WASHINGTON — The Supreme Court wrestled Wednesday with South Carolina's attempt to defund Planned Parenthood, with some conservative justices expressing skepticism that individual Medicaid patients can sue to enforce their right to pick a medical provider.
Although the divisive issue of abortion lurks in the background, the case focuses on a technical legal question of whether those eligible to use Medicaid, a program for low-income people administered by states, can sue to pick their preferred health care providers.
Federal funding that flows to abortion is already banned, but anti-abortion activists have long argued that any funding for groups like Planned Parenthood, even if it is used for other purposes, helps them carry out their broader mission.
If the court rules that people should not have a right to sue, it would benefit South Carolina's effort to cut Planned Parenthood off from Medicaid funds in the sense that if the state were to do so, patients would not have any legal recourse to enforce their right to pick the health care organization of their choice.
Ahead of the oral argument, competing groups of activists gathered outside the Supreme Court building, with a brass band providing a lively soundtrack. Some held signs saying, "I will fight for Planned Parenthood," while others had signs that said, "Planned Parenthood puts politics over people."
In court, conservative Justice Samuel Alito said the justices would have to find "something that's quite extraordinary" to conclude that patients have a right to sue.
Fellow conservative Justice Neil Gorsuch said it was an "imaginable scenario" that Congress included language in the Medicaid law that allowed people to pick providers of their choice but did not intend for them to sue.
Justice Brett Kavanaugh, another conservative, noted that patients have a separate mechanism under state law to challenge determinations that remove providers from Medicaid.
It remains unclear whether that view will hold sway, with other justices, including conservative Chief Justice John Roberts, also expressing concerns about Medicaid patients’ not being able to enforce their rights.
Noting the language in the Medicaid law that allows people to choose their doctors, Roberts asked: "If the person thinks that’s not being provided, what remedies do they have?"
Opposition to abortion drove the state's move to defund Planned Parenthood, which came four years before the Supreme Court, which has a 6-3 conservative majority, rolled back the landmark Roe v. Wade abortion rights ruling.
South Carolina now has a six-week abortion ban, meaning abortions are rare in the state.
Planned Parenthood has facilities in Charleston and Columbia that provide limited abortion care in accordance with the new restrictions, as well as other health care services, including contraception, cancer screenings and pregnancy testing.
The case arose in 2018 when Gov. Henry McMaster issued an executive order that barred Planned Parenthood of South Atlantic, the local affiliate of the national group, from providing family planning services under Medicaid.
Julie Edwards, a Medicaid-eligible patient who wants to use Planned Parenthood services, joined the group in suing the state, saying that under federal civil rights law she could enforce her rights in court.
A federal judge ruled in her favor, and after lengthy litigation, the Supreme Court agreed to weigh in on the legal question.
In court papers, Edwards' lawyers cited a Medicaid provision that says patients can choose a "qualified provider" and noted that no one disputes that Planned Parenthood can safely provide the services she requires.
During the oral argument, conservative justices raised concerns about a potential flood of lawsuits if patients could sue to pick their preferred medical providers.
But liberal justices pushed back, saying that if patients cannot sue, states could defund providers for all kinds of reasons, such as whether they provide contraceptive services or gender transition treatment.
"Every state could split up the world by providers like that," Justice Elena Kagan said. "That does not seem what this statute is all about."
That prompted conservative Justice Amy Coney Barrett to wonder whether a patient could sue if a doctor were kicked out of Medicaid because of complaints about medical malpractice.
"Does it make sense in that circumstance for Congress to want plaintiffs to be able to sue?" she said.
Planned Parenthood's lawyers rely in part on a 2023 Supreme Court ruling that allowed people to sue to enforce their rights under a different federal law called the Federal Nursing Home Reform Act. The vote was 7-2, with Alito and fellow conservative Justice Clarence Thomas the only dissenters.
The state, which has the backing of the Trump administration, points out that there are 140 clinics and pregnancy centers in the state, as well as other health providers who accept Medicaid.
The Medicaid statute differs from the law at issue in the 2023 ruling because it has no "rights-creating provisions," the state's lawyers argue in court papers. South Carolina is represented by the conservative Christian legal group Alliance Defending Freedom.
