The U.S. Supreme Court on Wednesday heard oral arguments for a lawsuit that will determine whether South Carolina and other states can deny Medicaid reimbursements to Planned Parenthood for non-abortive medical services.

All three justices appointed by Democrats appeared to empathize with Planned Parenthood in the case, but the six Republican-appointed justices were more nuanced with their questions for the lawyers representing both parties.

Federal Medicaid funds cannot be used to cover elective abortions, but federal law does not restrict abortion businesses, such as Planned Parenthood facilities, from receiving Medicaid funds for other services they offer.

However, in 2016, South Carolina Gov. Henry McMaster signed an executive order to block abortion facilities from receiving Medicaid reimbursements for any services, arguing that tax money should not support institutions that perform abortions. This spurred a lawsuit from Planned Parenthood and a patient named Julie Edwards who was receiving non-abortive services at a Planned Parenthood facility through Medicaid.

The bulk of the legal arguments focus on one line in federal law that regulates the way in which state governments must structure their Medicaid reimbursement policies.

Under the federal law, “any individual eligible for medical assistance … may obtain such assistance from any [doctor or health care provider] qualified to perform the service or services required.”

Interpretation of Federal Law

John Bursch, a lawyer with Alliance Defending Freedom representing South Carolina, and Nicole Saharsky, a lawyer representing Planned Parenthood, disputed the meaning of the federal law and whether patients can file lawsuits about the matter.

Bursch told the justices that states have the authority to set their own eligibility requirements and argued that the federal law does not establish an absolute “right” to receive services from any medical provider and patients should not be able to seek recourse through the courts.

“[There’s] a difference between a benefit and a right,” he said and alleged that to assert an absolute right, there would need to be “rights-creating language with … an unmistakable focus on the benefited class.”

Bursch argued that South Carolina has many other alternative health care providers that can provide the services covered by Medicaid and acknowledged that one of the primary reasons the state denied funding to Planned Parenthood was because “they’re the nation’s largest abortion provider.”

Saharsky disputed those claims, arguing that the federal law uses “individual-centric rights-creating language that imposes a mandatory obligation” on South Carolina and all other states.

She said the federal law ensures that a patient “may obtain [these services] from any qualified and willing provider,” which she said prevents health care providers from “being excluded from Medicaid arbitrarily.” She argued that this language has the same effect as it would if Congress had used the word “right” or the language that no person “shall be denied.”

Saharsky referred to South Carolina’s rules as imposing a “magic word test” by asserting that there is no established “right” based on the word choice used.

Justices Weigh the Arguments

Justices appointed by Democrats landed heavily on the side of Planned Parenthood during the oral arguments.

“What this language does is the same as the rights language does,” Justice Elena Kagan said.

While questioning Bursch, Kagan asserted: “It’s impossible to even say the thing without using the word ‘right,’” adding: “The right is the right to choose your doctor.”

Justice Sonia Sotomayor said Congress was motivated to pass the law because “states were limiting the choices people had.” She added: “It seems hard to understand that states didn’t understand that they had to give individuals the right to choose a provider.”

“You’re not quite calling it a ‘magic word,’ but you’re coming pretty close,” she added.

Alternatively, Republican-appointed justices assumed a more nuanced approach when addressing the lawyers.

Justice Brett Kavanaugh, for example, said he’s “not opposed to magic words” if it could provide clarity on “the words that are rights-creating.”

He added, “One of my goals coming out of this will be to provide that clarity.”