Planned Parenthood may not survive the Trump administration

The Guardian

16 hours ago

Planned Parenthood, the massive, 108-year-old network of women's and reproductive health clinics that operates almost 600 health centers across the United States, may not survive the Trump administration. Long a hated symbol on the right, and unable to summon enthusiastic support from the left, the medical network has nevertheless remained a symbolic and material cornerstone of women's equality, serving millions of patients – many of them indigent or low-income – each year, and housing one of the biggest feminist and pro-choice lobbying and litigation shops in America, in addition to being one of the nation's largest healthcare providers.
Since returning to power in January, the Trump administration has made repeated cuts targeting Planned Parenthood's clinics, excluding the group from the vast Title X family planning program, on the pretext of scurrilous claims that they have violated federal anti-discrimination law by adopting resolutions stressing their 'commitment to Black communities' and by providing medical treatment to undocumented immigrants.
Now, the supreme court has struck another blow. Last week, the court ruled that patients cannot sue to challenge their states' exclusion of Planned Parenthood from their Medicaid programs. The ruling threatens to transform the Medicaid program, giving states leeway to ban Medicaid reimbursements to any practice that provides politically disfavored medicine – notably abortion, but potentially also including contraception, IVF, gender-affirming care, or HIV treatment. The court functionally nullifies a clause in the bill that established the Medicaid program, which gives patients the right to seek care from 'any qualified provider' of their choosing. Now, the choice of provider can be dramatically limited by the state on the basis of that provider's political beliefs.
The ruling also dramatically weakens section 1983 of the Civil Rights Act of 1871, a landmark Reconstruction-era law that allows for citizens to sue states that deprive them of federally protected rights – raising the troubling prospect that the court will look askance at citizens' ability to enforce their constitutional rights against states that are disdainful of them. In the process, the court provided states with yet another way to choke off Planned Parenthood's funding, and to deprive their residents – particularly women – of the healthcare that they need to live safe, healthy and dignified lives. Many states – most – will now probably proceed to do so.
The case, Medina v Planned Parenthood South Atlantic, concerns South Carolina's decision to exclude Planned Parenthood from its Medicaid program. State funding of abortions is not at issue: abortion is banned in South Carolina, and even before it was, the state did not provide Medicaid coverage for abortions out of its state funds. (Federal money is not used to pay for abortions, either: a budget rider known as the Hyde Amendment has prevented federal Medicaid funding from covering abortion care since 1977, in effect prohibiting low-income women from accessing the procedure under their government healthcare plans.)
What is at issue, rather, is whether Planned Parenthood, which provides a wide array of services for a disproportionately low-income clientele, can be prohibited from receiving reimbursement for other services that they provide – like pap smears, prenatal care and STD testing. Planned Parenthood challenged their own exclusion by the law in tandem with a Medicaid patient who went to them seeking birth control; because she chose a provider that her state government had a disdain for, she was denied. The suit questioned whether the plaintiffs could sue to enforce the right of patients to choose their own providers. Writing for the court's six-justice majority of Republican-appointed judges, Neil Gorsuch found that they can't.
In practice, this decision enables an aggressive expansion of the states' power to put the political preferences of Republican lawmakers between women and gender-nonconforming people and their doctors. Delivered the day after the third anniversary of Dobbs, the decision expands the court's attack on abortion rights by granting states broad latitude to exclude abortion providers from the government subsidy programs that structure much of American healthcare: in practice, this will make abortion provision even more prohibitively expensive and onerous for doctors and practices, and will shutter many clinics.
The ruling also comes on the heels of Skrimetti, the court's ruling upholding bans on transition-related healthcare for minors, on the absurd claim that such laws are somehow not sex discrimination. Collectively, the cases illustrate a judicial agenda that is not just vehemently anti-choice, but aggressively gender prescriptive: willing to use the levers of medicine and its regulation to enforce a narrow and regressive vision of gender roles, from identity to sexuality to gestation.
The decision comes at a moment when Donald Trump's domestic policy agenda, known humiliatingly as the 'big, beautiful bill,' is working its way through the Senate, which among other things is considering a provision to ban Planned Parenthood from all Medicaid reimbursements nationwide. The organization has said that as a result of the supreme court and Trump administration actions, nearly a third of their clinics – about 200 – may have to close; the group has already decided to close 20 clinics just this year.
The result is a de facto ban not just on abortion, but on any healthcare provision by pro-choice providers for vast swaths of American women. One in three women in the US has received services from Planned Parenthood; more than half of American Black women have. When combined with the independent reproductive health clinics that will also be excluded from Medicaid due to their abortion politics, that number rises higher.
These Medicaid-enrolled women have now been denied the right to choose a doctor for their most intimate care based on their own comfort and values: instead, they will be forced to choose one based on the whims and bigotries of elected Republicans. In her dissent for the court's three Democratic appointees, Ketanji Brown Jackson wrote that the decision will strip patients 'of a deeply personal freedom: 'the ability to decide who treats us at our most vulnerable''.
Instead, those vulnerable patients will probably be pushed, in growing numbers, toward religiously affiliated groups that deceive rather than treat. While abortion-providing medical practices like Planned Parenthood are being pushed out of Medicaid, the program is giving more and more money to crisis pregnancy centers, the Christian fake clinics that lure in frightened women, lie to them about their health, do not provide comprehensive care, and often lack any doctors on staff. These fake clinics, which are lavishly funded and outnumber real reproductive health centers nationwide at a rate of three to one, are not a substitute for real healthcare. But they are a means of restricting women's freedom. For the court, that's good enough.
Moira Donegan is a Guardian US columnist