The SCOTUS Case Threatening Medicaid Recipient’s Ability to Choose Their SRH Provider

A new case with tremendous possible consequences for U.S. sexual and reproductive health and rights has made its way onto the Supreme Court docket. Medina v. Planned Parenthood of South Atlantic is a culmination of decades of anti-choice activist’s attacks to Planned Parenthood and other reproductive health care providers, specifically targeting efforts to kick these providers out of Medicaid. Jessica Mason Pieklo, Senior Vice President and Executive Editor of Rewire News Group and co-host of Boom! Lawyered, sits down to talk with us about the implications of this case for the country’s most vulnerable.

The question in front of the Supreme Court is whether the Medicaid statute confers a right to its recipients to go to providers of their choosing. Not only does this open doors to re-defining “qualified” and “unqualified” reproductive health care providers, it allows an opportunity for legal conservatives on the court to meander around Congressional conferring of rights via statute. Oftentimes, Planned Parenthood affiliates are the only option for low-income, Medicaid patients.

Links from this episode

Jessica Mason Pieklo on X
Rewire News Group on X
Boom! Lawyered Live Podcast Recording Information
‘Medina v. Planned Parenthood’ Is One of the Term’s Most Consequential SCOTUS Cases

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. Hi rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I feel like a huge weight has been lifted off my shoulders. Just, like, having the report card out there for everybody to see and, and just have it done. I feel so much lighter and, like, now I can just concentrate on the rest of my job and digging out from under the mountain of email that I am under I, yeah, so nice to just have that done and I think the new microsite looks great. I hope y'all have had a chance to go and explore it at reportcard.reprosfightback.com. It's been so much fun to be able to play on it and see comparisons across indicators and just instead of just the overall grade. I think it's a great tool. I hope you all do as well. It was a lot of work and I am just so proud of the work that our team has done, especially Rachel and Heidi. They put so much work in to get this microsite ready in particular I'm just so grateful for all of the time and effort they put into it. And for the report card design, our amazing designer Tanya, made a beautiful report card. If you go to the PDFs, like, she just did an outstanding job. And yeah, I'm just so grateful to everybody for all of the time and effort they put into the report card and I'm just so happy to have it done.

Jennie: If you are listening to this on- when it comes out, I am at the last day of a conference and I am so excited to be around a bunch of Title X providers and other people who work on Title X. If you're at the conference and you've, and you hear this episode, make sure to come stop by our booth. We've got fun things that we're handing out, including some fun Liberal Jane stickers we had her designed for rePROs. We have fun bags and I think we have some other fun things at the booth too. So, make sure to come by and say hi. I'm very excited to do that. I'm recording this before the conference, but I'm just really excited to get to talk to people about the podcast. It's always so much fun and not only to get to meet people who are listeners or may be listeners, but get to hear ideas, particularly from a group that does this work day in and day out to hear about what things they would like us to talk about on the podcast. So, I love doing that. And if you have ideas of things you'd love to hear us talk about, always feel free to reach out. You can reach out to us on social media at rePROs Fight Back on Facebook, Twitter and Blue Squ- Bluesky—sorry, y'all, I don't know where my mouth is at—or @reprosfb on Instagram. Or you can email me at jennie@reprosfightback.com. And that's Jennie with an IE. Yeah, all the ways please. I always love to hear what y'all think. And I guess while I'm at it, if I'm gonna do, like, housekeeping, things like that, if you love the podcast, it'd be awesome if you could rate and review us on your favorite podcast platform. It helps other people find the podcast and always appreciate the love from y'all. Okay, I think with that, let's turn to this week's episode. I am very excited to have on the always amazing Jessica Mason Pieklo with Rewire News Group and host, co-host of Boom! Lawyered podcast on with us to talk about a case in front of the Supreme Court tomorrow Medina v. Planned Parenthood of Southern Atlantic- Southeast Atlantic. Sorry, I'll bungled that a little bit, but it's an important case that is flying a bit under the radar, so I'm excited for y'all to hear about it. So, with that, let's go to my interview with Jess.

Jennie: Hi Jess. Thanks so much for being here.

Jess: Oh, thanks so much for having me back. It's always a treat.

Jennie: So, before we get started, let's just do a quick, like who are you, you wanna do your pronouns and stuff as well?

Jess: Sure. I am Jess Pieklo. I use she/her pronouns, and I am the executive editor at Rewire News Group and co-host of our flagship podcast, Boom! Lawyered.

Jennie: So, I was gonna make sure to do this at the end, but like, let's do it right now. Do you have anything else you would maybe, like, to promote, like, maybe something that's happening in DC this week?

Jess: DC friends, oh my gosh. You all are in it. You are in the ringer. And so, Imani Gandy and I are coming to see you. We're gonna be there with Liz Winsted and the amazing Abortion Access Front folks for a live podcast mashup that you didn't know you needed. Yes, it's Boom! Buzzkilled, and we will be at the Black Cat on April 3rd. Doors open at seven. Show starts at eight. You can get tickets online. And please come see us. Come laugh. We are gonna have a ball.

Jennie: So, that's like the bit of good news. I figured we should just start with, like, some happiness at the top 'cause...

Jess: Thank you.

Jennie: The rest is, like, less than happy, but okay. So, I feel like there's a big Supreme Court case that's flying a bit under the radar right now. Like, I was shocked. I went to prep for this interview to make sure that I could have a decent conversation with you about, like, what is going on and I was, like, googling and I was like, wait, news. It was like three pages deep and it was mostly ADF and I was like what is going on? Like, there is hardly any information about this case. So, can you tell us about this case that is coming up this week?

Jess: Yeah. So you are right with the fire hose of terrible news in Trump 2.0 in this tremendous and very real threat to Medicaid recipients is before the Supreme Court. And it's a case called Medina v. Planned Parenthood Southeast. And it is, for longtime listeners, the culmination of decades of efforts truly by the anti-choice community to try and kick Planned Parenthood, but really any reproductive healthcare provider that services Medicaid patients out of Medicaid generally. And so, this is truly an attack on Medicaid recipients and we see it coming in the form of limiting or attempts to limit access to reproductive healthcare generally. And so, this is pretty classic anti-choice playbook here: find the repro boogeyman and use it as a way to come for poor people. And it feels like in many ways that this case is the culmination of Henry Hyde's legacy and the conversation around the Hyde Amendment that we continue to have in this country. And that is whether or not if you are a low income person who relies on Medicaid for your health insurance coverage, whether or not you get to decide who you get to see as a health provider and whether or not that health provider has to provide you healthcare at all. It's shocking.

Jennie: Yes, it is absolutely part of the continuation of the Hyde conversation. It also feels like a big part of the defund Planned Parenthood conversation with people thinking there's like-

Jess: Yes.

Jennie: A line item in the budget that they're just like, okay, erase no funding to Planned Parenthood. This is, this is what they mean. This is what they mean is preventing people on Medicaid from going to Planned Parenthood.

Jess: Right? And so it's exactly [that]. I mean, you're right. There is no line item that goes to Planned Parenthood, right? Like, if only, and I'm saying that just in the sense of like, wow, that would be light years from where we are right now. But instead what conservatives like to do is monkey around with definitions within the Medicaid statute and within the rules governing it. And usually this comes in the case—and we see it here in this South Carolina challenge—as to whether or not Planned Parenthood, in this case, is a qualified medical provider within the definitions of the Medicaid statute. So, Medicaid dictates that only qualified providers get the funding and naturally conservatives see that as an opening to define who is qualified and who is not. If you happen to provide comprehensive reproductive healthcare, they like to target you as being "not qualified" under the statute. Now, that's not the issue that's teed up before the Supreme Court in this case though, which is why I think this case is even more dangerous than whether or not medical providers who offer abortion and contraception are qualified under Medicaid. The question that the Supreme Court is going to answer is whether the Medicaid statute confers a right to its recipients to go to providers of their choosing. That's the inverse of that, "is Planned Parenthood a qualified provider?" question. And it is much bigger, and it is much more dangerous because what it is an opening for the legal conservatives on the court to have a walk about on how Congress confers rights via statute. And that should alarm everyone who has been paying attention to the way this court interprets rights and who has them and how they have been historically recognized and created.

Jennie: Yeah, I definitely started like reading this stuff and I was like, oh, this is way more, more complicated than I originally had thought and gets much more legalese than my depth. So, I'm so glad that you were on to talk about, like, what is actually at stake in this case.

Jess: The nugget of the case is whether or not poor people have rights. I really need listeners to understand that because it is an opening to the larger conversation. Do poor people have rights under Medicaid to see a healthcare provider that they want to? Check that box. Do you know poor people have rights under other public programs to access those benefits that are accordant with those rights? Like, this is where the dominoes start to fall. We're seeing this in a long line of attacks right now on social safety programs, for example, right? We know that Medicaid generally is completely in the budget cross hairs would have a tremendous ripple effect in this case as well. We know that section 504 of the Rehab Act right now is in the cross hairs from the legal conservatives. That is a statute and real broad safety net that requires accommodation in basically anything that receives federal funding. You know, if you are somebody who interacts with the federal or state government in any way, shape or form, you will be touched by the outcome of these cases and these movements at some point. Why do I say that? Well, Medicaid, for example, covers a majority of pregnant women in this country who are low-income. Seniors, this is a joint program between the federal government and the states for providing benefits, the same way that education has been historically in this country, the same way other, you know, types of public services have been. So for the Supreme Court to decide in this particular case, you know what, no, maybe the Medicaid statute, all it does is grant you the ability to have insurance coverage, but there's no right to access that care. That is a way that the Supreme Court can create the foundation that there is no fundamental right to healthcare in this country. We saw it in Dobbs. They can build on that in Medina.

Jennie: Oof, okay. That hits hard. And I think the other thing I've really also been thinking about is how many people think this Medicaid fight isn't their fight and how it's not gonna impact them because, because they're not on Medicaid and you know, a lot of people go to hospitals that are covered by Medicaid.

Jess: Mm-hmm.

Jennie: And if those people no longer have Medicaid like it, those hospitals are gonna suffer. And so, a hospital you go to with your non-Medicaid insurance may no longer exist if they are not able to treat patients who are on Medicaid because they're losing the sources of funding.

Jess: It's such an important point and one that is so, that just needs to be underscored because so many of those hospitals also have a wide range of specialties under them as well. And that is in part because they can operate thanks to Medicaid funding and the ability to see those patients. And so, this is something that you and I have chatted about. You know, we will not be having a conversation, for example, around this case that asks the question of why institutions don't have an obligation to see Medicaid patients. This has become a burden by design on some public institutions, and it's because of a for-profit healthcare system that really just does not like folks with low incomes. Like, they want to extract money from patients. And so that is, that is wrapped up in the larger conversation as well. And I mean, I think the reality is folks are one accident away from a debilitating event that puts them or someone they love on Medicaid. And we are very cavalier in this country, and COVID did not teach us that, but it is the truth. We are one accident away from someone we love being on Medicaid.

Jennie: And I think that leads to this other point of like, why this is so important. We're talking about Planned Parenthood because not all providers accept Medicaid. Planned Parenthood does.

Jess: Right.

Jennie: And for reproductive health, for family planning, you can get into Planned Parenthood, like, they can see more patients because this is what they do. They know, and the appointments can move faster than if you go to, like, a general OB/GYN who may not take Medicaid. So it is such a core part of sexual and reproductive healthcare that Planned Parenthood is, well, Medicaid, in general, is just a huge sexual and reproductive health program.

Jess: Yes.

Jennie: But then also that patients can go to the provider they choose, which is often Planned Parenthood.

Jess: And given the nature of those healthcare interactions, those patients end up getting a majority of their primary care through those Planned Parenthood affiliates. So, you know, that is the give and take of planned Parenthood as a, as a healthcare provider in this space. Right? I mean, we would love to see all of the Planned Parenthood affiliates offer, you know, wide ranging abortion services, for example. We know that's not the case, but they see Medicaid patients and those patients that see them receive comprehensive care oftentimes beyond just reproductive care. Sometimes those Planned Parenthood affiliates are the only point of access for healthcare generally for Medicaid patients. And so, this is really a targeted attack on that pipeline.

Jennie: Okay. So I guess that covers basically, like, what's at stake in this case? I know there's so much happening. What, what else is like stressing you right now?

Jess: I mean...

Jennie: I know it's a long list, right? But like-

Jess: Wanna know why David Weldon didn't get the votes. [laughs] I'm really concerned about what is unknown if I am being honest. First of all, kudos to everybody who, who worked that campaign to make sure-

Jennie: Yeah.

Jess: -that David Weldon was not confirmed to head the CDC, because that would have been a nightmare. But I also wanna know what was so bad that Republicans were like, no, we can't, we. And so that is something that is stressing me out because it is part of the larger whole scale attack on the public health infrastructure that we are seeing right now that exists well beyond the attacks on bodily autonomy and reproductive health, rights, and justice. We are undermining the effectiveness of this nation in just doing what it has done very well. I mean, we all got warts, but like, you know, broadly speaking, our stem dominance, our real, like, presence in public health both domestically and globally, like, I am bewildered at the speed on those attacks. And I thought I was pretty well prepared for Trump 2.0. So, that's absolutely stressing me out. The capitulation by centrist stems on everything right now is super stressing me out. You know I just...

Jennie: I'm thinking about, like, the lost data, like, the lost data sets. Like, one of the big things that USAID funded was the demographic and health surveys around the world, and like, they hold the data sets so, so much data one may not be continued to be collected in the same way without the US investment. And two, some of that historic data, like, people may have parts of it, but they might not have all of it. Just lost.

Jess: I mean, demography is gonna be vibes now, Jennie.

Jennie: Yeah.

Jess: Just vibes, not data.

Jennie: Isn't everything just vibes now?

Jess: Yeah. And they're the worst. I mean, look, I'm not gonna say- I'm not gonna, I'm not gonna stay down. Weldon was a tremendous win. The advocates who are challenging everything right now out of Trump 2.0 are doing amazing work in throwing sand in the gears. And I know that there are people who are still employed in federal capacities who are also throwing sand in the gears and doing so behind the scenes and without notice and rightly so. So, those are the places where I am really digging in right now and offering as much solidarity and support and, you know, anything I can, because hopelessness is a political tool and I refuse to, I'm not necessarily hopeful, but I'm not going to stay hopeless. Right. I am really feeling that work that folks are doing and the need to support it and be very clear-eyed about it in the moment.

Jennie: Yeah. And I just thinking of those people who are still working for the government and, and are doing that, like throwing sand in the gears, like, just what a thankless, like, amazing job and like-

Jess: Exactly.

Jennie: Still, like, I'm sure advocates are reaching out to them mad that they're like...and, and so I, I just, I really feel for those people who are doing that work and trying to do everything they are able to do to slow things down or stop things and while also being advocated at for not doing enough. And that is advocates’ jobs, but also I do feel for the person that's, like, stuck in the middle trying to do it. And I also just feel for people I know who've left the US government and are like watching their life's work be torn apart 'cause...

Jess: Yeah, I know. I mean, it's, it's, it's wild times right now. The oligarchy is no fun.

Jennie: Okay. So I guess we could go back to the case.

Jess: Okay.

Jennie: I'm just thinking through like, there's so much, so much happening around Medicaid right now that it does feel like there is...it just, it, it, it feels so much right now, and I'm just thinking through all of the ways where Medicaid plays such a pivotal role. Like, 41% of births in this country are covered by Medicaid. And so, watching these attacks and then watching access to family planning may be under attack with this Medina case. I just...and we're already in a maternal mortality crisis, particularly for Black women. It's just like all of it coming together to really possibly have really devastating consequences.

Jess: Mm-hmm.

Jennie: And it is just weighing on me right now.

Jess: I mean, I think that that's a reasonable response to the times because there's not a, I mean, there's not really an answer to that that's clean-

Jennie: Yeah.

Jess: -at any rate in the, in this current moment. But it is incredibly important to connect the dots. And I think that that's one thing that the Medina case really does, is it allows us to have a conversation about how Medicaid folds into the delivery of healthcare services in this country generally. And the fact that, you know, to sort of bring it back to the, my observation that this feels like a full circle moment in the conversation of Henry Hyde's legacy, the idea that conservatives have always said that they may not be able to block reproductive healthcare for everybody, but they will absolutely block it for folks with low incomes. And that's what Henry Hyde said in passing the Hyde Amendment out of the gates. And that's the spirit in which the conservatives have, and some centrist democrats have embraced this fight. And so, I think we just in this moment where, you know, I said the oligarchy's no fun, but really we find ourselves deeply ingrained in class warfare from the top down right now in this country, to see this as a way to further limit the ability of people who are not born into wealth to live their full civic lives is real. Because what does it mean to restrict access to healthcare? Well, it makes going to your job harder. It makes earning a living consistently harder. It makes all of the things that bodily autonomy and policies that embrace and endorse that as far as a full civic life possible, right? I mean, let's have the conversation about this case in the same breath as the DOGE cuts, because who are those affecting? A large swath of workers with disabilities, disabled veterans—those are folks who are beneficiaries of federal programs and dollars in some ways. They're getting cut out. This is, they're, they're in alliance now with South Carolina Medicaid recipients in this case in many ways. And whoever can is the organizer that can get these folks in the room talking to each other, has the answer to this moment.

Jennie: Yeah. I think it is so important to be talking, making sure that we are connecting those dots and having those cross-cutting conversations because we get so focused on our siloed part of that conversation, whether that's abortion or some people are focused on birth control, or some people are focused on people with disabilities or the LGBTQ community, and we need to make sure that we are connecting the dots of how this is across all of these issues and has impacts on all of the communities.

Jess: Exactly. Exactly. Because by keeping that conversation siloed, by a shotgun approach of attacks from the conservative legal movement, the ability to separate and isolate these folks and us all from being in community is a political strategy. It's a political strategy and it's working. And the times in which it has not worked have been those moments where folks really did collectively come together around this. And so, you know, I do if to the extent that, that we can be looking for silver linings in this particular moment, I do see a galvanizing opportunity in just the parade of horribles that we have seen on under Trump 2.0 so far. And we know that it's emboldening psych fans in state legislatures. So, this is not just something that is a, oh, that's a DC fight, or that's not gonna hit me here in Colorado or California. Medi-Cal serves like 80% of Californians right now, and that's the state Medicaid program. And I think that's another thing that folks maybe don't understand is that, you know, they hear Medicaid and don't know that that's actually a program that they're using because states name it their own thing. So, they're like, no, you can cut Medicaid, but hands off Medi-Cal. Babe, that's the same thing.

Jennie: Yep. Or I'm even thinking back to the fights over the ACA of, like, "get rid of the ACA, but I want Medicaid," or...

Jess: Yes. Right. Like, or like, you know "repeal Obamacare,"

Jennie: Yeah.

Jess: "but, you know, hands off my insurance," like...sweetheart.

Jennie: Yeah.

Jess: But again, I mean, you know, same playbook, right? Like, we can look back and, like, roll our eyes and sigh and all of that stuff, but it is the same tactical playbook. And this is where I think the conservative legal movement deserves a bouquet of dried flowers because they have really waited, right. They have pursued this line of attack for the entirety of my career in this space. Since I have been a legal journalist, I have not, there has not been a moment where I have not talked about efforts to defund Planned Parenthood or to unwind Medicaid or, you know, some combination of both. And I have been doing this now, going on two full decades to give listeners a sense of how long folks like, you know, the Alliance or ADF and like, you know, all of those folks, the Becket Fund, all of them. Right? 20 years. 20 years. I mean, I remember when Texas made a whole new public health program. [laughs].

Jennie: Yes. I was just thinking of Texas. I was thinking of that with also Texas getting rid of their family planning funding.

Jess: Yeah.

Jennie: And then seeing like, oh, shit. Like-

Jess: Oops!

Jennie: Oops! I guess we do need to fund that.

Jess: Yeah. You know, so, you know, we can make some jokes about that and everything, but really like, you know, have, as folks are, are listening to this episode, really think about the various ways in which we are seeing conservatives target folks who are not in the 1%—not to like use that kind of corny class jargon, but truly this is about taking away from folks who are contributing, right? It's not like the folks who are Medicaid beneficiaries aren't contributing into the system that doles out Medicaid dollars. They absolutely are. Elon Musk just thinks he deserves that money more.

Jennie: Okay. So that's all kind of bleak, but as you said, not hopeless. We are not hopeless. So, what can the audience do right now? How can they get involved in some of these fights?

Jess: That's an excellent question. Everybody has a lane. And I think that that's really important to acknowledge out of the gates because we are in a moment that is not going to be solved in one electoral cycle. It is not, there's not one court case that's gonna be like, "whew, okay, back to normal folks," like that, that ship has sailed. So first and foremost, spend a little time, figure out what your lane is. Maybe that lane right now is calling your representatives and senators and calling the senators in other places to remind them that we are all connected and advocating like that. Maybe your lane is finding resources and donating to local direct support organizations that are helping folks right now get basic needs, whether that be their orgs that provide folks assistance in accessing abortion care, whether they're food banks and, you know, community shelters. I mean, one of the things that we are not talking enough about is the chaos on the local level for a lot of social services that this administration has unleashed. Places like, you know, domestic violence shelters, places that provide services to queer youth and queer young adults. Folks, you know, services for folks who have aged out of foster care and are trying to find their way. These are organizations and services that are upended that are in complete like upheaval right now with all of this chaos serving some of our most vulnerable populations. And they need help right now. So, that is absolutely one way and really build community where and how you can…we've talked about it a little bit, but this is an effort to keep folks isolated and siloed and overwhelmed. And a strategy against that is to be in community and, when possible, to do so joyfully. Art, music, literature—all of that is so important right now because fascists hate joy.

Jennie: I really love the like, find your lane as somebody who is like the people pleaser and feels like I need to do all the things. I always feel like I'm a failure when I'm not doing all the things. So I am a huge fan of, like, reminding people-

Jess: Yeah.

Jennie: -that you don't need to do all the things. It's okay if you can't show up for that protest, if you can't call your person because of 'cause of whatever. Like, you'll find your way that works for you in this moment.

Jess: Exactly. And it's not possible for one person to do all the things. And if we buy into that, we burn out, which is also a political strategy.

Jennie: Jess, thank you so much for being here. I'm so bummed I'm gonna miss you when you're in DC, but I know it will be a great show and I hope some of our DC audience can attend in my place.

Jess: Please do. And if you do show up, say hi. We really, like, I love actually meeting people in the wild. I know that I may not seem like it, but really Imani and I do. And it is just, you know we are gonna be out in DC for this case anyway, and when the opportunity with Liz came up and she said, you know, it's just really seems like folks could, could use some, you know some targeted good humor right now, we said, yeah, let's do it. So hopefully we'll see you there, folks. Can't wait.

Jennie: Thanks, Jess.

Jess: Thank you so much, Jennie.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Jess. Hearing about this case was really important. Like I said, it's been flying a bit under the radar, so I'm glad that we were able to talk about it and can focus on what that will mean for people. Okay. With that, I will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!