Fourteenth Amendment, Section 1:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

In three related 1977 decisions, the Court ruled on whether Title XIX of the Social Security Act, which establishes the Medicaid program, or the Constitution requires the government to pay for nontherapeutic or elective abortions sought by indigent women. In Beal v. Doe, the Court held that nothing in the language or legislative history of the Medicaid statute requires a participating state to fund every medical procedure falling within delineated categories of medical care.1 The Court determined that it was not inconsistent with the statute’s goals to refuse to fund unnecessary medical services.2 Nevertheless, the Court also indicated that the statute permits a state to include coverage for nontherapeutic abortions “if it so desires.” 3

In Maher v. Roe, the Court concluded that the Equal Protection Clause does not require a state participating in the Medicaid program to pay expenses incident to nontherapeutic abortions simply because the state has made a policy choice to pay expenses incident to childbirth.4 The Court determined that Connecticut’s policy of favoring childbirth over abortion did not impinge on the right to abortion recognized in Roe.5 Distinguishing the policy from the Texas law at issue in Roe and other abortion restrictions it previously invalidated, the Court explained that the policy “places no obstacles—absolute or otherwise—in the pregnant woman’s path to an abortion.” 6

Finally, in Poelker v. Doe, the Court upheld a St. Louis, Missouri regulation that denied indigent pregnant women nontherapeutic abortions at city-owned public hospitals.7 Citing Maher, the Court explained that the constitutional question presented in Poelker was “identical in principle,” and that the city’s decision to provide publicly financed hospital services for childbirth, but not nontherapeutic abortions, was permissible.8 Poelker addressed only the performance of abortions at public hospitals and did not consider the authority of private hospitals to prohibit abortion services.

The Court’s decisions in Beal, Maher, and Poelker left unresolved the question whether the government could prohibit the use of federal or state funds for therapeutic or medically necessary abortions. In 1980, the Court upheld the Hyde Amendment, an annual appropriations provision that restricts the use of federal funds to pay for abortions provided through the Medicaid program.9 The Court found that the Hyde Amendment did not violate the Due Process, the Equal Protection guarantees of the Fifth Amendment, or the Establishment Clause of the First Amendment.10 The Court also recognized the right of a state participating in the Medicaid program to fund only those medically necessary abortions for which it received federal reimbursement.11 In a companion case raising similar issues, the Court held that an Illinois statutory funding restriction comparable to the Hyde Amendment also did not violate the Equal Protection Clause.12 As a result of the Court’s decisions, neither the states nor the federal government have a statutory or constitutional obligation to fund all medically necessary abortions.

Footnotes

1

432 U.S. 438 (1977).

2

Id. at 444–45.

3

Id. at 447.

4

432 U.S. 464 (1977).

5

Id. at 474.

6

Id.

7

432 U.S. 519 (1977) (per curiam).

8

Id. at 521.

9

Harris v. McRae, 448 U.S. 297 (1980). For further discussion on the Hyde Amendment, see Amdt5.7.6 Abortion and Substantive Due Process.

10

Harris, 448 U.S. at 326.

11

Id. at 310.

12

See Williams v. Zbaraz, 448 U.S. 358 (1980).