The Case of the Vanishing Right: When the Supreme Court Redefined Choice by Erasing It

In 2025, the Supreme Court found itself untangling a puzzle that barely made headlines until the moment it reshaped the country’s healthcare landscape. The case, Medina v. Planned Parenthood South Atlantic, began with what looked like an unremarkable question: does a Medicaid patient have the right to choose their own qualified healthcare provider? It was the kind of question that usually gets answered quietly in lower courts. And yet, once it reached the justices, it revealed something far more consequential—a growing divide between rights as they appear in federal law and rights as individuals can actually enforce.

Medicaid had always been described in lofty terms, a promise of access for tens of millions of low-income Americans. One of its most cherished ideas was “free choice of provider,” the notion that patients could visit any clinic or doctor meeting basic medical qualifications. But when states like South Carolina began excluding Planned Parenthood from their Medicaid networks for political reasons, patients discovered the uncomfortable truth that a promise is not the same as a power. The plaintiffs argued that the law protected their ability to seek care from providers the state itself admitted were qualified. What they wanted was simple: the chance to challenge the state’s exclusion in court.

When the justices confronted that request, they looked not at health outcomes or patient needs, but at the architecture of the Medicaid Act. Instead of seeing a patient-centered guarantee, the Court described the law as a funding arrangement between the federal government and the states. In that framework, the people receiving the services were not the enforcers of the agreement but merely the beneficiaries of it. And if the statute didn’t clearly give them the right to sue, then such a right, in the Court’s view, did not exist at all.

The effect was immediate but strangely quiet. Suddenly, states had far more leeway to remove providers for reasons having nothing to do with medical competence. Patients lost one of the few tools they had to fight back. And a principle that once seemed foundational—that guaranteed programs come with guaranteed protections—melted away with the Court’s reasoning. The decision didn’t strike down a right; it simply revealed that the supposed right had never been enforceable to begin with.

Observers noted that Medina was less a dispute about reproductive health than a milestone in a larger trend. Federal benefits programs, once thought to offer personal safeguards, were increasingly interpreted as contracts between governments, not shields for individuals. Rights were no longer assumed—they had to be written with perfect clarity or they were treated as aspirations rather than guarantees.

When the decision was handed down, it didn’t create protests or sweeping headlines. It created something subtler: a quiet recognition that the ground beneath some of America’s most important social programs was shifting. In a system built on the idea of choice, the Court had redefined choice itself—as something states could grant, states could withdraw, and patients could no longer defend in court. The right didn’t disappear with a bang. It vanished the moment the Court declared it unenforceable.