When politics pick your doctor: The Supreme Court's dangerous shift in Medina

The United States Supreme Court discreetly destroyed a fundamental safeguard in American healthcare law in the recent decision, Medina v. Planned Parenthood South Atlantic. The Court ruled in a 6-3 decision that Medicaid recipients may no longer sue to enforce their statutory right to choose among qualified healthcare providers. This holds true even when providers are targeted for ideological reasons unrelated to medical competence. On the surface, this decision appears to be about abortion providers, which can divide reactions along political lines. However, the decision affects much more than "just" those seeking abortions and their advocates: it targets every healthcare provider and their patients who want care. Medina greenlights a new era where states can weaponize healthcare access to punish viewpoints and disenfranchise vulnerable patients across all fields of medicine.

The plaintiffs in Medina challenged South Carolina's decision to deem Planned Parenthood "unqualified" for Medicaid reimbursement. The real reason, of course, wasn't whether Planned Parenthood was actually medically qualified for anything. This was a political move posing as judicial restraint. South Carolina's executive branch objected to Planned Parenthood's association with reproductive rights despite the fact that Medicaid dollars do not fund abortion services. As a result, patients like petitioner Ashley Medina lost access to cancer screenings and contraceptive care provided by Planned Parenthood simply due to the organization's "association" with reproductive care.

Lower courts had rightly concluded that the Medicaid Act's "free choice of provider" clause (§ 1396a(a)(23)(A)) gave Medina and others the right to sue. After all, Congress had created a rule: Medicaid beneficiaries must be free to choose from any provider willing and able to perform covered services. But the Supreme Court disagreed. In an opinion authored by Justice Gorsuch, the majority held that this statutory protection was not phrased with sufficient "rights-creating language" to be privately enforceable under 42 U.S.C. § 1983.

Let us be clear about what this means: a woman who loses access to her cancer screening provider because a governor doesn't like the sign or a flag on the clinic door now has no federal judicial remedy. Instead, she must place her faith in the same political forces that orchestrated her exclusion.

Proponents of the decision would argue that Medina does not outlaw Planned Parenthood. It does not deny Medicaid patients care. It simply affirms that states, not judges, determine which providers are "qualified" under Medicaid. However, the framing that "Medina doesn't criminalize Planned Parenthood or deny care, it just lets states decide who's 'qualified'" is a rhetorical sleight of hand that buries the impact. Yes, technically, the ruling doesn't criminalize Planned Parenthood or end its ability to provide care. However, functionally, this decision is an erosion of the right of Medicaid recipients to pick their doctor because the state didn't like that doctor's moral viewpoints. Medina gives state governments the green light to defund politically disliked providers under the pretense of "qualifications" and leaves patients with no recourse. Patients are stripped of the right to choose medically sound care because their State may not like the provider's "associations."

This isn't about a state determining that a provider lacks proper credentials or has failed a health inspection. Remember, there are already quality standards for medical professionals, such as state medical licenses, board certifications and background checks. These providers have already been deemed medically qualified by the very states that can now strip them of funding due to being morally unqualified based on ideals lawmakers find unsavory. South Carolina excluded Planned Parenthood not because it provided substandard care, but because of its association with abortion rights advocacy -- in spite of the fact Medicaid dollars don't fund abortion procedures. By declaring such providers "unqualified," the state is mixing politics with medicine.

So yes, Medina absolutely does deny care to Medicaid patients. It does so not in theory, but in practice. If Planned Parenthood is the only provider in a low-income patient's area that offers STI screenings or cervical cancer exams, then that patient's "right to care" has been stripped of all meaning. The ruling just shifts blame: it's not that the court denied her healthcare, it's that the state did and the court looked the other way.

The idea that states should get to decide this issue ignores the fact that Medicare is not just a state program. It is jointly funded by federal and state tax dollars, and those federal dollars come with the "any qualified provider" clause. When Congress says Medicaid patients must be allowed to choose among qualified providers, it shouldn't be up to states to rewrite "qualified" as "politically palatable, especially not when federal dollars are paying.

Letting states unilaterally decide which medical providers are "qualified" with no judicial check is dangerous. It opens the door to discrimination dressed up as discretion. Medina replaces patient choice with political censorship. The court didn't just step back from protecting rights. It failed the American people by allowing state leaders to weaponize healthcare access against providers they dislike and the patients who rely on them.

This ruling should alarm everyone. This is not just a niche gripe for reproductive justice advocates. The reasoning in Medina opens the door for states to redefine "qualified" providers according to the political flavor of the day. Imagine a scenario where a cardiologist is stripped of Medicaid referrals because he dared to criticize a state's fetal "heartbeat" bill as pseudoscience. Could a pediatrician be excluded from funding because she treats refugee children from Gaza? Could an HIV clinic be labeled "unqualified" for posting Pride flags in its waiting room? Where does it end?

Medina makes all of this plausible. The court has now cut off patients' ability to push back when politics takes precedence over medicine. The chilling effect on providers, especially those who serve marginalized populations, will be immediate and severe.

And yes, this is political. The 6-3 Supreme Court ruling in Medina v. Planned Parenthood South Atlantic exposes a stark counter majoritarian reality: half of the justices in the majority (Gorsuch, Kavanaugh, and Barrett) were appointed by a president who did not win the popular vote in that election cycle. Even if the majority were split between justices appointed by popular-vote-winning presidents (Roberts, Thomas, Alito) and those who were not, the deciding outcome still reflects a judicial philosophy shaped disproportionately by minority electoral power. When a bare majority of the court can erase statutory rights held by millions (rights enacted by elected legislatures and long upheld by precedent) this decision raises urgent questions about democratic legitimacy and judicial overreach.

The majority insists that enforcement of Medicaid rules should come not through courts but through federal oversight. But this is a hollow assurance. The Centers for Medicare & Medicaid Services (CMS) cannot possibly police 50 states and thousands of health policy decisions in real time. Patients cannot afford to wait years while bureaucracies investigate or, more likely, decline to act. Rights without remedies are not rights. They are wishes.

The court has failed the vulnerable because the practical impact of Medina will fall hardest on those already navigating barriers: low-income women, people of color, rural patients and LGBTQ+ communities. Clinics like Planned Parenthood often provide the only accessible care in certain places. And unlike their private counterparts, they serve patients regardless of ability to pay or immigration status. Stripping them of Medicaid eligibility under the guise of "qualification" is putting a velvet rope in front of healthcare.  

There is also a broader message here, one that aligns with the court's post-Dobbs hostility to reproductive autonomy. The court has once again placed the whims of state executives above the lived realities of patients in the name of judicial restraint. This is not neutral. It is an abdication of responsibility and it emboldens states to discriminate at a dog whistle pitch.

Justice Ketanji Brown Jackson's dissent hits the right note: "Today's decision strips Americans of a deeply personal freedom: the ability to decide who treats us at our most vulnerable." Her words underscore the very purpose of Medicaid, which is to protect the dignity and health of economically marginalized people. Let's be frank. The majority does not treat poor people as rights-holders, but as passive recipients of whatever care the state is in the mood for.

Make no mistake: this is not a narrow procedural ruling. It is an invitation to ideological health policy. A green light to purge providers for their views, their affiliations, or the populations they serve. And unless Congress steps in to restore private enforcement mechanisms (fat chance) patients will be left without recourse.

Medina is a warning shot. The next time you hear the phrase "any qualified provider," remember, under this ruling, "qualified" no longer means medically competent. It can mean politically convenient. When health care becomes a loyalty test, we all lose. Even patients who never set foot in a Planned Parenthood.