Harris v. McRae

The Respondent, McRae, a Medicaid recipient seeking an abortion, brought a class action suit challenging the constitutional validity of the ‘Hyde Amendment’, which prohibited federal reimbursement under the Medicaid system for some abortions which were medically necessary.

As established by an amendment to Title XIX of the Social Security Act in 1965, the Medicaid system offers federal funding to States providing reimbursement for certain medical expenses for the indigent.

The Hyde Amendment, introduced in 1976, banned the use of federal funds for some abortions that were medically necessary, while federal funding remained available for abortions required because of endangerment to the pregnant woman’s life.

The District Court held that the Hyde Amendment was valid under the Establishment Clause of the First Amendment, but that it violated the equal protection component of the Fifth Amendment’s Due Process Clause and the Free Exercise Clause of the First Amendment. It granted an injunction that required federal reimbursement for abortions under the standards applicable before the Hyde Amendment had been enacted.

The Court held that Title XIX of the Social Security Act did not require a participating State to pay for all medically necessary abortions for which federal reimbursement was not available under the Hyde Amendment. The Court held that Title XIX did not intend to burden participating States with a continuing unilateral obligation to pay for particular medical services for which federal reimbursement was withdrawn, including some medically necessary abortions. It declared that Title XIX simply made federal funds available to States for the provision of medical services contingent upon Congressional approval.

The Court held that the funding restrictions of the Hyde Amendment did not impinge on the liberty protected by the Due Process Clause of the Fifth Amendment, which, following Roe v. Wade, 410 U.S. 113 (1973), included the freedom of a woman to decide whether to terminate a pregnancy. Applying Maher v Roe, 432 U.S. 464 (1977), the Court held that “a woman’s freedom of choice [did not carry] with it a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.” It held that the Hyde Amendment did not impose a “governmental obstacle in the path of a woman who chooses to terminate her pregnancy,” but only encouraged alternatives by providing greater subsidies for other medical services deemed to be more in the public interest. The Court explained that the government was not obligated to remove restrictions imposed by obstacles, like indigency, which were “not of its own creation.”

The Court further held that the Hyde Amendment did not violate the establishment clause of the First Amendment, as the funding restrictions in the Hyde Amendment embodied “traditionalist values” just as much as they reflected the views of some religions. It explained that when a statute happens to coincide or harmonize with the tenets of a religion, it does not follow that the statute violates the Establishment Clause.

The Court held additionally that McRae and others in the class action did not have standing to raise First Amendment issues under the Free Exercise Clause, as none of the named plaintiffs indicated they sought an abortion in connection with religious beliefs.

Finally, the Court held that the Hyde Amendment did not violate the equal protection component of the Due Process Clause of the Fifth Amendment. Applying Maher, the Court reaffirmed that “poverty, standing alone, is not a suspect classification”. It also held that despite the principal impact of the Hyde Amendment falling on women who are indigent, the funding restrictions were rationally related to the government’s legitimate interest in protecting the potential life of the fetus, except in the most urgent circumstances.

“[R]egardless of whether the freedom of a woman to choose to terminate her pregnancy for health reasons lies at the core or the periphery of the due process liberty recognized in [Roe v. Wade], it simply does not follow that a woman's freedom of choice carries with it a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.” 448 U.S., p. 316.

“The financial constraints that restrict an indigent woman's ability to enjoy the full range of constitutionally protected freedom of choice are the product not of governmental restrictions on access to abortions, but rather of her indigency.” 448 U.S., p. 316.

“Although the liberty protected by the Due Process Clause affords protection against unwarranted government interference with freedom of choice in the context of certain personal decisions, it does not confer an entitlement to such funds as may be necessary to realize all the advantages of that freedom. To hold otherwise would mark a drastic change in our understanding of the Constitution.” 448 U.S., pp. 317-18.

“[W]e are convinced that the fact that the funding restrictions in the Hyde Amendment may coincide with the religious tenets of the Roman Catholic Church does not, without more, contravene the Establishment Clause.” 448 U.S., pp. 319-20.

“[T]he Hyde Amendment, by encouraging childbirth except in the most urgent circumstances, is rationally related to the legitimate governmental objective of protecting potential life. By subsidizing the medical expenses of indigent women who carry their pregnancies to term while not subsidizing the comparable expenses of women who undergo abortions (except those whose lives are threatened), Congress has established incentives that make childbirth a more attractive alternative than abortion for persons eligible for Medicaid. These incentives bear a direct relationship to the legitimate congressional interest in protecting potential life.” 448 U.S., p. 325.