This article is part of TPM Cafe, TPM’s home for opinion and news analysis. It was originally published at The Conversation.
Having the freedom to choose your own health care provider is something many Americans take for granted. But the U.S. Supreme Court’s conservative supermajority ruled on June 25, 2025, in a 6-3 decision that people who rely on Medicaid for their health insurance don’t have that right.
The case, Medina v. Planned Parenthood South Atlantic, is focused on a technical legal issue: whether people covered by Medicaid have the right to sue state officials for preventing them from choosing their health care provider. In his majority opinion, Justice Neil Gorsuch wrote that they don’t because the Medicaid statute did not “clearly and unambiguously” give individuals that right.
As law professors who teach courses about health and poverty law as well as reproductive justice, we think this ruling could restrict access to health care for the more than 78 million Americans who get their health insurance coverage through the Medicaid program.
Excluding Planned Parenthood
The case started with a predicament for South Carolina resident Julie Edwards, who is enrolled in Medicaid. After Edwards struggled to get contraceptive services, she was able to receive care from a Planned Parenthood South Atlantic clinic in Columbia, South Carolina.
Planned Parenthood, an array of nonprofits with roots that date back more than a century, is among the nation’s top providers of reproductive services. It operates two clinics in South Carolina, where patients can get physical exams, cancer screenings, contraception and other services. It also provides same-day appointments and keeps long hours.
In July 2018, however, South Carolina Gov. Henry McMaster issued an executive order that barred Medicaid reimbursement for health care providers in the state that offer abortion care.
That meant Planned Parenthood, a longtime target of conservatives’ ire, would no longer be reimbursed for any type of care for Medicaid patients, preventing Edwards from transferring all her gynecological care to that office as she had hoped to do.
Planned Parenthood and Edwards sued South Carolina. They argued that the state was violating the federal Medicare and Medicaid Act, which Congress passed in 1965, by not letting Edwards obtain care from the provider of her choice.
A ‘free-choice-of-provider’ requirement
Medicaid, which mainly covers low-income people, their children and people with disabilities, operates as a partnership between the federal government and the states. Congress passed the law that led to its creation based on its power under the Constitution’s spending clause, which allows Congress to subject federal funds to certain requirements.
Two years later, due to concerns that states were restricting which providers Medicaid recipients could choose, Congress added a “free-choice-of-provider” requirement to the program. It states that people enrolled in Medicaid “may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”
While the Medicaid statute does not, by itself, allow people enrolled in that program to enforce this free-choice clause, the question at the core of this case was whether another federal statute, known as Section 1983, did give them a right to sue.
The Supreme Court has long recognized that Section 1983 protects an individual’s ability to sue when their rights under a federal statute have been violated. In fact, in 2023, it found such a right under the Medicaid Nursing Home Reform Act. The court held that Section 1983 confers the right to sue when a statute’s provisions “unambiguously confer individual federal rights.”
In Medina, however, the court found that there was no right to sue. Instead, the court emphasized that “the typical remedy” is for the federal government to cut off Medicaid funds to a state if a state is not complying with the Medicaid statute.
The ruling overturned lower-court decisions in favor of Edwards. It also expressly rejected the Supreme Court’s earlier rulings, which the majority criticized as taking a more “expansive view of its power to imply private causes of action to enforce federal laws.”
Restricting Medicaid funds
This dispute is just one chapter in the long fight over access to abortion in the U.S. In addition to the question of whether it should be legal, proponents and opponents of abortion rights have battled over whether the government should pay for it – even if that funding happens indirectly.
Through a federal law known as the Hyde Amendment, Medicaid cannot reimburse health care providers for the cost of abortions, with a few exceptions: when a patient’s life is at risk, or her pregnancy is due to rape or incest. Some states do cover abortion when their laws allow it, without using any federal funds.
As a result, Planned Parenthood rarely gets any federal Medicaid funds for abortions.
McMaster explained that he removed “abortion clinics,” including Planned Parenthood, from the South Carolina Medicaid program because he didn’t want state funds to indirectly subsidize abortions.
After the Supreme Court ruled on this case, McMaster said he had taken “a stand to protect the sanctity of life and defend South Carolina’s authority and values – and today, we are finally victorious.”
But only about 4% of Planned Parenthood’s services nationwide were related to abortion, as of 2022. Its most common service is testing for sexually transmitted diseases. Across the nation, Planned Parenthood provides health care to more than 2 million patients per year, most of whom have low incomes.
Consequences beyond South Carolina
This ruling’s consequences are not limited to Medicaid access in South Carolina.
It may make it harder for individuals to use Section 1983 to bring claims under any federal statute. As Justice Ketanji Brown Jackson, joined by Justices Sonia Sotomayor and Elena Kagan, wrote in her dissent, the court “continues the project of stymying one of the country’s great civil rights laws.”
Enacted in 1871, the civil rights law has been invoked to challenge violations of rights by state officials against individuals. Jackson wrote that the court now limits the ability to use Section 1983 to vindicate personal rights only if the statutes use the correct “magic words.”
The dissent also criticized the majority decision as likely “to result in tangible harm to real people.” Not only will it potentially deprive “Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them,” Jackson wrote, but it could also “strip those South Carolinians – and countless other Medicaid recipients around the country – of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable.’”
The decision could also have far-reaching consequences. Arkansas, Missouri and Texas have already barred Planned Parenthood from getting reimbursed by Medicaid for any kind of health care. More states could follow suit.
In addition, given Planned Parenthood’s role in providing contraceptive care, disqualifying it from Medicaid could restrict access to health care and increase the already-high unintended pregnancy rate in America.
States could also try to exclude providers based on other characteristics, such as whether their employees belong to unions or if they provide their patients with gender-affirming care, further restricting patients’ choices.
With this ruling, the court is allowing a patchwork of state exclusions of Planned Parenthood and other medical providers from the Medicaid program that could soon resemble the patchwork already seen with abortion access.
Portions of this article first appeared in another article published on April 2, 2025. This article is republished from The Conversation under a Creative Commons license. Read the original article.
