Supreme Court seems to back Planned Parenthood in patients rights case

The Supreme Court on Wednesday appeared likely to side with Planned Parenthood in a South Carolina case testing whether Medicaid patients may sue for access to non-abortion health care from the organization’s medical providers.

After South Carolina cut off all Medicaid funding for Planned Parenthood South Atlantic because it provides abortion services, the organization and one of its patients sued to reinstate its health centers as qualified providers.

The case does not directly involve abortion access. Federal law already prevents states from using Medicaid funds to cover abortions in most cases. But abortion opponents have long tried to stop Planned Parenthood from receiving government money for other health care, too.

The Trump administration, which backed South Carolina’s position in court Wednesday, recently notified nine Planned Parenthood affiliates of its plans to begin withholding some funding as part of the nationwide family-planning program known as Title X.

In 2018, South Carolina Gov. Henry McMaster (R) issued an order directing all state agencies to stop providing public funds to any physician or professional medical practice affiliated with an abortion clinic. The state had paid for non-abortion services at Planned Parenthood for decades through the joint state and federal Medicaid program, which supports low-income people.

Advocates for Planned Parenthood say that its health centers provide critical medical services beyond abortion, such as birth control and cancer screenings, and that the case before the Supreme Court could affect access to those health services for low-income patients, including in other states.

At issue for the justices is whether a provision of the federal Medicaid Act allows individuals to sue for access to their provider of choice. The federal statute says a state that participates in Medicaid must ensure that “any individual” insured through Medicaid “may obtain” care from any qualified and willing provider.

In court Wednesday, the three liberal justices - Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson - suggested that Congress had clearly established an obligation on the part of states to allow patients to see any qualified provider and to go to court for that right.

“The state has to ensure that individuals have a right to choose their doctor,” Kagan told South Carolina’s lawyer. “If you know that you have an obligation and you know that the individual has a right to choose their doctor, that suggests that there’s some kind of enforcement.”

Other justices, including Chief Justice John G. Roberts Jr. and Justice Neil M. Gorsuch, pressed South Carolina’s lawyer about the availability of meaningful recourse for patients other than litigation if a Medicaid recipient is denied access to their chosen medical provider.

“One of the benefits provided by the act is that you may choose your own doctor,” Roberts said. “If a person thinks that’s not being provided, what remedies do they have?”

Several justices seemed eager to provide clarity to help lower courts determine when a statute simply confers a benefit to an individual and when it goes further, empowering those individuals to sue to enforce that benefit or right. The Supreme Court has typically set a high bar for allowing lawsuits against the government, seeking to shield public officials from liability.

“It seems to me Congress could hypothetically say an individual should be entitled to these benefits but not want to create a right of enforcement,” Gorsuch said.

John J. Bursch, the attorney representing South Carolina’s director of health and human services, Eunice Medina, warned about opening the floodgates to litigation if Medicaid recipients can sue states for access to providers. He noted that patients can appeal through an administrative process instead of turning to courts - a process Gorsuch pointed out is controlled by the governor, whose disqualification of Planned Parenthood led to the lawsuit.

To allow enforcement, Bursch said, the statute must have what he called clear “rights-creating language” that puts states on notice of the risk of litigation.

Just as private insurers don’t provide coverage for any doctor patients may want, Bursch said, the state decides which providers are qualified and “you get to choose among them.” In this case, he said, South Carolina “decided that Planned Parenthood was unqualified for many reasons, chiefly because they’re the nation’s largest abortion provider.”

Bursch is senior counsel with Alliance Defending Freedom, the Christian conservative legal organization behind many major cases at the high court in recent years, including one last term that sought to limit access to abortion medication.

During the argument Wednesday morning, Sotomayor asked the lawyer representing the Trump administration why the federal government had changed its long-held view that the Medicaid provision is enforceable in court.

Kyle D. Hawkins, the new counselor to the solicitor general, answered that the government had reevaluated its position.

“We believe that the view we’re advancing today is the best reading of the statute,” he said.

Nicole A. Saharsky, the lawyer for Planned Parenthood, said Congress did not want states to be able to cut off funding for certain providers for reasons unrelated to medical competency. Lawmakers, she said, were trying to ensure that people on Medicaid have the same right as privately insured patients to choose their providers, even if they don’t have the same ability to pay for that care.

“We’re talking about an intensely personal right that Congress wanted to protect. There aren’t that many things that are more important than being able to choose your doctor, the person that you see when you’re at your most vulnerable, facing, you know, some of the most significant challenges to your life and your health,” she said.

The long-running case was brought by Julie Edwards, a patient at Planned Parenthood’s Columbia location who said her plans to obtain gynecologic and reproductive care at the clinic were disrupted when funding was terminated.

A district court judge sided with Edwards and Planned Parenthood, and the U.S. Court of Appeals for the 4th Circuit affirmed that decision, saying South Carolina had impinged on the rights of Medicaid patients by terminating Planned Parenthood as a qualified provider.

“We refuse to nullify Congress’s undeniable desire to extend a choice of medical providers to the less fortunate among us, individuals who experience the same medical problems as the more fortunate in society but who lack under their own means the same freedom to choose their healthcare provider. In the Medicaid Act, Congress attempted a modest corrective to this imbalance,” wrote Judge J. Harvie Wilkinson III of the 4th Circuit. Wilkinson, a nominee of President Ronald Reagan, was joined by Judge James A. Wynn Jr., a nominee of President Barack Obama.