Planned Parenthood is the nation’s biggest abortion provider. Trump tried, and failed, to defund it before.
Who is on Medicaid? The popular program could be on the chopping block
72 million people in the U.S. are enrolled in Medicaid, the federal and state health insurance program for those who are disabled or low income.
WASHINGTON − A long-time Republican goal − defunding Planned Parenthood − could get a major boost from the Supreme Court.
In a push backed by the Trump administration, South Carolina wants to lock Planned Parenthood out of its Medicaid program because it performs abortions.
“Taxpayer dollars shouldn’t be used to fund facilities that choose to profit off abortion,” said John Bursch, a lawyer with Alliance Defending Freedom, a conservative group. Bursch will be representing the state when the Supreme Court takes up South Carolina’s appeal on Wednesday.
Medicaid, which is funded primarily through federal dollars and operated by states for their low-income residents, already prohibits coverage of abortion in most cases.
But South Carolina argues that money Planned Parenthood gets from the government for providing birth control, cancer screenings, physical exams, testing and treatment for sexually transmitted diseases and other health services “frees up their other funds to provide more abortions.”
Nearly half of Planned Parenthood patients nationwide get their health care through Medicaid, although that share is lower in South Carolina which has tighter eligibility rules than most states, according to the organization.
Three other states – Texas, Arkansas and Missouri – already block Planned Parenthood from seeing Medicaid patients and many other Republican-led states are expected to do the same if the Supreme Court sides with South Carolina.
“It would be a potentially big deal,” Mary Ziegler, a law professor at the University of California at Davis, said of the effect on low-income patients. “And it would be a pretty big symbolic win for the anti-abortion movement.”
The Trump administration and Congress would face even more pressure from the movement to disqualify Planned Parenthood as a provider nationwide.
“It will be the blow that brings them down,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said last week at a Capitol Hill rally for a national ban. “They will not be able to survive this.”
Trump tried, and failed, to defund Planned Parenthood before
Efforts to stop government dollars from flowing to Planned Parenthood – the nation’s biggest abortion provider − have waxed and waned since the 1980s, according to Ziegler, who has written multiple books about the fight over abortion.
Planned Parenthood, one of the best funded and most influential lobbyists on reproductive rights, is viewed by abortion foes as their biggest obstacle to a national abortion ban, Ziegler said.
Trump tried to strip funding from Planned Parenthood during his first administration. But Republicans were unable to get the restriction through Congress. It didn’t help that the nonpartisan Congressional Budget Office found that blocking Planned Parenthood from Medicaid and other programs would have cost the government tens of millions of dollars by reducing access to birth control for low-income women. That would have increased the number of births paid for Medicaid, the budget office projected.
Trump was able, however, to disqualify Planned Parenthood − and other health care providers that provide or refer their patients for abortions − from receiving federal funding through the Title X program that subsidizes family planning and related health services.
The year after that change went into effect, the federal program served 844,083 fewer people seeking birth control, cancer screenings testing for sexually transmitted disease and pregnancy diagnosis, according to the U.S. Department of Health and Human Services.
After Texas cut off Planned Parenthood from government funds in 2013, Medicaid spending for some forms of birth control declined and spending on births increased, according to a 2016 study published by the New England Journal of Medicine.
What federal Medicaid law requires
The federal Medicaid Act says eligible people may receive health care “from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”
South Carolina says Planned Parenthood is not a qualified provider because it performs abortion, which is “a denial of the right to life.”
The Supreme Court is not deciding whether or not Planned Parenthood is qualified.
Instead, they’re reviewing whether a Medicaid patient can fight a state’s rejection of a provider.
‘I feel judged for being poor and disabled’
In this case, the challenger is Julie Edwards, a 37-year-old woman who said she’s had trouble finding doctors who will see Medicaid recipients. Edwards said she’s willing to drive more than an hour to go to Planned Parenthood for contraception services because she’s treated “without judgment.”
“I have called doctors in the past who have told me they are accepting new patients, only to have them reverse themselves when they find out I have Medicaid,” she said in a sworn statement when the litigation began in 2018. “I feel judged for being poor and disabled, and after a while that can wear a person down.”
Michael A. Kurs, an attorney who practices health care law including handling Medicaid issues, said the fact that the Supreme Court overturned the constitutional right to an abortion in 2022 doesn’t automatically mean a majority will side with South Carolina. This case is about statutory interpretation, not abortion, he said.
“I don’t foresee that being a factor,” he said. “I expect that the justices will try to figure out what Congress intended as far as the right to choose your Medicaid provider.”
For federally funded programs, the Supreme Court has said individuals can sue over an alleged violation of their rights if the statute that created the program clearly includes an enforceable right. The court has called that a “demanding bar.”
Planned Parenthood’s lawyers say the Medicaid statute readily meets that test.
“It protects a deeply personal right that is fundamental to individual dignity and autonomy – the right to choose one’s doctor,” they told the court in filings.
But South Carolina – and the Trump administration – say Congress did not intend for Medicaid patients to be able to sue. It’s up to the U.S. Department of Health and Human Services to determine if a state isn’t complying with the law, they contend.
The Justice Department asked for, and was granted, time during Wednesday’s oral arguments to help South Carolina make that argument.
Former top Health and Human Services officials filed a brief arguing against the administration’s reversal of “the long-time position of HHS.”
Impact on Medicaid patients disputed
The two sides also disagree on the impact of blocking Medicaid patients from getting health care from Planned Parenthood’s clinics in Charleston and Columbia.
South Carolina says Medicaid patients have many other options, including 140 federally qualified health clinic and pregnancy centers.
But the American Public Health Association and other health groups told the court more than half of South Carolina’s counties don’t have enough health services to meet demand and nearly two in five are considered “contraceptive deserts.”
Planned Parenthood “fills the gaps where South Carolina’s providers are scarcest — women’s health and preventative care—lessening the burden on other parts of the state’s healthcare system,” various healthcare policy experts, advocates, and providers in South Carolina told the Supreme Court.
`Our doors will stay open’
The year before the litigation started, Planned Parenthood provided over 450 health care visits to Medicaid recipients in South Carolina, according to filings.
Without Medicaid reimbursements, the organization may not be able to keep delivering services “in the same manner we have been” and may need to reduce hours at its South Carolina clinics, the organization said in a filing.
But Dr. Katherine Farris, chief medical officer for Planned Parenthood South Atlantic, emphasized that they’re not going away.
“Our doors will stay open,” she said in an interview. “Planned Parenthood is used to fighting for our patients, and we will continue to do so.”