According to Nicole Huberfeld, JD, professor of law, ethics, and human rights at the Boston University School of Law, the 5th U.S. Circuit Court of Appeals’ ruling allows Texas and Louisiana to terminate Planned Parenthood’s status as a Medicaid provider and to stop paying Planned Parenthood for Medicaid beneficiaries.
Planned Parenthood is still able to provide services through the Medicaid program in Texas until December 15 based on the 5th Circuit’s ruling. For Louisiana, Planned Parenthood is able to provide services for Medicaid patients; however, there will be additional proceedings that may change coverage.
“It’s unconscionable that Governor Greg Abbott and his political allies have continued their attempts to block Medicaid patients from seeking care at Planned Parenthood during a pandemic," Bhavik Kumar, MD, MPH, medical director for primary and trans care at Planned Parenthood Gulf Coast in Houston, Texas, tells Verywell. “Healthcare access in Texas is already hanging by a thread for too many people.”
Medicaid is the largest single health insurance program in the U.S., covering 74.2 million people. The health insurance program has served as a gateway for family planning, pregnancy-related care, STI testing and treatment, and other reproductive health care.
“Texas decided to exclude Planned Parenthood from being a Medicaid provider," Huberfeld tells Verywell. “Planned Parenthood treats about 12[,000] or 13,000 women a year.”
How This Ruling Exacerbates Healthcare Barriers
The ruling will disproportionately impact women and people of color. Data from the Kaiser Family Foundation shows that the majority of Medicaid beneficiaries were Black, Hispanic, and Native American people, with Asian people closely behind.
“This ruling means that communities already facing systemic discrimination, greater barriers to care, and disparately worse health outcomes will now also lose their freedom to choose the healthcare provider that best serves their needs—all in the middle of an unprecedented public health crisis,” Kumar says.
“We see a disproportionate number of women of color within the Medicaid program," Rachel Fey, senior director of public policy at Power to Decide—a campaign to prevent teen pregnancy and unplanned pregnancy, tells Verywell. “According to the 5th Circuit, women who have Medicaid can’t get high-quality family planning care at Planned Parenthood. We already live in a world where not everyone has insurance. Now, we’re talking about women who are under a certain income and depend on this publicly funded health insurance.”
According to Fey, low-income women already face many barriers to accessing reproductive health care and family planning services. “When you don’t live in those circumstances, it’s hard to imagine the number of hurdles women who are struggling to make ends meet have to jump through in order to get basic reproductive health care,” she says. “Whether it’s their transportation, the cost of insurance, the latest ruling from the 5th Circuit, the barriers pile.”
For low-income women, “that might mean making multiple trips to the clinic, arranging for childcare, and paying for gas,” Fey says.
Services Planned Parenthood Provides
It is important to note that Planned Parenthood provides crucial and life-saving services that extend beyond abortion.
According to Kumar, “when politicians initially took action against Planned Parenthood, our health centers served thousands of patients in Texas who depend on Medicaid for essential health care” including:
Birth controlSTI testing and treatmentBreast and cervical cancer screeningsAnnual examsTrans servicesOther primary care services
Planned Parenthood also provides access to birth control options and thousands of people could lose that access. “Birth control access is deeply inequitable,” Fey says. “And it’s inadequate in this country. Now, we’re making it even harder for people who are struggling to make ends meet to get that birth control access.”
Currently, over 19 million women live in contraceptive deserts, which are areas that lack access to health centers that offer a full range of contraceptive methods, according to Power to Decide. The ruling would essentially take away access to preventative reproductive health care and services.
This isn’t the federal court’s first move towards dismantling Medicaid. “Federal courts have been closing the courthouse doors to Medicaid beneficiaries for years,” Huberfeld says. Historically, federal courts have shaped Medicaid policy by interpreting Medicaid’s meaning and enforcing the program, like what’s happening with Texas and Louisiana.
For now, Planned Parenthood is still able to provide affordable services to these patients through the Medicaid program, but they will quickly have to adapt, according to Kumar. “We are quickly careening toward a cliff where patients will lose that access, forcing them to navigate yet another barrier to affordable health care—a task that has become increasingly insurmountable for Black and Latinx communities due to a myriad of policies designed to stack the deck against people of color,” Kumar says.
Will The Case Move Forward To The Supreme Court?
According to Huberfeld, it is hard to tell whether the case will advance to the Supreme Court. “The court doesn’t like to take Medicaid cases and reproductive health cases with any frequency," Huberfeld says. “So, I think that makes it harder to predict whether or not the court would take this particular case.”
More specifically, the 5th Circuit has gained a reputation for leaning more conservative, according to Huberfeld. “And so, the 5th Circuit sometimes seems to be willing to push the boundaries of precedent in order to force the Supreme Court to rethink issues," she says.
Huberfeld states that the Supreme Court prefers to wait and see how cases will play out. “It’s possible that Planned Parenthood will be successful on merits," she says. “So there would be procedural reasons to wait and see.”
What Happens Next?
Because Medicaid reimbursement is a big feature of Planned Parenthood, access will be disrupted for low-income women and men. Huberfeld suggests that individuals who believe that Planned Parenthood does good work should consider donating as it would provide cost-free services to low-income people.
At the community level, providers can also support Medicaid beneficiaries impacted by this ruling by recommending other sources for care. “Where Planned Parenthood is no longer being reimbursed by Medicaid, healthcare providers can help women to find alternative sources of care,” Huberfeld says.
You can also communicate the issues that are important to you with members of Congress and policymakers. “Making your voice heard and ensuring that Medicaid beneficiaries can go to any qualified provider, including Planned Parenthood, it’s critically important for everyone to hear,” Fey says.
The bottom line: Access to Planned Parenthood is on the line for Texans and Louisianans on Medicaid. “It’s important for people to remember that politicians have been playing political games with the health care infrastructure for years, with Texas leading the charge in the cruelest ways,” Kumar says. “Planned Parenthood will continue fighting these inhuman efforts in every way possible because the patients we serve deserve nothing less.”
