Harris v. McRae

Supreme Court of United States
448 U.S. 297 (1980)

ELI5:

Rule of Law:

The government is not constitutionally required to fund medically necessary abortions for indigent women, even if it funds other medically necessary procedures, including those related to childbirth. A legislative decision to withhold public funding for a constitutionally protected activity does not impinge upon the protected right itself.

Facts:

In 1965, Congress established the Medicaid program under Title XIX of the Social Security Act, providing federal funds to states to reimburse medical treatment costs for needy persons.
Participating states are required to fund several mandatory categories of health services to receive federal financial assistance.
Beginning in 1976, Congress enacted the Hyde Amendment, a legislative provision prohibiting the use of federal funds to reimburse the cost of abortions under Medicaid.
The specific exceptions to the funding prohibition varied by year, but generally limited funding to cases where the mother's life was endangered, or in later versions, to pregnancies resulting from promptly reported rape or incest.
Cora McRae was a New York Medicaid recipient in her first trimester of pregnancy who wished to obtain a medically necessary abortion that was not covered under the Hyde Amendment's exceptions.
The New York City Health and Hospitals Corp., which operated numerous public hospitals, provided abortion services and was affected by the funding restriction.
The Women's Division of the United Methodist Church joined the suit, alleging that the funding restriction interfered with the decisions of its Medicaid-eligible members who, as a matter of religious belief, would choose a medically necessary abortion.

Procedural Posture:

Cora McRae and other plaintiffs filed suit against the Secretary of Health, Education, and Welfare in the U.S. District Court for the Eastern District of New York, seeking to enjoin the Hyde Amendment.
The district court (a court of first instance) granted a preliminary injunction, prohibiting the Secretary from enforcing the amendment.
The Secretary appealed to the U.S. Supreme Court, which vacated the injunction and remanded the case for reconsideration in light of its recent decisions in Maher v. Roe and Beal v. Doe.
On remand, the district court conducted a full trial and entered a final judgment, holding that the Hyde Amendment was unconstitutional on Fifth Amendment due process/equal protection and First Amendment free exercise grounds.
The district court recertified the case as a nationwide class action and permanently enjoined the Secretary from enforcing the amendment.
The Secretary (appellant) then filed a direct appeal to the U.S. Supreme Court to review the district court's final judgment.

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Issue:

Does the Hyde Amendment, by prohibiting federal Medicaid funding for certain medically necessary abortions, violate the Due Process Clause, the equal protection component of the Fifth Amendment, or the Religion Clauses of the First Amendment?

Opinions:

Majority - Stewart, J.

No, the Hyde Amendment does not violate the Fifth Amendment or the First Amendment's Establishment Clause, and the appellees lack standing to bring a Free Exercise Clause challenge. The constitutional right to an abortion established in Roe v. Wade protects a woman from unduly burdensome government interference with her choice, but it does not create a constitutional entitlement to the financial resources necessary to exercise that choice. The government's refusal to fund an activity does not constitute an unconstitutional obstacle to it; the indigency that prevents a woman from obtaining an abortion is a product of her poverty, not a government-created barrier. Under equal protection analysis, poverty is not a suspect classification, so the law is subject only to rational basis review. The Hyde Amendment is rationally related to the legitimate government interest in protecting potential life by encouraging childbirth over abortion through the allocation of public funds. Finally, the law does not violate the Establishment Clause merely because it coincides with the tenets of a particular religion, and the plaintiffs lack standing for a free exercise claim because they failed to show the law operated against them as a coercive effect on their personal religious practice.

Concurring - White, J.

No, the Hyde Amendment is constitutional. The right recognized in Roe v. Wade is a right to be free from coercive government interference with a private choice, not a right to have abortions funded by the government. The government is not attempting to impose a coercive restraint on a woman's choice. Therefore, in disbursing Medicaid funds, it is free to rationally implement its legitimate interest in protecting potential life by covering the costs of childbirth while denying funds for abortions.

Dissenting - Brennan, J.

Yes, the Hyde Amendment is unconstitutional. The amendment is an attempt by Congress to circumvent Roe v. Wade by using coercive financial incentives to pressure indigent women into forgoing abortions. For a poor woman, the government's funding of all childbirth expenses but none for abortion is not a neutral choice; it is a coercive offer that she cannot afford to refuse. This selective distribution of government benefits effectively discourages the exercise of a fundamental right just as effectively as a direct prohibition would, thereby impinging on the due process liberty recognized in Roe v. Wade.

Dissenting - Marshall, J.

Yes, the Hyde Amendment is unconstitutional. For indigent women, the denial of Medicaid funding is equivalent to a denial of a legal abortion altogether, forcing them to resort to dangerous alternatives or suffer serious health consequences. This law is a form of discrimination against the most powerless members of society that is repugnant to the guarantee of equal protection. The government's asserted interest in protecting fetal life was explicitly held in Roe v. Wade to be subordinate to a woman's interest in preserving her health, a principle this law unconstitutionally ignores.

Dissenting - Blackmun, J.

Yes, the Hyde Amendment is unconstitutional. The Court's holding is disingenuous and alarming, as it punitively imposes the government's moral concepts upon a needy minority. The majority's condescending view that an indigent woman 'may go elsewhere for her abortion' ignores the reality of poverty and the serious consequences of this decision for the poorest members of society.

Dissenting - Stevens, J.

Yes, the Hyde Amendment is unconstitutional. This case is fundamentally different from Maher v. Roe because it involves medically necessary abortions, not elective ones. The plaintiffs here satisfy the neutral statutory criteria for Medicaid—financial and medical need—but are excluded solely because their necessary treatment is an abortion. Roe v. Wade explicitly held that the state's interest in potential life cannot justify jeopardizing the mother's health. The Hyde Amendment unconstitutionally denies a benefit to an otherwise entitled person to further a government interest that is constitutionally subordinate to the woman's health.

Analysis:

This decision solidified the principle that a negative constitutional right (freedom from government interference) does not translate into a positive right (an entitlement to government aid). By upholding the Hyde Amendment, the Court confirmed that the government can use its spending power to promote a policy preference, such as favoring childbirth over abortion, without unconstitutionally burdening the underlying right itself. The ruling created a significant practical, though not formal, obstacle for indigent women seeking to exercise their right to abortion, effectively creating a two-tiered system of access based on wealth. It remains a cornerstone precedent distinguishing between the existence of a right and the government's obligation to facilitate its exercise.

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