Harris v. McRae

1980-06-30

Headline: Court upholds Hyde Amendment, allows withholding federal Medicaid funds for many abortions and confirms states need not pay, shifting costs onto low-income women and states.

Holding: The Court held that Title XIX does not require states to fund medically necessary abortions when federal reimbursement is barred by the Hyde Amendment, and that the Hyde Amendment does not violate the Fifth or First Amendments.

Real World Impact:

Removes federal payment for many Medicaid abortions, leaving states or women to pay.
States may choose whether to use state funds to cover abortions.
Leaves low-income women more likely to face health and financial risks.

Topics: abortion funding, Medicaid and health care, Hyde Amendment, women's health, state vs. federal funding

Summary

Background

A Medicaid recipient, public hospitals, and others challenged the Hyde Amendment, a congressional rule that bars most federal Medicaid payments for abortions except to save the mother's life (and later for rape or incest reported to authorities). They argued that Title XIX (Medicaid) or the Constitution required funding for medically necessary abortions and sued the Secretary of HEW after lower courts blocked the restriction.

Reasoning

The Court first held that Title XIX is a federal–state shared funding program, and when Congress withholds federal reimbursement for a service the statute does not force states to pick up the full cost. Turning to constitutional claims, the Court relied on prior decisions saying the Constitution does not create a right to federal subsidy. It concluded the Hyde Amendment does not violate the Due Process or Establishment Clauses and that the selective funding is rationally related to Congress’s legitimate interest in protecting potential life. The Court also held the plaintiffs lacked standing to bring a Free Exercise challenge.

Real world impact

As a result, states that participate in Medicaid need not pay for medically necessary abortions when federal funds are barred. That makes federal reimbursement unavailable in most cases covered by the Hyde Amendment and leaves low-income women, providers, or states to cover costs. The ruling affirms congressional authority to set funding priorities and leaves political branches, not the courts, to change the funding policy.

Dissents or concurrances

Justice White concurred with the judgment. Several Justices dissented, arguing the funding restriction effectively coerces poor women, burdens the constitutional choice to have an abortion, and causes real health risks for indigent women denied funded care.