Supreme Court divided over state effort to defund Planned Parenthood

In nearly two hours of oral arguments, the court's conservative majority offered measured support for South Carolina's position.

Federal law bans taxpayer money from going to fund almost all abortions, but Planned Parenthood also provides a range of other medical services with and without Medicaid subsidies, including gynecological care and cancer screenings.

Blocking the provider from Medicaid networks could effectively defund it. Given the divisive underlying issue of abortion, groups on both sides rallied outside the high court ahead of the arguments. 

The state's governor in 2018 signed an executive order blocking Medicaid funding for the state's two Planned Parenthood clinics, saying it amounted to taxpayers subsidizing abortions. 

Courts have put that order on hold, leading to the current case. 

The key provision in the 1965 Medicaid Act guarantees patients a "free choice of provider" that is willing and qualified. 

Much of the court session dealt with whether Planned Parenthood was a "qualified provider" under the Medicaid law, and whether individual patients have an unambiguous "right" to sue to see their provider of choice, under its specific language.

"The state has an obligation to ensure that a person... has a right to choose their doctor," added Justice Elena Kagan. "It's impossible to even say the thing without using the word 'right.'"

"One can imagine a statute written as an individual benefit that's mandatory on the states but isn't right-creating" for the patient, said Justice Neil Gorsuch. "I mean, that's an imaginable scenario." 

The votes of Chief Justice John Roberts and Justice Amy Coney Barrett could be key: They asked tough questions of both sides.

Barrett offered a hypothetical of the right of a patient to go to court over their doctor accused of medical malpractice. "Does it make sense in that circumstance for Congress to want plaintiffs to be able to sue?" she asked.

Planned Parenthood says its future is at stake, noting nearly $700 million - about a third of its overall nationwide revenue - originates from Medicaid reimbursements, and government grants and contracts.

But the group notes just $90,000 in Medicaid funding goes to Planned Parenthood facilities every year in South Carolina, which is comparatively small to the state's total Medicaid spending.

A federal appeals court ruled against the state in 2024, concluding the "free choice of provider" provision "specifies an entitlement given to each Medicaid beneficiary: to choose one's preferred qualified provider without state interference."

In a 2023 Supreme Court opinion involving care for nursing home residents, the justices concluded that a different law from Medicaid gives individuals the right to sue. 

A year earlier, the high court overturned its Roe v. Wade precedent of a nationwide right to abortion.

"The people in this state do not want their tax money to go to that organization," said Republican South Carolina Gov. Henry McMaster, who attended the oral argument. "I believe the decision of this court will be that the people of South Carolina have the right to make this decision for themselves, for our state. Other states may make a different decision, but not ours. South Carolina stands for the right to life, and we'll do whatever is necessary to protect that."

"Our health centers serve an irreplaceable role in the state's healthcare system, providing birth control and cancer screenings to people who can't afford those services anywhere else," said Paige Johnson, interim president and CEO of Planned Parenthood South Atlantic. "Government officials should never block people from getting healthcare or be able to decide which doctor you can or cannot see." 

Justice Brett Kavanaugh said he would make it his mission to bring as much clarity over when patients can go to court, which he called a 45-year "odyssey."

Much of the public arguments dealt with whether a "right" to sue was a magic word to automatically decide the matter.

"I'm not allergic to magic words, because magic words - if they represent the principle - will provide the clarity that will avoid the litigation that is a huge waste of resources for states, courts, providers, beneficiaries."

The case is Medina (SC DOH) v. Planned Parenthood South Atlantic (23-1275). A ruling is likely by early summer.