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An Originalist Perspective on Medina v. Planned Parenthood South Atlantic

An Originalist Perspective on Medina v. Planned Parenthood South Atlantic: State Sovereignty Triumphs in Medicaid Funding Dispute

On June 26, 2025, the U.S. Supreme Court delivered a 6-3 decision in Medina v. Planned Parenthood South Atlantic, upholding South Carolina’s authority to exclude Planned Parenthood from its Medicaid program without facing private lawsuits under 42 U.S.C. §1983. From an originalist perspective, the ruling reflects a faithful adherence to the original public meaning of §1983 (enacted in 1871) and the Spending Clause (Article I, Section 8, Clause 1 of the Constitution), reinforcing state sovereignty, judicial restraint, and legislative authority. This column explores the case’s background, the Court’s opinion, and its likely effects, grounded in originalist principles that prioritize the text and historical context of the law as understood at the time of its enactment.

Case Background

The Medina case originated from South Carolina Governor Henry McMaster’s 2018 executive order, which disqualified Planned Parenthood South Atlantic (PPSAT) from participating in the state’s Medicaid program due to its provision of abortion services, even though Medicaid funds only cover non-abortion care such as cancer screenings, STI testing, and contraception. Planned Parenthood and patient Julie Edwards sued under §1983, arguing that this exclusion violated the Medicaid Act’s free-choice-of-provider provision (§1396a(a)(23)(A)), which mandates that state Medicaid plans allow beneficiaries to choose any qualified provider. The district court and the Fourth Circuit sided with the plaintiffs, but South Carolina appealed, supported by 18 states and the Trump administration, which argued that the provision does not confer an enforceable individual right. The Supreme Court reversed, holding that §1983 does not permit private lawsuits to enforce the Medicaid provision, thereby allowing South Carolina to exclude Planned Parenthood.

The Majority Opinion: A Strict Originalist Approach

Writing for the majority, Justice Neil Gorsuch, joined by the Court’s conservative justices, grounded the decision in the original public meaning of §1983 and the Spending Clause. Section 1983, enacted in 1871 as part of the Civil Rights Act, was intended to provide a remedy for clear deprivations of constitutional or statutory “rights, privileges, or immunities,” primarily targeting Reconstruction-era violations such as racial discrimination. The majority applied the stringent test from Gonzaga University v. Doe (2002) and Health and Hospital Corporation of Marion County v. Talevski (2023), requiring statutes to “clearly and unambiguously” use “rights-creating” language with an “unmistakable focus” on individuals to be enforceable under §1983. The Medicaid provision, which states that state plans must “provide that … any individual eligible for medical assistance … may obtain such assistance” from any qualified provider, lacks the explicit, individual-centric language required, unlike the Federal Nursing Home Reform Act’s clear “residents’ rights” provisions in Talevski.

From an originalist lens, the majority’s reasoning aligns with the 1871 understanding of §1983, which was not intended to encompass programmatic benefits under Spending Clause statutes like Medicaid (enacted in 1965). The Court emphasized that Medicaid operates as a contractual agreement between the federal government and states, reflecting the 1787 constitutional understanding of the Spending Clause as a mechanism for allocating funds with conditions, not creating enforceable third-party rights absent explicit congressional intent. Gorsuch argued that private lawsuits under §1983 would divert state resources from public services to litigation, disrupting the state-federal balance-a concern rooted in the original constitutional framework of federalism and separation of powers. The “typical remedy” for noncompliance, such as federal funding termination, respects this contractual structure, and the majority noted that Congress could revise the Medicaid Act to include explicit enforcement mechanisms if it so chooses.

Justice Thomas’s concurrence further reinforced the originalist perspective, arguing that §1983’s original scope was narrower, targeting clear constitutional violations rather than modern “entitlements” like Medicaid benefits. Citing early cases like McAuliffe v. Mayor (1892), Thomas critiqued the post-1960s expansion of “rights” under cases like Goldberg v. Kelly (1970), urging a return to the statute’s 1871 boundaries. This strict textual and historical approach underscores the majority’s commitment to limiting judicial overreach, ensuring that states have clear notice of enforceable obligations as the 1871 Congress intended.

The dissent, led by Justice Ketanji Brown Jackson and joined by Justices Sotomayor and Kagan, took a broader view, arguing that the Medicaid provision’s mandatory language (“must”) and individual focus (“any individual eligible”) create an enforceable right, citing §1983’s “grand ambition” to protect federal rights and the provision’s 1967 enactment to counter state steering of Medicaid recipients. From an originalist perspective, the dissent’s reliance on modern precedents and statutory purpose diverges from the 1871 meaning of §1983, which required explicit rights-creating language, not inferred benefits. The majority’s textual fidelity prevails, as the dissent’s interpretation risks expanding §1983 beyond its historical scope.

Likely Effects: Reinforcing Federalism and Legislative Authority

The Medina decision has significant implications, viewed through an originalist lens, for state autonomy, Planned Parenthood’s funding, and the broader policy landscape:

  1. Strengthened State Sovereignty: The ruling empowers states to define “qualified” providers within their Medicaid programs, aligning with the Tenth Amendment’s reservation of powers to the states. Web sources, including NPR, Axios, and CBS News, note that 18 states supported South Carolina, and states like Texas, Arkansas, and Missouri may follow suit, leveraging their discretion under the Spending Clause’s contractual framework. From an originalist perspective, this respects the 1787 constitutional balance, where states retain authority absent clear federal mandates. The Federalist, PJ Media, Townhall, RedState, and Hot Air articles celebrate this as a “significant victory for federalism,” citing X posts from figures like Kristi Burton Brown (@KBBColorado) and Susan B. Anthony Pro-Life America (@SBALIST) praising “states’ rights to prioritize life-affirming healthcare.”
  2. Impact on Planned Parenthood: The decision could threaten Planned Parenthood’s financial stability, as Medicaid funds 34% of its revenue for 2.4 million patients annually, per KFF. CBS News, AP News, Axios, and NPR estimate that up to 200 clinics could close, particularly in red states, limiting access to non-abortion services like cancer screenings and STI testing. The Federalist, PJ Media, Townhall, and RedState (O’Connell) frame this as a conservative victory, with RedState declaring Planned Parenthood’s funding “in the coffin.” However, an originalist would caution that Medina is procedural, limiting §1983 lawsuits, not banning funding outright. The Medicaid Act still requires states to allow provider choice, and alternative remedies like administrative appeals or federal funding cutoffs (unlikely per Armstrong v. Exceptional Child Center (2015)) remain. The ruling’s immediate impact may be overstated, as policy shifts depend on state or federal legislative action.
  3. Legislative Momentum and the “Big Beautiful Bill”: The ruling dovetails with the Republican-led “Big Beautiful Bill,” a budget proposal discussed in AP News, CBS News, Axios, NPR, RedState (O’Connell), Townhall, PJ Media, and the Federalist, which seeks to federally defund Planned Parenthood and impose Medicaid work requirements. The AP News article notes the bill’s passage in the House by a single vote on May 22, 2025, with CBO estimates of 8.6 million losing coverage over a decade. From an originalist perspective, this legislative effort aligns with the 1787 Spending Clause, where Congress can impose funding conditions, and Medina’s deference to “elected representatives” for policy trade-offs. The bill’s Senate hurdles, noted in AP News, highlight that legislative action, not judicial rulings, is the proper mechanism for defunding, reinforcing the separation of powers.
  4. Broader Policy Implications: The ruling could extend beyond Planned Parenthood, potentially allowing states to exclude providers offering controversial services like gender-affirming care, as suggested by Axios. CBS News, AP News, Axios, and NPR emphasize the ruling’s harm to low-income patients in underserved areas (e.g., 39% of South Carolina counties lack OB-GYNs, per NPR; 48% of Black women have used Planned Parenthood, per Slate), aligning with the dissent and sources like The Guardian and Mother Jones. An originalist would view these policy impacts as secondary to the legal question, as the 1871 Congress did not intend §1983 to enforce modern benefits, and the 1787 Constitution vests policy decisions in legislatures. The dissent’s focus on patient harm, echoed in progressive X posts like @FFRF and @RepSaraJacobs, reflects valid concerns but strays from the original meaning of the statutes.
  5. Judicial Restraint and Future Precedent: Medina reinforces a narrow interpretation of §1983, correcting prior expansions under cases like Wilder v. Virginia Hospital Assn. (1990) and aligning with the originalist aversion to judicially created rights. The ruling’s emphasis on textual clarity and state-federal balance may influence future cases involving Spending Clause programs, ensuring courts defer to Congress for explicit rights creation. Conservative X posts, like @SBALIST and @AlishaNasse, celebrate this as a “huge win for states’ rights,” while progressive posts criticize it as a “shameful attack” on healthcare access, reflecting polarized sentiment but not altering the originalist focus on statutory text.

Conclusion

From an originalist perspective, the Medina decision is a model of textual fidelity and constitutional restraint. The majority’s holding-that the Medicaid Act’s free-choice-of-provider provision lacks the explicit rights-creating language required for §1983 enforcement-honors the 1871 meaning of §1983, limiting it to clear constitutional or statutory violations. The ruling’s deference to the Spending Clause’s contractual nature, as understood in 1787, reinforces state autonomy and the legislative prerogative to shape policy, as seen in the “Big Beautiful Bill.” While the ruling empowers red states to exclude Planned Parenthood, potentially impacting its 34% Medicaid-funded revenue and leading to clinic closures, its procedural scope suggests that claims of immediate defunding, as in RedState (O’Connell) and PJ Media, are overstated. Patient harm concerns, raised in CBS News, AP News, Axios, and NPR, are significant but belong to Congress, not courts, under the originalist framework. Medina thus reaffirms the constitutional balance of federalism, separation of powers, and textual fidelity, ensuring that policy battles over Planned Parenthood’s funding play out in legislatures, as the Framers intended.

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James K. Bishop

James K. Bishop is a conservative writer and raconteur hailing from Texas, known for his incisive and often provocative takes on political and cultural issues. With a staunch commitment to originalist constitutional principles, he emphasizes limited government, individual liberties, and traditional American values. Active on X under the handle @James_K_Bishop, he frequently engages his audience with sharp critiques of progressive policies, media narratives, and overreaches by the federal government. His style is direct, often laced with humor and wit, which resonates strongly with his conservative followers.