power, which “allows Congress to offer funds to States that agree to certain conditions.”
When a state fails to comply with conditions that Congress has placed on the receipt of funds, Gorsuch noted, the remedy is usually the termination of the funds by the federal government, not a private lawsuit.
To bring such a suit, Gorsuch wrote, a plaintiff must meet a “demanding bar” “that will be cleared only in the ‘atypical case’”: It must show that the law at issue clearly and unambiguously reflects Congress’ “intent to confer individual rights,” because only that kind of language will put the entity receiving the federal funds – here, South Carolina – on notice that it could face private lawsuits if it does not comply with the federal conditions.
The ”any qualified provider” provision, Gorsuch said, fails to meet that high bar. He compared the text of the provision with provisions of the Federal Nursing Home Reform Act, which the Supreme Court in 2023 held created an individual right allowing private lawsuits under federal civil rights laws. The two provisions in that case, Gorsuch emphasized, explicitly refer to the rights of nursing-home residents, while the “any qualified provider” is not so explicit.
Moreover, Gorsuch added, the nursing-home law specifically creates a “right to choose a personal attending physician” – which shows that “Congress knows how to give a grantee clear and unambiguous notice that, if it accepts federal funds, it may face private suits asserting an individual right to choose a Medicaid provider.”
“Someday,” Gorsuch observed, “Congress might choose to revise” the “any qualified provider” provision to more closely resemble the nursing-home laws. “But that is not the law we have,” Gorsuch concluded.
In a dissent joined by the two other liberal judges on the Court, Justice Ketanji Brown Jackson wrote that the ruling “is likely to result in tangible harm to real people”.
Jim Campbell, chief legal counsel for the conservative Alliance Defending Freedom, said that the decision gave states the right to freely decide how funding should be allocated: “This is a really big deal for states that have been sucked into a lot of federal litigation,” he said. “And if states decide to adopt pro-life policies, then they should be free to determine that Medicaid dollars are spent consistent with that.”
Pro-life groups welcomed the ruling, with Live Action’s Lila Rose saying “Let’s finish the job and defund them at the state and federal levels now” – while activist Rev Patrick Mahoney described the ruling as a “major pro-life victory”.
National pro-life organisation, Susan B Anthony Pro-Life America, said that SCOTUS had “delivered a major win for babies and their mothers in Medina v. PP South Atlantic, clearing the way for SC and other states to stop funding big abortion businesses like Planned Parenthood in their Medicaid programs.”
In contrast, Planned Parenthood’s president Alexis McGill Johnson told NPR that the decision would have widespread ramifications and would allow seventeen states to strip Planned Parenthood clinics of funding for non-abortion services to rural and low income people.
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