Petitioner
Beal, Secretary, Department of Public Welfare of Pennsylvania, et al.
Respondent
"Jane Doe"
Petitioner's Claim
That Title XIX of the Social Security Act, a statute governing the federal Medicaid program, did not require states participating in that program to provide financial assistance for non-therapeutic abortions--i.e., abortions that are not deemed medically necessary.
Chief Lawyer for Petitioner
Norman J. Watkins
Chief Lawyer for Respondent
Judd F. Crosby
Justices for the Court
Warren E. Burger, Lewis F. Powell, Jr. (writing for the Court), William H. Rehnquist, John Paul Stevens, Potter Stewart, Byron R. White
Justices Dissenting
Harry A. Blackmun, William J. Brennan, Jr., Thurgood Marshall
Place
Washington, D.C.
Date of Decision
20 June 1977
Decision
That Title XIX neither required states to fund non-therapeutic abortions norprevented them from doing so.
Significance
Together with Maher v. Roe and Poelker v. Doe, all of them decided on 20 June 1977, Beal v. Doe addressed the controversial issue ofpublic provisions for abortion. Beal and Maher involved publicfunding for abortion in Pennsylvania and Connecticut respectively, Poelker involved the use of publicly run hospitals for the purpose of terminating pregnancies in St. Louis. The three cases raised, rather than settled, questions regarding abortion in public facilities and/or with public funds.
Title XIX, Medicaid, and Pennsylvania
In 1965, the federal government established Medicaid as a program providing government-funded medical assistance to the poor, and in 1970, Congress passedTitle XIX of the Social Security Act, which regulated Medicaid. States wereto administer their Medicaid programs and provide qualified individuals withassistance in five areas: inpatient hospital services, outpatient hospital services, other laboratory and X-ray services, skilled nursing facility/familyplanning services, and physicians' services furnished by a physician. Title XIX did not require that states provide funding for abortion; it could not have, since that practice would not become legal for another three years, when the Supreme Court made its historic decisions in Roe v. Wade and Doev. Bolton. Title XIX did not, in fact, require states to fund all formsof medical treatment within the five categories, but it did impel states to use "reasonable standards . . . for determining . . . the extent of medical assistance under the plan . . . consistent with the objectives of [Title XIX.]"
The respondent in Beal v. Doe, "Jane Doe," was eligible for medical assistance under Medicaid, and she requested funding for an abortion. Her homestate of Pennsylvania, however, had regulations in place forbidding financialassistance for any but therapeutic (that is, medically necessary) abortions.Following denial of the respondent's application, she and others filed an action with the U.S. District Court for the Western District of Pennsylvania, alleging that the state had violated both Title XIX and the provision of equalprotection under the Fourteenth Amendment to the Constitution. In the suit,she sought declaratory and injunctive relief--i.e., a statement of the exactlaw by the court, and an injunction against the State of Pennsylvania.
As would occur when the case went on to higher courts, the three-judge panelof the district court reviewed the suit from both the statutory and constitutional standpoints, the statutory issue being the alleged violation of Title XIX, and the constitutional one being the question of equal protection. The court ruled against Pennsylvania on both issues, and granted a declaratory judgement that the state's requirement was unconstitutional as applied during thefirst trimester. Pennsylvania's Secretary of Public Welfare Beal took the case to the U.S. Court of Appeals for the Third Circuit, which reversed on thestatutory issue. The court did, however, declare that Title XIX prohibited participating states from requiring a physician's certificate of medical necessity before funding a first- or second-trimester abortion. It did not addressthe constitutional issue.
A Question of Statutory Construction
When Beal v. Doe reached the Supreme Court, the only question before the Court was one of statutory construction. In his opinion for the majority,Justice Powell quoted a statement he had made in Blue Chip Stamps v. ManorDrug Stores (1975): "The starting point in every case involving construction of a statute is the language itself." Looking strictly at the language,he found that Title XIX did not require the funding of non-therapeutic abortions; nor did it require participating states to fund every possible medical procedure that fell within the five established categories. "[S]erious statutory questions might be presented," Powell wrote, if a state plan did not include coverage of necessary medical treatment. But that was not the case here, and "it is not inconsistent with the Act's goals to refuse to fund unnecessary(though perhaps desirable) medical services."
The respondents had asserted that exclusion of non-therapeutic abortions fromMedicaid coverage was unreasonable both from the standpoint of economics andhealth. In the case of economics, it would be much cheaper for a state to pay for an abortion than it would be to provide financial assistance to an indigent woman having a baby. As for the health argument, the respondents presented data which showed that a woman was more likely to die in childbirth than from an early abortion. Nonetheless, the Court cited its holding in Roe v.Wade to the effect that the state had "a strong interest in encouraging normal childbirth"; furthermore, "nothing in Title XIX suggests that it is unreasonable for a State to further that interest."
Powell noted the fact that at the time of Title XIX's passage, non-therapeutic abortions were against the law in most states. Title XIX was administered by the Department of Health, Education, and Welfare (HEW), later renamed the Department of Health and Human Services, and HEW held that the statute "allows, but does not mandate, funding for such abortions." For these reasons, the Court ruled in favor of the respondents and reversed the lower court's decision.
The Court left one question open, involving the Pennsylvania program's requirement that financial assistance required the written opinion of two physicians--in addition to the attending physician--attesting to the necessity of theoperation. "Whether or not," the Court wrote, "that aspect of Pennsylvania'sprogram . . . interferes with the attending physician's judgment in a mannernot contemplated by Congress should be considered on remand."
Dissent: Forcing Poor Women to Have Children
The dissenting justices each filed an opinion. Justice Brennan, joined by Justices Marshall and Blackmun in his opinion, began by disagreeing with the Court's position that elective abortions did not belong among the "necessary medical services" for which Pennsylvania was required to provide funding. Pregnancy was "unquestionably a condition requiring medical services," and therefore any treatment associated with it--including the termination of the pregnancy--should be covered as well. That choice should belong not to the states, Brennan held, but to the doctors, a concept reinforced in a statement by the Senate Finance Committee in its 1965 report on the Medicaid bill: the physician, the committee recommended, "is to be the key figure in determining utilization of health services." The Court's previous decisions in Roe and Doe concurred with this judgment, Brennan held, but its current positiondid not.
Brennan reasoned that if Pennsylvania was not required to fund non-therapeutic abortions, then it had the authority to refuse funding for therapeutic onesor even for live births because any of these could be judged unnecessary. Hefurther cited a 1972 amendment to the 1970 act which reinforced his argumentwith its statement that one purpose of Medicaid was to assist recipients inattaining or maintaining their ability to care for themselves. This could beachieved, the amendment said, in part by helping individuals "control familysize in order to enhance their capacity and ability to seek employment and better meet family needs."
Brennan treated the majority's observation that abortions were illegal in 1965 as a moot point, because the Medicaid Act "deals with general categories ofmedical services, not with specific procedures." As for the judgment expressed by HEW, Brennan treated this as irrelevant because "The principle of according weight to agency interpretation is inapplicable when a departmental interpretation . . . is patently inconsistent with the controlling statute." Brennan further rejected Pennsylvania's claim of health and financial reasons behind the statute, using an argument similar to that of the respondents: the cost and health risks of abortion were actually lower than those for live birth.
"The Court's construction," Brennan said near his conclusion, "can only result as a practical matter in forcing penniless pregnant women to have childrenthey would not have borne if the State had not weighted the scales to make their choice to have abortions substantially more onerous." He closed by briefly addressing the unanswered question regarding the requirement that two physicians other than the attending physician must agree to the procedure in writing before it could be performed. Due to the "paramount role played by the attending physician in the abortion decision," Brennan held, he would judge thatportion of the statute invalid as well.
Marshall took a similar, though stronger, position in his own dissent. Like Brennan, he asserted that "the enactments challenged here brutally coerce poorwomen to bear children whom society will scorn for every day of their lives"; but he also held that "the government actions in these cases, ostensibly taken to `encourage' women to carry pregnancies to term, are in reality intended to impose a moral viewpoint that no state may constitutionally enforce." Laws such as the Pennsylvania statute under discussion, as well as those othersexamined by the Court in the other two abortion-related cases that day, hadbeen made by people opposed to the Court's decisions in Roe and Doe, in order "to circumvent the commands of the Constitution and impose their moral choices upon the rest of society."
In Marshall's view, the fact that many of the women seeking abortions under Medicaid were members of minority groups, and that most were poor, meant thatthe Court's decision would hurt the most vulnerable members of society. Givenalso the fact that "opposition remains strong against increasing Aid to Families With Dependent Children [welfare] benefits for impoverished mothers andchildren," the effects would be particularly hurtful. "I am appalled," Marshall wrote, "at the ethical bankruptcy of those who preach a `right to life' that means, under present social policies, a bare existence in utter misery forso many poor women and their children."
After examining the Court's decisions in Maher and Poelker, Marshall judged that the statutes questioned in those cases and the current onewere all violative of the Fourteenth Amendment's Equal Protection Clause. Hecommented on the Court's retreat from its position in Roe and Doe, which he compared to Brown v. Board of Education for their controversial qualities. The decision in Beal, he wrote, would only help "well-financed and carefully orchestrated lobbying campaigns" persuade public officials to put more restrictions into place. "The effect," he concluded,
Blackmun, in an opinion joined by Brennan and Marshall, echoed the theme thatwithholding public funds for abortion was equal in practice to forcing poorwomen to have children they did not want. The Court's ruling, he wrote, implied that even if the government refused to pay for it, a poor woman could comeup with the funds for an abortion from some other source. This he compared to the statement of Marie Antoinette when told that the peasants of France hadno bread: "Let them eat cake." In concluding words not unlike those of Marshall, Blackmun suggested that the Court was ignoring "another world `out there' . . . " As a consequence of this, he wrote, "the cancer of poverty will continue to grow. This is a sad day for those who regard the Constitution as a force that would serve justice to all evenhandedly and, in so doing, would better the lot of the poorest among us."
Impact
Beal, along with its two companion cases, left in its wake a growing uncertainty as to laws governing abortion in a public arena. To abortion-rights advocates, the cases were judged as a setback because they failed to extendthe practice of abortion (and as some argued, actually prevented poor womenfrom receiving abortions); but opponents of abortion gained little from the cases either. Beal and its companions simply helped to establish the fact of abortion's legality as decided four years earlier in Roe v. Wadeand Doe v. Bolton, and left open the question of public funding. TheCourt affirmed its position in Harris v. McRae (1980), in which it upheld the so-called Hyde Amendment to Title XIX, which forbade the use of federal funds for non-therapeutic abortions.
Related Cases
Beal, Secretary, Department of Public Welfare of Pennsylvania, et al.
Respondent
"Jane Doe"
Petitioner's Claim
That Title XIX of the Social Security Act, a statute governing the federal Medicaid program, did not require states participating in that program to provide financial assistance for non-therapeutic abortions--i.e., abortions that are not deemed medically necessary.
Chief Lawyer for Petitioner
Norman J. Watkins
Chief Lawyer for Respondent
Judd F. Crosby
Justices for the Court
Warren E. Burger, Lewis F. Powell, Jr. (writing for the Court), William H. Rehnquist, John Paul Stevens, Potter Stewart, Byron R. White
Justices Dissenting
Harry A. Blackmun, William J. Brennan, Jr., Thurgood Marshall
Place
Washington, D.C.
Date of Decision
20 June 1977
Decision
That Title XIX neither required states to fund non-therapeutic abortions norprevented them from doing so.
Significance
Together with Maher v. Roe and Poelker v. Doe, all of them decided on 20 June 1977, Beal v. Doe addressed the controversial issue ofpublic provisions for abortion. Beal and Maher involved publicfunding for abortion in Pennsylvania and Connecticut respectively, Poelker involved the use of publicly run hospitals for the purpose of terminating pregnancies in St. Louis. The three cases raised, rather than settled, questions regarding abortion in public facilities and/or with public funds.
Title XIX, Medicaid, and Pennsylvania
In 1965, the federal government established Medicaid as a program providing government-funded medical assistance to the poor, and in 1970, Congress passedTitle XIX of the Social Security Act, which regulated Medicaid. States wereto administer their Medicaid programs and provide qualified individuals withassistance in five areas: inpatient hospital services, outpatient hospital services, other laboratory and X-ray services, skilled nursing facility/familyplanning services, and physicians' services furnished by a physician. Title XIX did not require that states provide funding for abortion; it could not have, since that practice would not become legal for another three years, when the Supreme Court made its historic decisions in Roe v. Wade and Doev. Bolton. Title XIX did not, in fact, require states to fund all formsof medical treatment within the five categories, but it did impel states to use "reasonable standards . . . for determining . . . the extent of medical assistance under the plan . . . consistent with the objectives of [Title XIX.]"
The respondent in Beal v. Doe, "Jane Doe," was eligible for medical assistance under Medicaid, and she requested funding for an abortion. Her homestate of Pennsylvania, however, had regulations in place forbidding financialassistance for any but therapeutic (that is, medically necessary) abortions.Following denial of the respondent's application, she and others filed an action with the U.S. District Court for the Western District of Pennsylvania, alleging that the state had violated both Title XIX and the provision of equalprotection under the Fourteenth Amendment to the Constitution. In the suit,she sought declaratory and injunctive relief--i.e., a statement of the exactlaw by the court, and an injunction against the State of Pennsylvania.
As would occur when the case went on to higher courts, the three-judge panelof the district court reviewed the suit from both the statutory and constitutional standpoints, the statutory issue being the alleged violation of Title XIX, and the constitutional one being the question of equal protection. The court ruled against Pennsylvania on both issues, and granted a declaratory judgement that the state's requirement was unconstitutional as applied during thefirst trimester. Pennsylvania's Secretary of Public Welfare Beal took the case to the U.S. Court of Appeals for the Third Circuit, which reversed on thestatutory issue. The court did, however, declare that Title XIX prohibited participating states from requiring a physician's certificate of medical necessity before funding a first- or second-trimester abortion. It did not addressthe constitutional issue.
A Question of Statutory Construction
When Beal v. Doe reached the Supreme Court, the only question before the Court was one of statutory construction. In his opinion for the majority,Justice Powell quoted a statement he had made in Blue Chip Stamps v. ManorDrug Stores (1975): "The starting point in every case involving construction of a statute is the language itself." Looking strictly at the language,he found that Title XIX did not require the funding of non-therapeutic abortions; nor did it require participating states to fund every possible medical procedure that fell within the five established categories. "[S]erious statutory questions might be presented," Powell wrote, if a state plan did not include coverage of necessary medical treatment. But that was not the case here, and "it is not inconsistent with the Act's goals to refuse to fund unnecessary(though perhaps desirable) medical services."
The respondents had asserted that exclusion of non-therapeutic abortions fromMedicaid coverage was unreasonable both from the standpoint of economics andhealth. In the case of economics, it would be much cheaper for a state to pay for an abortion than it would be to provide financial assistance to an indigent woman having a baby. As for the health argument, the respondents presented data which showed that a woman was more likely to die in childbirth than from an early abortion. Nonetheless, the Court cited its holding in Roe v.Wade to the effect that the state had "a strong interest in encouraging normal childbirth"; furthermore, "nothing in Title XIX suggests that it is unreasonable for a State to further that interest."
Powell noted the fact that at the time of Title XIX's passage, non-therapeutic abortions were against the law in most states. Title XIX was administered by the Department of Health, Education, and Welfare (HEW), later renamed the Department of Health and Human Services, and HEW held that the statute "allows, but does not mandate, funding for such abortions." For these reasons, the Court ruled in favor of the respondents and reversed the lower court's decision.
The Court left one question open, involving the Pennsylvania program's requirement that financial assistance required the written opinion of two physicians--in addition to the attending physician--attesting to the necessity of theoperation. "Whether or not," the Court wrote, "that aspect of Pennsylvania'sprogram . . . interferes with the attending physician's judgment in a mannernot contemplated by Congress should be considered on remand."
Dissent: Forcing Poor Women to Have Children
The dissenting justices each filed an opinion. Justice Brennan, joined by Justices Marshall and Blackmun in his opinion, began by disagreeing with the Court's position that elective abortions did not belong among the "necessary medical services" for which Pennsylvania was required to provide funding. Pregnancy was "unquestionably a condition requiring medical services," and therefore any treatment associated with it--including the termination of the pregnancy--should be covered as well. That choice should belong not to the states, Brennan held, but to the doctors, a concept reinforced in a statement by the Senate Finance Committee in its 1965 report on the Medicaid bill: the physician, the committee recommended, "is to be the key figure in determining utilization of health services." The Court's previous decisions in Roe and Doe concurred with this judgment, Brennan held, but its current positiondid not.
Brennan reasoned that if Pennsylvania was not required to fund non-therapeutic abortions, then it had the authority to refuse funding for therapeutic onesor even for live births because any of these could be judged unnecessary. Hefurther cited a 1972 amendment to the 1970 act which reinforced his argumentwith its statement that one purpose of Medicaid was to assist recipients inattaining or maintaining their ability to care for themselves. This could beachieved, the amendment said, in part by helping individuals "control familysize in order to enhance their capacity and ability to seek employment and better meet family needs."
Brennan treated the majority's observation that abortions were illegal in 1965 as a moot point, because the Medicaid Act "deals with general categories ofmedical services, not with specific procedures." As for the judgment expressed by HEW, Brennan treated this as irrelevant because "The principle of according weight to agency interpretation is inapplicable when a departmental interpretation . . . is patently inconsistent with the controlling statute." Brennan further rejected Pennsylvania's claim of health and financial reasons behind the statute, using an argument similar to that of the respondents: the cost and health risks of abortion were actually lower than those for live birth.
"The Court's construction," Brennan said near his conclusion, "can only result as a practical matter in forcing penniless pregnant women to have childrenthey would not have borne if the State had not weighted the scales to make their choice to have abortions substantially more onerous." He closed by briefly addressing the unanswered question regarding the requirement that two physicians other than the attending physician must agree to the procedure in writing before it could be performed. Due to the "paramount role played by the attending physician in the abortion decision," Brennan held, he would judge thatportion of the statute invalid as well.
Marshall took a similar, though stronger, position in his own dissent. Like Brennan, he asserted that "the enactments challenged here brutally coerce poorwomen to bear children whom society will scorn for every day of their lives"; but he also held that "the government actions in these cases, ostensibly taken to `encourage' women to carry pregnancies to term, are in reality intended to impose a moral viewpoint that no state may constitutionally enforce." Laws such as the Pennsylvania statute under discussion, as well as those othersexamined by the Court in the other two abortion-related cases that day, hadbeen made by people opposed to the Court's decisions in Roe and Doe, in order "to circumvent the commands of the Constitution and impose their moral choices upon the rest of society."
In Marshall's view, the fact that many of the women seeking abortions under Medicaid were members of minority groups, and that most were poor, meant thatthe Court's decision would hurt the most vulnerable members of society. Givenalso the fact that "opposition remains strong against increasing Aid to Families With Dependent Children [welfare] benefits for impoverished mothers andchildren," the effects would be particularly hurtful. "I am appalled," Marshall wrote, "at the ethical bankruptcy of those who preach a `right to life' that means, under present social policies, a bare existence in utter misery forso many poor women and their children."
After examining the Court's decisions in Maher and Poelker, Marshall judged that the statutes questioned in those cases and the current onewere all violative of the Fourteenth Amendment's Equal Protection Clause. Hecommented on the Court's retreat from its position in Roe and Doe, which he compared to Brown v. Board of Education for their controversial qualities. The decision in Beal, he wrote, would only help "well-financed and carefully orchestrated lobbying campaigns" persuade public officials to put more restrictions into place. "The effect," he concluded,
will be to relegate millions of people to lives of poverty and despair. When elected leaders cower before public pressure, this Court, more than ever, must not shirk its duty to enforce the Constitution for the benefit of the poor and powerless.
Blackmun, in an opinion joined by Brennan and Marshall, echoed the theme thatwithholding public funds for abortion was equal in practice to forcing poorwomen to have children they did not want. The Court's ruling, he wrote, implied that even if the government refused to pay for it, a poor woman could comeup with the funds for an abortion from some other source. This he compared to the statement of Marie Antoinette when told that the peasants of France hadno bread: "Let them eat cake." In concluding words not unlike those of Marshall, Blackmun suggested that the Court was ignoring "another world `out there' . . . " As a consequence of this, he wrote, "the cancer of poverty will continue to grow. This is a sad day for those who regard the Constitution as a force that would serve justice to all evenhandedly and, in so doing, would better the lot of the poorest among us."
Impact
Beal, along with its two companion cases, left in its wake a growing uncertainty as to laws governing abortion in a public arena. To abortion-rights advocates, the cases were judged as a setback because they failed to extendthe practice of abortion (and as some argued, actually prevented poor womenfrom receiving abortions); but opponents of abortion gained little from the cases either. Beal and its companions simply helped to establish the fact of abortion's legality as decided four years earlier in Roe v. Wadeand Doe v. Bolton, and left open the question of public funding. TheCourt affirmed its position in Harris v. McRae (1980), in which it upheld the so-called Hyde Amendment to Title XIX, which forbade the use of federal funds for non-therapeutic abortions.
Related Cases
- Roe v. Wade, 410 U.S. 113 (1973).
- Doe v. Bolton, 410 U.S. 179 (1973).
- Bellotti v. Baird, 428 U.S. 132 (1976).
- Maher v. Roe, 432 U.S. 464 (1977).
- Poelker v. Doe, 432 U.S. 519 (1977).
- Harris v. McRae, 448 U.S. 297 (1980).
- Akron v. Akron Center for Reproductive Health, 462 U.S. 416 (1983).
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