Maher v. Roe
432 U.S. 464 (1977)
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Rule of Law:
The Equal Protection Clause of the Fourteenth Amendment does not require a state participating in the Medicaid program to fund nontherapeutic abortions, even if it chooses to subsidize the costs associated with childbirth.
Facts:
- Connecticut's Welfare Department had a regulation limiting state Medicaid benefits for first-trimester abortions to those certified by a physician as "medically necessary."
- The state's Medicaid program fully subsidized the medical costs associated with pregnancy and childbirth.
- Appellees Poe and Roe were two indigent women who qualified for Medicaid.
- Both Poe and Roe sought first-trimester abortions that were not considered medically necessary.
- Poe and Roe were unable to obtain a physician's certificate of medical necessity, and as a result, Connecticut refused to provide Medicaid funding for their abortions.
Procedural Posture:
- Poe and Roe sued Maher, the Connecticut Commissioner of Social Services, in the U.S. District Court for the District of Connecticut.
- The plaintiffs challenged a state regulation on both statutory (Title XIX) and constitutional (Equal Protection) grounds.
- The District Court initially ruled for the plaintiffs on statutory grounds, holding Title XIX required abortion funding.
- On appeal by the state, the U.S. Court of Appeals for the Second Circuit reversed in part, holding Title XIX permitted, but did not require, such funding.
- The case was remanded to the District Court for consideration of the constitutional claims.
- A three-judge District Court panel was convened and held that the Connecticut regulation violated the Equal Protection Clause.
- Maher, the Commissioner, appealed the District Court's constitutional ruling to the U.S. Supreme Court.
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Issue:
Does a state regulation that provides Medicaid funding for childbirth but denies public funding for nontherapeutic abortions violate the Equal Protection Clause of the Fourteenth Amendment?
Opinions:
Majority - Justice Powell
No. The Connecticut regulation does not violate the Equal Protection Clause because it does not impinge upon a fundamental right or discriminate against a suspect class. The constitutional right recognized in Roe v. Wade protects a woman from undue, direct state interference in her decision to have an abortion, but it does not create an entitlement to state financial assistance for that choice. The state has not placed an obstacle in the woman's path to an abortion; her indigency, which the state did not create, is the obstacle. By funding childbirth, the state may be encouraging an alternative activity, but it is not penalizing the choice of an abortion. Since no fundamental right is burdened, the regulation is subject only to rational basis review. The state's interest in encouraging normal childbirth is a legitimate state purpose, and subsidizing childbirth costs is a rational means of furthering that interest.
Dissenting - Justice Brennan
Yes. The Connecticut regulation unconstitutionally violates the Equal Protection Clause by impinging upon a fundamental right. For an indigent woman, the state's refusal to fund an abortion while offering to pay for childbirth is not mere encouragement of an alternative, but a coercive financial pressure that forces her to carry a pregnancy to term against her will. This disparity in funding operates as an effective barrier to exercising the fundamental right to abortion recognized in Roe v. Wade. As such, the regulation 'unduly burdens' the right and should be subject to strict scrutiny. The state has not presented a compelling interest to justify this infringement, particularly since its interest in potential life is not compelling during the first trimester.
Concurring - Chief Justice Burger
No. The Connecticut regulation does not violate the Equal Protection Clause. The Court's precedents in Roe v. Wade and Doe v. Bolton only require that a state not create an absolute barrier to a woman's decision to have an abortion. These cases do not suggest that a state is constitutionally required to assist her in procuring one. A state legislature has the policy discretion to decide which health services it will and will not finance, and the decision to fund childbirth expenses does not obligate it to fund nontherapeutic abortions.
Analysis:
This decision established that the constitutional right to an abortion is a "negative" right—a right to be free from governmental interference—rather than a "positive" right or an entitlement to government aid. It allows states to use their spending power to promote a policy preference for childbirth over abortion, a practice that has significantly influenced abortion access for low-income women. By applying rational basis review instead of strict scrutiny, the Court created a framework where states could enact funding restrictions that disproportionately affect indigent women without violating the Equal Protection Clause, shaping the legal landscape for abortion rights for decades.
