Facts—Title XIX of the Social Security Act established the Medicaid program in 1965 to provide federal financial assistance to states that choose to reimburse certain costs of medical treatment for needy persons. Since 1976, versions of the so-called Hyde Amendment have severely limited the use of any federal funds to reimburse the cost of abortions under the Medicaid program. The Hyde Amendment, named after Illinois Congressman Henry Hyde, was attached on the grounds, inter alia, that it violates the due process clause of the Fifth Amendment and the religion clauses of the First Amendment and that, despite the Hyde Amendment, a participating state remains obligated under Title XIX to fund all medically necessary abortions. The District Court agreed that the state was free from obligation to pay for elective abortions but ruled that the Hyde Amendment violated the First, Fifth, and Fourteenth Amendments.
Questions—(a) Must a state pay for elective abortions when, under the Hyde Amendment, Congress has withdrawn its support? (b) Does the Hyde Amendment violate constitutional guarantees?
Decisions—(a) No; (b) No.
Reasons—J. Stewart (6–3). Nothing in Title XIX as originally enacted, or in its legislative history, suggests that Congress intended to require a participating state “to assume the full costs of providing any health services in its Medicaid plan . . . if Congress chooses to withdraw federal funding for a particular service, a state is not obliged to continue to pay for that service as a condition of continued federal financial support of other services.” The state, Maher v. Roe, 432 U.S. 464 (1977), can make a value judgment favoring childbirth over abortion “but it has imposed no restriction on access to abortions that was not already there. [I]t 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.” To require this funding as a due process entitlement would mean that Congress was mandated “to subsidize the medically necessary abortion of an indigent woman even if Congress had not enacted a Medicaid program to subsidize other medically necessary services.” The parties lack standing under the free exercise clause, and the Fifth Amendment is not a source of substantive rights or liberties, but rather a right to be free from invidious governmental discrimination.
J. Brennan, J. Marshall, J. Blackmun, and J. Stevens all authored dissents arguing that this decision permitted discrimination against women unable to afford abortions.