UPDATE: Hurting Medicaid recipients just to hurt Planned Parenthood

Free choice of provider is a heralded right of autonomy. Some states wants to take that away.

Dec 18, 2024

UPDATE:

On December 18, 2024, the Supreme Court of the United States agreed to hear South Carolina's appeal in Kerr v. Edwards, a case that will decide “whether the Medicaid Act’s any-qualified-provider provision” will continue to “confer[] a private right upon a Medicaid beneficiary to choose a specific provider.”1

Free choice of provider is a heralded right of autonomy. South Carolina wants to take that away.

The following was originally posted on March 8, 2024.

Do politicians get to choose your doctor for you?

“The freedom-of-choice provision was added to Medicaid through an amendment in 1967.”2 “When family planning services and supplies were added to Medicaid as a required benefit in 1972, the free-choice-of-provider statute automatically applied to this new set of benefits.”3 “The Medicaid freedom-of-choice provision is intended to protect the right of beneficiaries to select the participating provider of their choice, regardless of state efforts to steer patients toward certain providers or to deny them access to qualified providers that satisfy all reasonable program requirements. The history of Medicaid's amendments demonstrates that states' authority to exclude providers is limited to cases of incompetence, fraud or abuse, or the limited circumstances of managed care. Moreover, even where states can limit free choice of provider, as in managed care, states must ensure that patients remain free to choose their provider for family planning services and supplies. Freedom of access to qualified providers goes hand in hand with Medicaid's primary goal of increasing access to health care, not impairing it.”4 However, this hasn't stopped anti-abortion groups and legislators from attempting to control where financially insecure citizens can and cannot receive healthcare.

On March 5, 2024, a federal appeals court ruled that South Carolina cannot cut off Medicaid funding to Planned Parenthood, noting “that doing so would deprive Medicaid patients of their right to choose their provider.”5 “The order marks the third time that a three-judge panel of the 4th U.S. Circuit Court of Appeals has stopped the state from defunding the reproductive health organization on the grounds that it provides abortions.”6 Writing for the unanimous panel, Circuit Judge J. Harvie Wilkinson said that “federal Medicaid law clearly gave beneficiaries of the government insurance program the right to ‘freely choose among qualified healthcare providers, of which Planned Parenthood is one.’”7

South Carolina is just one of multiple states that have attempted to defund Planned Parenthood and prohibit citizens from receiving healthcare from their trusted provider of choice.

The Missouri legislature was undeterred by the ruling against South Carolina. Nor was Missouri deterred by a “ruling last month by the Missouri Supreme Court [that] halted Republicans from defunding Planned Parenthood through the budgeting process.”8 Instead, that ruling “provided the impetus to defund it through policy.”9 Now, the Republican-controlled Missouri House of Representatives has advanced legislation to prevent Planned Parenthood from receiving Medicaid reimbursements.10

Planned Parenthood is “one of the nation's leading providers of high-quality, affordable health care for women, men, and young people,”11 and provides “comprehensive, quality health care to” millions of people in the United States each year.12

While abortion is illegal in Missouri, the sponsor of the Missouri bill, Rep. Cody Smith (R-Carthage), claimed, “When you do business with an entity like a Planned Parenthood, you’re ultimately subsidizing those abortion services, even if they are in other states.”13

Michelle Trupiano, executive director with Missouri Family Health Council, Inc., “was among a number of people to testify” against the bill, noting a “medical provider shortage across Missouri.”14 “On average, Trupiano said, it takes between three and six weeks for new patients in Missouri to get a doctor across the health council’s 68 safety net clinics, several of which are Planned Parenthood. Without Planned Parenthood, she said the wait for essential services would become months-long.”15 Trupiano added, “If you put another hole in the safety net by eliminating Planned Parenthood, then that safety net is going to break and affect not just Planned Parenthood and how they keep their doors open to ensure care… It’s going to affect every other safety net provider.”16

Nevertheless, the bill’s sponsor, Republican Cody Smith from Carthage, says if organizations that lose state funding under the bill stop providing services, the market will fill the gap.17 Vanessa Wellbery, vice president of policy and advocacy for Planned Parenthood of the St. Louis Region and Southwest Missouri, said, “Any suggestion that patients could just go somewhere else or go to another provider is simply wrong… There are not enough sexual and reproductive health care providers to fill the gap. This bill is discriminatory, it’s irresponsible, and it would issue a devastating blow to our public health safety net here in Missouri.”18

Free choice of provider is a heralded right of autonomy. “The right to choose who provides your health care is protected under federal law and it is fundamental to patient autonomy and the principle of person-centered care.”19 “Exercising patient autonomy empowers patients to feel more in control and confident in their ability to make educated health decisions and choose the right doctors. Autonomy leads to positive health outcomes.”20 The right to bodily integrity “includes an individual’s access to high-quality, affordable healthcare.”21

Unfortunately, “to many people opposed to all abortion,” concerns regarding the ways in which defunding Planned Parenthood violate citizens’ autonomy, access to affordable healthcare, and right to choose their own provider “will fall on deaf ears.”22 Many are the partakers “of a counter-tradition that has no problem with limiting personal freedom in private life,” even if it harms the health of needy members in a community. “In fact,” this counter-tradition “holds that personal freedom in one's intimate life has to be constrained by wise government. Yet they'll still sincerely pledge allegiance to liberty.”23

Regardless, we need to call out these attacks for all that they are: Fundamentally, states’ attempts to prohibit Medicaid reimbursement to healthcare services provided by Planned Parenthood are attacks on citizens’ autonomy and right to access high-quality, affordable healthcare through the provider of their own choosing. These attacks are all about justifying controlling and harming vulnerable people's healthcare in order to harm Planned Parenthood— no matter the human cost.

rePro-Truth

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