Beal v. Doe

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. Manor Drug 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 from Medicaid coverage was unreasonable both from the standpoint of economics and health. 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 the operation. "Whether or not," the Court wrote, "that aspect of Pennsylvania's program . . . interferes with the attending physician's judgment in a manner not contemplated by Congress should be considered on remand."