Society / April 3, 2025

This Supreme Court Case Is About More Than “Defunding” Planned Parenthood

If South Carolina succeeds, there will be almost no check on states that discriminate against healthcare providers for any reason.

Rachel Rebouché

A demonstrator holds a sign in front of the US Supreme Court as the Medina v. Planned Parenthood South Atlantic case is heard on Wednesday, April 2, 2025.


(Tom Williams / CQ-Roll Call, Inc via Getty Images)

This week, the US Supreme Court heard oral arguments in Medina v. Planned Parenthood South Atlantic, a case that has received much less attention than others the court will hear this term, despite its potential to “destroy” the Medicaid program. The question before the court is, do Medicaid patients have a right to sue, in federal court, to enforce the “free-choice of provider” provision in Medicaid’s statute? If they do not have a right to sue, then states will be largely unaccountable for decisions to include or exclude providers from the Medicaid program.

As it sounds, the “free choice” provision allows patients to choose any qualified provider of family planning services participating in the program. Specifically, the provision states, “A State plan for medical assistance must…provide that any individual eligible for medical assistance…may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”

However, in 2018, South Carolina excluded Planned Parenthood clinics, and all abortion providers, from its Medicaid program, not because the clinics were unqualified to provide family planning services but because they also provided abortions. (The state currently bans abortion after six weeks, which is before many people know they are pregnant.) Abortion care is not covered under the federal Medicaid program, except in cases of rape, incest, or threat to the pregnant person’s life—and South Carolina, along with 17 other states, follows that standard. But the state’s policy means that Medicaid patients who choose Planned Parenthood as their preferred provider for services besides abortion care, like cervical cancer screenings and contraception, will not have their care reimbursed. Said another way, patients have to find another place to receive basic reproductive and preventive healthcare.

On Wednesday, the court heard arguments regarding the different interpretations of the statute regarding an individual’s right to challenge the state’s exclusion of certain providers. The justices asked questions that demonstrated that the court had addressed this question—whether individuals can sue under Medicaid’s law—in previous cases. In 2023, for instance, the court upheld a patient’s right to sue under a different provision but made clear that the test for whether such a right exists is a tough one to meet. An individual right is enforceable under a civil rights statute, Section 1983, when the provision is “phrased in terms of the person’s benefits” and contains “right-creating individual centric language with an unmistakable focus on the benefited class.”

Lawyers for South Carolina and the Trump administration (reversing the solicitor general’s position under the Biden administration) argued that the Medicaid provision has no such “right-creating, individual centric language.” Planned Parenthood argued the opposite. And every justice asked, multiple times, about how the parties thought the provision should be interpreted. Are there “magic words” that confer a right?

Interestingly, only two questions from the justices mentioned the word “abortion.” In fact, in listening to the oral arguments, one would have no clue what’s at stake for reproductive health care across the country in this case—but, in fact, a lot is at stake.

Medina is entirely about abortion animus. In signing an executive order prohibiting any abortion provider from participating in the state’s Medicaid program, South Carolina’s governor made clear that the order targeted the state’s Planned Parenthood clinics to force them out of operation by hamstringing their ability to provide non-abortion services.

Repro Nation

Monthly. A collection of stories, analysis, and resources on the global struggle for reproductive freedom.
By signing up, you confirm that you are over the age of 16 and agree to receive occasional promotional offers for programs that support The Nation’s journalism. You may unsubscribe or adjust your preferences at any time. You can read our Privacy Policy here.

The heart of the case, as Justice Amy Coney Barrett noted, is a state’s right to treat abortion providers differently from other Medicaid participants offering the same services. Justice Elena Kagan underscored the point that South Carolina isn’t and has never argued that Planned Parenthood is unfit or medically unqualified to provide family planning services. Indeed, the state offered no reason grounded in patient care or safety when they disqualified the clinics. What is to stop, Justice Kagan asked, a state from excluding a provider for any reason—for providing or not providing abortion or contraceptives or gender-affirming care? If individuals cannot sue states for taking providers out of the Medicaid pool, then there is almost no check on state discretion to discriminate against healthcare entities for any reason.

That’s exactly what Congress, in passing the free-choice of provider provision, wanted to prevent: funneling patients toward state-picked providers. If the Supreme Court finds that Medicaid beneficiaries have the right to bring an action to enforce their right to choose any qualified provider, the case will return to the federal district court to determine whether South Carolina acted according to law in stripping Planned Parenthood of its qualified status. But if the Supreme Court rules for South Carolina, then Planned Parenthood could appeal the governor’s decision, which, as the parties already have agreed, will not succeed.

That is the extent to which the justices talked about the consequences of the case. But much more is on the line. A Supreme Court’s decision for South Carolina will open the door for states to exclude providers, like Planned Parenthood, because of politics and not because of their medical or clinical qualifications. Texas, Arkansas, Indiana, and Missouri have already indicated support for or enacted Medicaid defunding policies.

Then, stripping Planned Parenthood from receiving Medicaid reimbursements or Title X grants, which the Trump administration has already moved to do, will bankrupt many clinics in those states and eliminate vital reproductive health services—cancer screenings, pregnancy tests, birth control—on which low-income patients depend.

Medicaid’s reach is hard to understate. It is a safety-net program that covers “one in five reproductive age women and is the largest source of coverage for women with low incomes, covering over four in ten.” It also is “the largest single public payer of family planning services.” Yet, the same week as the Medina arguments, the Trump administration froze almost $30 million in family planning grants under the Title X Family Planning Program, ostensibly to target organizations like Planned Parenthood for also providing abortion care in some communities.

We know that making reproductive health care of any kind, including abortion, inaccessible correlates with unintended pregnancies, pregnancy complications, and higher infant mortality rates. These costs will be absorbed by those already unable to pay and they will burden an already broken healthcare system. But those consequences do not seem to trouble either South Carolina or the executive branch.

The Supreme Court is expected to issue its ruling this summer.

Rachel Rebouché

Rachel Rebouché is the dean and a professor of law at Temple University School of Law.

More from The Nation

A person sits at a desk that has a taped sign that reads,

The Trump Administration’s Education Agenda: A Tragedy in 2 Acts The Trump Administration’s Education Agenda: A Tragedy in 2 Acts

The Trump administration’s funding cuts and attacks on public education are just the beginning.

Jack Schneider and Jennifer C. Berkshire

The Google AI logo displayed on a smartphone with Gemini in the background in this photo illustration, taken in Brussels, Belgium, in February 2024.

The Human Workforce Behind AI Wants a Union The Human Workforce Behind AI Wants a Union

Contractors who work on Google’s AI products are trying to organize, but new obstacles keep appearing in their path.

Emmet Fraizer

Wendy Raymond, president of Haverford College; Robert Manuel, president of DePaul University; David Cole, a professor at Georgetown Law and former legal director of the ACLU; and Jeffrey Armstrong, president of California Polytechnic State University testify during a hearing before the House Education and Workforce Committee at the Rayburn House Office Building on May 7, 2025, in Washington, DC. The committee held a hearing on “Beyond The Ivy League: Stopping the Spread of Antisemitism on American Campuses.”

McCarthyism 2.0: Reflections on Testifying in the House Antisemitism Hearings McCarthyism 2.0: Reflections on Testifying in the House Antisemitism Hearings

I soon realized that neither the law nor the facts matter to the Committee on Education’s Republican inquisitors.

David Cole

President Donald Trump signs an executive order to eliminate the Department of Education in Washington, DC, on March 20, 2025.

The Gutting of the Department of Education Is Worse Than You Think The Gutting of the Department of Education Is Worse Than You Think

Four experts on public education in the US spoke to The Nation about how the dismantling of the Department of Education will hurt students immediately and in the years to come.

StudentNation / Elsie Carson-Holt and Adelaide Parker

President Donald Trump gestures on stage as he tours the Al Udeid Air Base on May 15, 2025, in Doha, Qatar.

Who Will Protect Judges From Trump’s Incitement? Who Will Protect Judges From Trump’s Incitement?

A threatened judiciary cannot rely on cops controlled by the White House.

Jeet Heer

Harvard University, in Cambridge, Massachusetts.

Trump Is Holding International Students at Harvard Hostage Trump Is Holding International Students at Harvard Hostage

In its quest to wreak vengeance on Harvard, the administration may ultimately fail at punishing the university—but it will harm thousands of young people.

Elie Mystal