Beal v. Doe

In 1965, the federal government established Medicaid as a program providing government-funded medical assistance to the poor, and in 1970, Congress passed Title XIX of the Social Security Act, which regulated Medicaid. States were to administer their Medicaid programs and provide qualified individuals with assistance in five areas: inpatient hospital services, outpatient hospital services, other laboratory and X-ray services, skilled nursing facility/family planning 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 Doe v. Bolton. Title XIX did not, in fact, require states to fund all forms of 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 home state of Pennsylvania, however, had regulations in place forbidding financial assistance 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 equal protection under the Fourteenth Amendment to the Constitution. In the suit, she sought declaratory and injunctive relief--i.e., a statement of the exact law 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 panel of 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 the first 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 the statutory 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 address the constitutional issue.