On Thursday, the Supreme Court delivered a decision that could be a death knell for Planned Parenthood health centers across the nation. 

In a 6-3 decision authored by Justice Neil Gorsuch, the court’s conservative supermajority decided that the federal Medicaid Act does not give an individual the right to bring a civil rights lawsuit challenging the termination of a specific Medicaid provider from that state’s network. 

The Supreme Court’s ruling in Medina v. Planned Parenthood South Atlantic is its latest assault on reproductive health care. The case also marks another victory for the Alliance Defending Freedom, the Christian conservative litigation shop behind the Dobbs decision, in which the high court reversed Roe v. Wade and ended the federal right to an abortion. (ADF lawyers represented the South Carolina Department of Health and Human Services in Medina.)

Supporters of Planned Parenthood have long feared that the case could pave the way for states across the country to kick the largest provider of women’s health care nationwide out of their Medicaid networks too. Now, that seems like a distinct possibility. 

Seven years ago — before Roe v. Wade was overturned, before President Donald Trump was elected again, and before a Republican-controlled Congress was poised to approve the largest-ever cuts to federal funding for Planned Parenthood — South Carolina Republican Gov. Henry McMaster sought to kick the organization out of his state’s Medicaid network. 

There are two Planned Parenthood health centers in South Carolina; together they serve an estimated 6,000 patients a year. But back in 2018, McMaster issued an executive order directing South Carolina’s Medicaid agency to look for ways to keep Planned Parenthood  — which provides birth control, STI testing, and cancer screenings, in addition to abortion services — from receiving any public money at all. “Taxpayer dollars must not directly or indirectly subsidize abortion providers,” he said at the time. 

Federal law already bars Medicaid money from going toward abortion care except in the most limited set of circumstances, and abortion is now banned in South Carolina at 6 weeks gestation with very few exceptions, but McMaster continued his crusade — even after court after court ruled against him. 

Back in 2018, a South Carolina woman — a Medicaid recipient who received her health care at a Planned Parenthood center — sued, saying that McMaster’s order deprived her of her right to choose her own health care provider, a right that was guaranteed by the federal Medicaid Act. Two years later, in 2020, the woman, Julie Edwards, won and the fight McMaster picked with Planned Parenthood looked to be over. 

But, two years after that, a new decision from the Supreme Court revived the case, and on Thursday, the Court’s majority ruled against Planned Parenthood. 

In a dissenting opinion, Justice Ketanji Brown Jackson wrote, “Today’s decision is likely to result in tangible harm to real people.” She was joined in her opinion by Justices Elena Kagan and Sonia Sotomayor. 

“At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them,” Jackson added. “And, more concretely, it will 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.’” 

Thursday’s loss before the Supreme Court was a first for the plaintiffs. Susanna Birdsong, the general counsel and vice president of compliance for Planned Parenthood South Atlantic, tells Rolling Stone that prior to this decision, “We won at every stage of the litigation.” Most recently, the Fourth Circuit re-examined the case and reached its original conclusion: that the federal Medicaid act allows patients to choose their provider — any qualified provider — and the state of South Carolina couldn’t arbitrarily tell a person like Julie Edwards that she cannot choose an otherwise qualified provider.

Now, Birdsong says that Planned Parenthood is “looking at all of our options” — legally and otherwise — “to continue to fight for our patients.”

“While I’m deeply disappointed that the court ruled the way that they did — and I think wrongly decided that the Medicaid Act does not confer this right… There are other potential ways to challenge what the state is trying to do here,” Birdsong adds. 

Condemnation of the decision, meanwhile, was swift and loud from reproductive rights advocates across the country. 

Destiny Lopez, CEO of the Guttmacher Foundation, a reproductive policy institute, called the decision “a grave injustice.” 

“At a time when health care is already costly and difficult to access, stripping patients of their right to high-quality, affordable health care at the provider of their choosing is a dangerous violation of bodily autonomy and reproductive freedom,” Lopez added, citing Guttmacher data that showed that one in three patients who sought out birth control in 2020 received it from a Planned Parenthood. 

“Today’s decision favors extremists who’d rather let someone die of cancer than let them get a cancer screening at Planned Parenthood,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement. “The decision will put fuel on the fire of the multi-year campaign to deny Medicaid patients their right to see Planned Parenthood providers for contraceptives, STI testing, and other non-abortion services. Right now, Congress is seeking to replicate South Carolina’s ban nationwide, putting politics above patients in making health care decisions.”

Planned Parenthood has previously estimated that if South Carolina won the case, nearly 200 of their health centers in 24 states across the country would be threatened with closure, with the vast majority — 90 percent — of those closures to occur in states where abortion is legal.

The state of Texas has already removed Planned Parenthood from both its publicly-funded family planning program and its Medicaid network. The results have been stark. According to a report released earlier this month, the percentage of enrollees accessing care dropped from 90 percent in 2011 to 59 percent in 2023. Over the same 12-year period, the use of birth control accessed through the program declined by 56 percent.