On Tuesday, Senate Republicans passed a budget reconciliation bill which, if enacted, would slash lifesaving health and food assistance by hundreds of billions of dollars, and transfer billions more to the country’s wealthiest people instead. Vice President J.D. Vance’s tiebreaking vote moved the legislative behemoth back to the House, which hopes to get the bill on the president’s desk by the Fourth of July. Donald Trump’s birthday present to America is basically a coffin, gift-wrapped in trillions of dollars added to the national debt.
Among the many nightmarish provisions is a section designed to defund Planned Parenthood: The bill would prohibit Medicaid from reimbursing organizations that provide healthcare to low-income people if (1) the organization’s available services include abortion, and (2) the organization received over $800,000 in Medicaid funds in Fiscal Year 2023. Planned Parenthood is the only organization that fits that description. The prohibition would last for a year; an earlier proposal would have cut off funds for a decade, but the Senate Parliamentarian struck it upon determining it didn’t comply with the chamber’s rules.
The Senate’s bill could force Planned Parenthood to close many facilities across the country, and would replace them with healthcare deserts. In 21 percent of counties with a Planned Parenthood health center, it is the only facility that provides reproductive healthcare services to low-income people. Millions of patients who rely on Planned Parenthood as their only accessible source of birth control, pregnancy tests, and cancer screenings would be deprived of critical care. And despite conservatives’ tiresome chatter about “states’ rights,” Republicans would, in effect, push abortion out of reach for many patients even in states where abortion is legal.
If this scheme feels familiar, it’s because the Supreme Court blessed one just like it a few days ago. Federal law requires states to ensure that Medicaid patients may obtain services from “any qualified provider.” In 2018, South Carolina Republicans excluded Planned Parenthood from Medicaid anyway—just like Senate Republicans are trying to do now. In South Carolina, a patient sued and successfully blocked the policy in the lower courts. But last Thursday, in Medina v. Planned Parenthood South Atlantic, the Supreme Court ruled that the patient didn’t have a right to sue in the first place.
According to Justice Neil Gorsuch, who authored the opinion for the Republican majority, Congress did not use sufficiently “clear and unambiguous rights-creating language” when it passed Medicaid’s any-qualified-provider provision. Since the provision does, in fact, specify what states ”must” do for Medicaid recipients, Gorsuch seems to mean that because the statutory text didn’t literally use the magic word “right,” it doesn’t confer an “individually enforceable right” under federal law. This is legalese for “tough luck.”
PPSAT provides a broad range of lifesaving services in South Carolina, and curbing access would exacerbate healthcare shortages that are already dire. Even before the Court decided Medina, the federal government recognized 41 of the state’s 46 counties as Health Professional Shortage Areas, which means they have too few primary care providers per capita to meet anticipated needs. And there are only three comprehensive reproductive healthcare clinics in South Carolina, which strain to serve over 980,000 women of reproductive age, 17.2 percent of whom are low-income. Two of those clinics are operated by Planned Parenthood.
Abortion only constitutes about 4 percent of the medical services Planned Parenthood provides annually; nevertheless, forced birth advocates have wanted to take down Planned Parenthood for decades. And since outright banning abortion is unpopular, conservatives use legal workarounds to make abortion unavailable and unaffordable. They just have different methods of putting their partisan preferences over patients’ lives. The legislative arm of the Republican party used budget reconciliation. The judicial arm of the Republican party used bad statutory interpretation.
