Updated June 26, 2025 at 2:11 PM AKDT
The Supreme Court delivered a back-door blow to Planned Parenthood on Thursday, ruling that states may cut off Medicaid reimbursements for the organization's non-abortion medical services.
At issue was a provision of the federal Medicaid law that guarantees Medicaid patients the ability to choose their doctors, or in the words of the statute, they are entitled to "any qualified and willing provider."
South Carolina, however, maintained that it could disqualify Medicaid providers for "any reason that state law allows." Or as Republican governor Henry McMaster put it, "Taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs."
On Thursday, the Supreme Court sided with the state by a 6-to-3 vote, along ideological lines.
Writing for the court's conservative super-majority, Justice Neil Gorsuch said that particularly in cases that put conditions on how federal money is spent, Congress must "clearly and unambiguously" authorize the right to sue as an enforcement mechanism, and Congress, he said, did not do that here. Indeed, he noted, the statute nowhere uses the term, "right to sue."
Justice Ketanji Brown Jackson, writing for the dissenting liberal justices, countered that the words in the statute "could not have been clearer."
The court's decision, she said, "will strip" Medicaid recipients all over the country of "a deeply personal freedom, the ability to decide who treats us at our most vulnerable."
A dark time for Planned Parenthood
Planned Parenthood's president and CEO, Alexis McGill Johnson, in an interview with NPR, said the decision would have widespread ramifications and would allow seventeen states to strip Planned Parenthood clinics of the ability to provide non-abortion medical services to rural and low income people.
"It's a dark time [when] a health center has to close, any time a patient is not able to get the care that they need" said Johnson, "That is a dark time because we can provide that care for our nation's most vulnerable."
These are undeniably tough days for Planned Parenthood, which also faces the possibility—or likelihood—that the Republican congress will soon cut off all its Medicaid funding in every state in the country. What's more, Planned Parenthood is facing financial difficulties nationwide — NPR reports that Planned Parenthood has closed at least 34 clinics since last year.
Support for the states' rights
Jim Campbell, chief legal counsel for the conservative Alliance Defending Freedom, however, sees Thursday's decision as a necessary correction to allow states to determine how they allocate federal funds.
"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."
Federal funds have long been banned for abortion, observes University of California, Davis Professor Mary Ziegler, author of seven books on the history of abortion and abortion policy. But, she notes that Planned Parenthood clinics serve as primary care providers in many underserved areas, including in South Carolina, where Thursday's case began.
In that sense, she says, Thursday's court ruling isn't about abortion, but it is likely to put a financial strain on many Planned Parenthood clinics, forcing some to close their doors. And if congress defunds Planned Parenthood entirely—as it may well do in the coming weeks-- she says, there would be ripple effects even in states where abortion is legal.
"Even in places like Southern California where Planned Parenthood does a pretty good job of fundraising," some affiliates there get 30 percent of their funding from Medicaid, "so that would be a huge hit," she says.
'Supreme irony'
Ziegler sees " a supreme irony" in the attacks on Planned Parenthood in the aftermath of the 2022 Supreme Court decision that overturned Roe v. Wade and the right to abortion.
"For years, the pro-choice movement thought it would need to defend its victories in court and the pro-life movement had this fantasy that if the courts were removed from the picture and Roe was gone, they would go from victory to victory," said Ziegler, "And instead we've seen the long term trend since the end of Roe is that pro-choice groups are winning victory after victory with voters and it's the pro-life groups that have seen they really need the courts to win."
How did we get here?
Since 1976, federal law has prohibited using federal Medicaid funding for abortion services with limited exceptions for rape, incest and life-threatening complications. But the Medicaid program reimburses "any qualified medical provider" for non-abortion services, and in South Carolina, a state with a shortage of primary care providers, Planned Parenthood South Atlantic has long provided routine medical services for low-income residents — including physical exams and cancer screenings.
When the governor removed the clinics from the state's Medicaid roster, the clinics sued, arguing that Medicaid patients should be able to choose their own health care providers for services that don't involve abortion.
They won, not once but repeatedly, the lower courts ruled that Planned Parenthood South Atlantic is qualified and willing to provide Medicaid services. Writing for the Fourth Circuit Court of Appeals, Judge J. Harvey Wilkinson, a Reagan appointee, concluded that Congress had clearly conferred "an individually enforceable right for Medicaid beneficiaries to freely choose their health care provider."
But on Thursday, the Supreme Court reversed that decision.
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