On April 2, the US Supreme Court will hear a case that is—at its heart—about the autonomy and reproductive freedom of some of the country’s most vulnerable communities. Medina v. Planned Parenthood South Atlantic challenges South Carolina’s efforts to prevent people enrolled in Medicaid from accessing health care at Planned Parenthood clinics in the state.
The South Carolina policy in question is a direct assault both on the rights of people living with low incomes and on reproductive health care more broadly. It prevents people who have Medicaid insurance from accessing contraception, STI testing, cancer screenings and other essential care from their provider of choice—in this case a trusted institution that provides health care to millions of people in the United States each year.
While anti-abortion advocates will try to frame this case in terms of withholding taxpayer dollars from abortion providers, the reality is that the South Carolina policy denies patients access to high-quality care from the providers they trust—all in the name of ideology. It is also no coincidence that this case is being heard at a moment when Congress is contemplating deep and unprecedented cuts to the Medicaid program overall.
An Attack on People with Low Incomes
Medicaid covers nearly one in five people in South Carolina and the policy at issue disproportionately impacts women, Black and Brown people, indigenous people, and other communities that already face systemic obstacles to health care. For example:
- 63% of Medicaid recipients in South Carolina are women.
- 20% of all women of reproductive age in South Carolina are enrolled in Medicaid.
- Nearly three in five South Carolinians (58%) enrolled in Medicaid identify as non-White.
These statistics are mirrored nationwide, where women of color are disproportionately likely to have low incomes and to be insured through Medicaid. For example, Medicaid covers more than two-thirds of US births to people who are Black or American Indian/Alaska Native.
An Attack on Contraception and More
The anti-abortion movement has been carrying out targeted attacks on Planned Parenthood for years, with a stated goal of shuttering clinics that offer abortion or are affiliated with abortion providers. As they have become more emboldened, anti-abortion activists have broadened these attacks with unfounded claims that falsely accuse Planned Parenthood of waste, abuse and potential fraud, and which threaten its provision of reproductive health care more generally. In South Carolina, Medicaid is already prohibited from covering almost all abortions, but the policy in Medina restricts recipients’ access to a wide range of reproductive health care services, including contraception, cancer screenings and STI testing. These are the kinds of services that Planned Parenthood offers Medicaid beneficiaries in South Carolina—and which the state aims to cut off.
In fact, while the state’s policy is motivated by opposition to abortion, it can fairly be described as an attack on contraception. Years of research have demonstrated that policies designed to limit one type of care—such as abortion—have ripple effects across all aspects of reproductive health. When those attacks are successful, people end up with less access to reproductive health care, lower quality care and less autonomy to make health care decisions.
The South Carolina policy at issue is also particularly cruel because it seeks to deny patients access to a network of providers known to offer high-quality, person-centered care that aligns with best practices for family planning. Guttmacher’s 2022–2023 Family Planning Clinic Survey Trends report, which draws on a nationally representative sample of 446 clinics providing publicly supported contraceptive services, found the following:
- Planned Parenthood clinics offer the widest contraceptive method mix, with nearly all (99%) offering 10 or more reversible methods.
- The vast majority of Planned Parenthood clinics (92%) offer a supply of 12+ months of oral contraceptive pills—far more than other clinic types. (Overall, just over a third of all clinics offer this extended supply).
- Planned Parenthood clinics continue to have the highest availability of same-day IUD insertion and same-day implant insertion (available at 98% of Planned Parenthood clinics for both procedures, compared to 59% IUD and 69% implant for clinics overall).
Planned Parenthood also serves a high number of people with low incomes. Nationwide, Planned Parenthood health centers serve more than 2 million patients a year, the majority of whom live below 150% of the federal poverty level. Guttmacher analyses show that if other types of safety-net family planning centers, including federally qualified health centers (FQHCs), had to fill the gap by serving all those currently obtaining care from Planned Parenthood, patients would find it considerably more difficult to access care. Furthermore, health care providers are not required to accept Medicaid insurance, leading to shortages of providers in some communities and specialties. Fewer physicians are willing to accept new Medicaid patients compared to new patients with Medicare or private insurance, leaving many Medicaid patients with limited options.
An Attack Beyond South Carolina
If the Supreme Court decides that Medicaid recipients cannot fight back in court when the South Carolina Department of Health and Human Services prevents them from freely choosing their health care provider, the effects could ripple far beyond South Carolina. Other states could follow suit, especially those that have tried to defund Planned Parenthood or otherwise cut it out of public programs.
Such a decision could also embolden the US Department of Health and Human Services (HHS) to take further action encouraging states to target Planned Parenthood. In fact, this strategy comes straight from the conservative Project 2025 playbook, which calls on HHS to issue guidance that states can defund Planned Parenthood through their state Medicaid plans and to propose rules that would disqualify abortion providers from being able to receive Medicaid reimbursement for any health care services.
At a time when health care is already costly and difficult to access, this effort by policymakers to target low-income people and to dictate which health care providers they can see is a profound violation of their reproductive rights and freedom. In Medina v. Planned Parenthood South Atlantic, the Supreme Court has one reasonable option: to affirm that Medicaid beneficiaries have the right to choose their health care providers and that they can go to court when the government violates that right. Denying patients the right to access high-quality, affordable health care at Planned Parenthood South Atlantic—including birth control, STI testing, cancer screenings, and more—would be a grave injustice.