The Supreme Court’s Republican-appointed majority rejected a lawsuit from Planned Parenthood and one of its patients on Thursday, over dissent from the court’s Democratic appointees who said the ruling portends “tangible harm to real people.”

The dispute stems from the GOP’s opposition to abortion. But the case implicates unrelated care for Medicaid recipients, like cancer screenings, blood work and annual physicals, at a time when Republicans are pushing for Medicaid cuts.

In 2018, South Carolina’s Republican governor, Henry McMaster, sought to bar abortion clinics from Medicaid participation, and the state told Planned Parenthood that it could no longer service Medicaid beneficiaries. That raised legal questions under part of the Medicaid Act known as the “free choice of provider” provision, which tells states to let anyone eligible for assistance obtain care from any qualified provider.

The Medicaid beneficiary in the case, Julie Edwards, received contraceptive care through Planned Parenthood and wanted to move all of her gynecological and reproductive health care there. But she said she wouldn’t be able to do that unless the services were covered by Medicaid.

A federal appeals court panel backed her suit, reasoning that the choice-of-provider provision “specifies an entitlement given to each Medicaid beneficiary: to choose one’s preferred qualified provider without state interference.” In the decision, written by Reagan appointee J. Harvie Wilkinson III, the appeals court said the provision couldn’t be clearer about conferring rights.

But the Supreme Court disagreed in an opinion from Trump appointee Neil Gorsuch, joined by the other five Republican appointees. Reversing the appeals court, the majority said the legal provision at issue doesn’t “clearly and unambiguously” give individuals enforceable rights. The state was represented by the conservative Christian legal group Alliance Defending Freedom. The Trump administration backed the state, too.

Joined by Justices Sonia Sotomayor and Elena Kagan, Justice Ketanji Brown Jackson wrote in dissent that the majority “thwarts Congress’s will twice over: once, in dulling the tool Congress created for enforcing all federal rights, and again in vitiating one of those rights altogether.” She described the ruling as the latest in a line of cases that weaken “landmark civil rights protections.” She said it’s “likely to result in tangible harm to real people.”

Ahead of the ruling, Medicaid beneficiaries told the justices that they rely on Planned Parenthood for nonabortion services “including annual physicals, blood work, screenings for various forms of cancer, infertility and prenatal services — indeed, some patients rely on Planned Parenthood for virtually all their health care needs.”

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