Planned Parenthood of Indiana, Inc. v. Commissioner of Indiana State Department of Health
699 F.3d 962
7th Cir.2012Background
- Indiana enacted Act 1210 prohibiting state contracts and grants to abortion providers and excluding such providers from Medicaid and other state funds.
- CMS declined to approve Indiana's plan amendment excluding abortion providers, citing the Medicaid free-choice-of-provider requirement and that funding cannot be conditioned on provider qualifications unrelated to medical fitness.
- Planned Parenthood and others sued, arguing Act 1210 violates §1396a(a)(23), §247c(c), and unconstitutional-conditions, seeking a preliminary injunction.
- The district court granted partial relief, enforcing the Medicaid claim and addressing the §247c(c) claim; it did not resolve the unconstitutional-conditions claim at that time.
- The Seventh Circuit affirmed in part, reversed in part, and remanded to modify the injunction relating to §247c(c) funding; it found private rights exist under §1396a(a)(23) but did not fully endorse the preemption theory.
- Concurrence in part noted that the unconstitutional-conditions issue should be given more record development before dispositive action.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does §1396a(a)(23) create private rights enforceable under §1983? | Planned Parenthood argues the provision creates individual rights enforceable via §1983. | Indiana contends no private right exists because the provision is a spending condition, not an individual entitlement. | Yes; §1396a(a)(23) creates enforceable private rights under §1983. |
| Does Act 1210 violate §1396a(a)(23) by excluding abortion providers from Medicaid? | Planned Parenthood asserts exclusion for non-fitness-based reasons violates the free-choice-of-provider right. | Indiana argues it may exclude providers for policy objectives like preventing indirect subsidization of abortion. | Likely violation; exclusion for non-fitness reasons infringes the right. |
| Does §247c(c) preempt Act 1210 or otherwise bar private relief? | Planned Parenthood claims §247c(c) preempts the Indiana law; the Supremacy Clause may provide a preemption remedy. | Indiana contends there is no express private right under §247c(c), and the district court erred in relying on Supremacy Clause preemption. | Preemption claim cannot succeed on the merits; §247c(c) imposes no conditions and does not preempt. |
| Does the unconstitutional-conditions doctrine support or defeat relief for Planned Parenthood regarding §247c funding? | PP argues the defunding acts condition funding on abortion-related activities, thereby coercing reproductive rights. | Indiana contends denial of funding does not coerce a woman's right to an abortion and is not an unconstitutional condition. | Unconstitutional-conditions claim not likely to succeed; funding denial does not directly or indirectly burden abortion rights. |
Key Cases Cited
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (test for whether statute creates private rights under §1983)
- Wilder v. Va. Hosp. Ass'n, 496 U.S. 498 (1990) (administrative enforcement does not foreclose private §1983 remedies for certain Medicaid rights)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (§1396a(a)(23) creates rights enforceable under §1983; open-question on provider qualifications)
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (1980) (Medicaid recipients' rights to choose qualified providers; no right to continued nonqualified services)
- Kelly Kare, Ltd. v. O’Rourke, 930 F.2d 170 (2d Cir. 1991) (defendant’s challenge to provider qualifications and due process in Medicaid context)
- Bontrager v. Ind. Fam. & Soc. Servs. Admin., 697 F.3d 604 (7th Cir. 2012) (enforces §1396a(a)(10) rights in Medicaid context)