448 U.S. 297 (1980)
The Medicaid program was created in 1965 when Congress added Title XIX to the Social Security Act to provide federal financial assistance to states that choose to reimburse certain costs of medical treatment for needy persons.1 Participation in the program is voluntary, but once a state elects to participate, it must comply with federal requirements including coverage of five general categories of medical services for the categorically needy.2 From the program's inception, federal funding was available for medically necessary abortions.3
In September 1976, Congress enacted the first version of the Hyde Amendment as part of the annual appropriations bill for the Department of Health, Education, and Welfare.4 This prohibited the use of federal funds to pay for abortions except when the life of the mother would be endangered if the fetus were carried to term.5 Subsequent versions applicable to fiscal years 1977 through 1980 varied in scope.6 The 1980 version added exceptions for rape and incest reported promptly to law enforcement or a public health service.7 Earlier versions included or excluded an exception for severe and long-lasting physical health damage to the mother.8
On September 30, 1976, the day the initial Hyde Amendment was enacted, Cora McRae, a New York Medicaid recipient in the first trimester of a pregnancy she wished to terminate, the New York City Health and Hospitals Corporation, which operates hospitals providing abortion services, and other plaintiffs filed suit in the United States District Court for the Eastern District of New York against the Secretary of Health, Education, and Welfare seeking to enjoin enforcement of the funding restriction.9 The District Court certified the case as a class action on behalf of all pregnant or potentially pregnant women in New York eligible for Medicaid who decide to have an abortion within the first twenty-four weeks of pregnancy and all authorized providers of abortion services to such women.10 It entered a preliminary injunction.11
After this Court decided Beal v. Doe and Maher v. Roe, the District Court vacated the injunction and remanded for reconsideration.12 On remand, additional plaintiffs intervened, including four individual Medicaid recipients seeking medically necessary abortions, several physicians who perform abortions for Medicaid recipients, and the Women's Division of the Board of Global Ministries of the United Methodist Church along with two of its officers.13 An amended complaint challenged multiple versions of the Hyde Amendment on statutory and constitutional grounds.14
Following a lengthy trial that produced a record exceeding five thousand pages of transcript and more than four hundred exhibits, the District Court rejected the plaintiffs' statutory claim but held that the Hyde Amendment violated the equal protection component of the Fifth Amendment and the Free Exercise Clause of the First Amendment.15 The court recertified the case as a nationwide class action on behalf of all pregnant and potentially pregnant women eligible for Medicaid who wish to have medically necessary abortions and all authorized providers of such abortions.16 It then ordered the Secretary to cease giving effect to the Hyde Amendment and to continue authorizing federal matching funds for medically necessary abortions.17 The Secretary appealed directly to this Court, which noted probable jurisdiction.18
Whether Title XIX of the Social Security Act requires a participating state to fund medically necessary abortions for which federal reimbursement is unavailable under the Hyde Amendment?19
Title XIX establishes a cooperative federal-state program of shared financial responsibility for Medicaid services.20 Once Congress withdraws federal funding for a service through an appropriations restriction such as the Hyde Amendment, Title XIX does not obligate a participating state to assume the full cost of that service as a condition of continued federal support for other services.21
No. The established facts demonstrate that the Medicaid program is a cooperative endeavor in which the federal government provides financial assistance to participating states.22 The Hyde Amendment was enacted in September 1976 and subsequent versions through 1980 restricted federal reimbursement for abortions except in narrow circumstances.23 The District Court rejected the plaintiffs' statutory claim after trial and the legislative history shows Congress assumed states would not be required to fund the excluded abortions.24 Therefore Title XIX imposes no independent obligation on states to fund medically necessary abortions for which federal reimbursement is unavailable.25
Title XIX does not require a participating state to fund medically necessary abortions for which federal reimbursement is unavailable under the Hyde Amendment.26
Whether the Hyde Amendment violates the liberty protected by the Due Process Clause of the Fifth Amendment by restricting public funding for medically necessary abortions?27
The Due Process Clause protects a woman's freedom to choose an abortion as recognized in Roe v. Wade but that freedom does not carry an affirmative entitlement to public funds necessary to exercise the choice.28 The government may make a value judgment favoring childbirth over abortion and implement that judgment through the allocation of public funds without thereby impinging on the protected liberty.29
No. The established facts show that the Hyde Amendment restricts only the use of federal funds and places no governmental obstacle in the path of a woman who chooses to terminate her pregnancy.30 The District Court held the restrictions unconstitutional under the Fifth Amendment after a lengthy trial but the Supreme Court concluded that indigency is not a barrier created by the government.31 The Amendment leaves an indigent woman with the same range of choice she would have if no health care costs were subsidized at all.32 The funding decision is therefore a policy choice for Congress rather than a constitutional command.33
The Hyde Amendment does not violate the liberty protected by the Due Process Clause of the Fifth Amendment.34
Related opinions on this issue
Justice White joined the Court's opinion and wrote separately to emphasize that Maher v. Roe controls this case.35 He noted that Roe v. Wade recognized a right to choose an abortion without coercive governmental interference but did not create a right to have abortions funded by the government.36 The Hyde Amendment implements the government's legitimate interest in potential life by covering childbirth costs while denying funds for abortions and neither Roe nor its progeny invalidates this legislative preference.37
White rejected the dissent's attempt to distinguish Maher on the ground that it involved only nontherapeutic abortions observing that Maher's analysis did not turn on that distinction and that the interest balancing in Roe is not controlling here.38
Whether the Hyde Amendment violates the Establishment Clause of the First Amendment by incorporating religious doctrines concerning abortion?39
A statute does not violate the Establishment Clause merely because it coincides with the tenets of some religious groups.40 The Hyde Amendment satisfies the three-part test of having a secular legislative purpose, a principal effect that neither advances nor inhibits religion, and no excessive governmental entanglement with religion.41
No. The established facts indicate that the Hyde Amendment was passed for a variety of reasons only one of which was the belief of some that abortion is immoral.42 The District Court found no Establishment Clause violation after trial and the Supreme Court agreed that the Amendment reflects traditionalist values as much as any particular religious doctrine.43 Because the statute has a secular purpose and its principal effect is not to advance religion it does not contravene the Establishment Clause.44
The Hyde Amendment does not violate the Establishment Clause of the First Amendment.45
Whether the Hyde Amendment violates the Free Exercise Clause of the First Amendment?46
No. The established facts show that the named indigent pregnant women did not allege they sought abortions under compulsion of religious belief.50 The officers of the Women's Division failed to allege they were or expected to be pregnant or Medicaid eligible.51 The Women's Division itself could not assert the claim on behalf of its members because the free exercise issue requires individual participation to show the coercive effect of the Amendment on religious practice and the organization conceded diversity of views among its membership on the permissibility of abortion.52
The appellees lack standing to challenge the Hyde Amendment under the Free Exercise Clause of the First Amendment.53
Whether the Hyde Amendment violates the equal protection component of the Fifth Amendment by denying public funding for medically necessary abortions while funding other medically necessary services and childbirth?54
Poverty is not a suspect classification.55 When a statutory classification does not impinge on a constitutionally protected right it is valid if rationally related to a legitimate governmental objective.56 The government's interest in protecting potential life is legitimate and rationally advanced by funding childbirth while withholding funds for most abortions.57
No. The established facts demonstrate that the Hyde Amendment withholds federal reimbursement for certain medically necessary abortions while funding other medically necessary services and childbirth.58 The District Court held this selective subsidization violated equal protection after an extensive evidentiary hearing.59 The Supreme Court concluded that the classification is not predicated on a suspect class and that the Amendment is rationally related to the legitimate objective of protecting potential life by creating incentives for childbirth.60 The Court emphasized that Congress may allocate limited public funds according to its view of the best use of those funds.61
The Hyde Amendment does not violate the equal protection component of the Fifth Amendment.62
Related opinions on this issue
Joined by Justice Marshall And Justice Blackmun
Justice Brennan dissented joined by Justices Marshall and Blackmun.63 He argued that the Hyde Amendment cannot be reconciled with Roe v. Wade because the right to choose an abortion is meaningless if the government can deny the means to exercise that right to those who cannot afford to pay.64 By funding childbirth but not abortion the government coerces indigent women to carry pregnancies to term imposing an unconstitutional condition on the exercise of a fundamental right.65
Brennan viewed the Amendment as an attempt to circumvent Roe by achieving indirectly what the Constitution forbids directly and he emphasized that the discriminatory distribution of governmental benefits can burden fundamental liberties as effectively as outright prohibitions.66
Justice Marshall dissented arguing that the Hyde Amendment is an effort to deny poor women the constitutional right recognized in Roe v. Wade even though the cost is serious health damage or death.67 He contended that the Court's two-tiered equal protection approach is inadequate and that the Amendment cannot survive even rational-basis review because the governmental interest in potential life is insufficient to outweigh the brutal effect on indigent women.68 Marshall highlighted that denial of funding for medically necessary abortions is equivalent to denial of legal abortion altogether for poor women and will lead to increased deaths and health damage from illegal procedures.69
Justice Blackmun joined Justice Brennan's dissent and added that the Court's holding reflects condescension and is disingenuous and alarming.70 He reiterated his view from the Beal and Maher dissents that the government punitively impresses upon a needy minority its own concepts of the socially desirable, the publicly acceptable, and the morally sound.71 Blackmun warned that the cancer of poverty will continue to grow and that the lot of the poorest among us, once again and still, is not to be bettered by the decision.72
He emphasized the disingenuous nature of suggesting that indigent women may go elsewhere for their abortions when the practical effect is to deny them access to necessary medical care.
Justice Stevens dissented contending that the federal sovereign must govern impartially and that the Hyde Amendments constitute an unjustifiable violation of that duty.73 He argued that when the government provides necessary medical care to the needy it must use neutral criteria and cannot deny benefits to a financially and medically needy person solely because the treatment involves an abortion.74 Stevens emphasized that Roe v. Wade held the state's interest in potential life subordinate to the interest in preserving the mother's health and the Amendments inflict serious harm on excluded women by forcing them to choose between health damage and forgoing a medically necessary procedure.75