harris mcrae argued april decided june title xix social security act established medicaid program provide federal financial assistance state choose reimburse certain costs medical treatment needy persons since versions hyde amendment severely limited use federal funds reimburse cost abortions medicaid program actions brought federal district appellees including indigent pregnant women sued behalf women similarly situated new york city health hospitals operates hospitals providing abortion services officers women division board global ministries methodist church women division women division seeking enjoin enforcement hyde amendment grounds violates inter alia due process clause fifth amendment religion clauses first amendment despite hyde amendment participating state remains obligated title xix fund medically necessary abortions ultimately district granting injunctive relief held hyde amendment substantively amended title xix relieve state obligation fund medically necessary abortions federal reimbursement unavailable amendment violates equal protection component fifth amendment due process clause free exercise clause first amendment held title xix require participating state pay medically necessary abortions federal reimbursement unavailable hyde amendment pp cornerstone medicaid financial contribution federal government participating state nothing title xix originally enacted legislative history suggests congress intended require participating state assume full costs providing health services medicaid plan contrary congress purpose enacting title xix provide federal financial assistance legitimate state expenditures approved medicaid plan pp hyde amendment legislative history contain indication congress intended shift entire cost medically necessary abortions participating rather suggests congress always assumed participating state required fund abortions federal funding withdrawn pursuant hyde amendment pp funding restrictions hyde amendment impinge liberty protected due process clause fifth amendment held roe wade include freedom woman decide whether terminate pregnancy pp hyde amendment places governmental obstacle path woman chooses terminate pregnancy rather means unequal subsidization abortion medical services encourages alternative activity deemed public interest cf maher roe regardless whether freedom woman choose terminate pregnancy health reasons lies core periphery due process liberty recognized wade supra follow woman freedom choice carries constitutional entitlement financial resources avail full range protected choices although government may place obstacles path woman exercise freedom choice need remove creation indigency falls within latter category although congress opted subsidize medically necessary services generally certain medically necessary abortions fact remains hyde amendment leaves indigent woman least range choice deciding whether obtain medically necessary abortion congress chosen subsidize health care costs pp translate limitation governmental power implicit due process clause affirmative funding obligation require congress subsidize medically necessary abortion indigent woman even congress enacted medicaid program subsidize medically necessary services nothing due process clause supports extraordinary result pp hyde amendment violate establishment clause first amendment fact funding restrictions hyde amendment may coincide religious tenets roman catholic church without contravene clause pp appellees lack standing raise challenge hyde amendment free exercise clause first amendment named appellees consisting indigent pregnant women suing behalf women similarly situated lack standing none alleged much less proved sought abortion compulsion religious belief named appellees consisting officers women division although provided detailed description religious beliefs failed allege either expect pregnant eligible receive medicaid therefore lacked personal stake controversy needed confer standing raise challenge hyde amendment women division satisfy standing requirements organization assert rights membership since asserted claim one required participation individual members proper understanding resolution free exercise claims pp hyde amendment violate equal protection component due process clause fifth amendment pp presumption constitutional validity statutory classification impinge right liberty protected constitution disappears classification predicated criteria suspect hyde amendment predicated constitutionally suspect classification maher roe supra although impact amendment falls indigent fact render funding restrictions constitutionally invalid poverty standing alone suspect classification pp congress neither invaded substantive constitutional right freedom enacted legislation purposefully operates detriment suspect class requirement equal protection congressional action rationally related legitimate governmental interest hyde amendment satisfies standard since encouraging childbirth except urgent circumstances rationally related legitimate governmental objective protecting potential life pp stewart delivered opinion burger white powell rehnquist joined white filed concurring opinion post brennan filed dissenting opinion marshall blackmun joined post marshall post blackmun post stevens post filed dissenting opinions solicitor general mccree argued cause appellant briefs assistant attorney general daniel eloise davies victor rosenblum dennis horan john gorby carl anderson patrick trueman lawrence washburn gerald bodell filed briefs buckley et appellees rule support appellant rhonda copelon argued cause appellees mcrae et al briefs nancy stearns sylvia law ellen sawyer janet benshoof judith levin harriet pilpel eve paul briefs amici curiae urging reversal filed john noonan william ball representative jim wright et al wilfred caron patrick geary catholic conference briefs amici curiae urging affirmance filed robert abrams attorney general shirley adelson siegel solicitor general peter bienstock arnold fleischer barbara levy assistant attorneys general state new york et joined rufus edmisten attorney general north carolina william special deputy attorney general steven mansfield shaber associate attorney general james redden attorney general oregon leo pfeffer american ethical union et al barbara ellen handschu association legal aid attorneys city new york district et al phyllis segal judith avner national organization women et al briefs amici curiae filed nadine taub health systems agency et al james kolb coalition human justice sanford jay rosen national council churches christ sanford jay rosen presbyterian church justice stewart delivered opinion case presents statutory constitutional questions concerning public funding abortions title xix social security act commonly known medicaid act recent annual appropriations acts containing hyde amendment statutory question whether title xix requires state participates medicaid program fund cost medically necessary abortions federal reimbursement unavailable hyde amendment constitutional question arises title xix imposes requirement whether hyde amendment denying public funding certain medically necessary abortions contravenes liberty equal protection guarantees due process clause fifth amendment either religion clauses first amendment medicaid program created congress added title xix social security act stat amended et seq ed supp ii purpose providing federal financial assistance choose reimburse certain costs medical treatment needy persons although participation medicaid program entirely optional state elects participate must comply requirements title xix one requirement participating state agree provide financial assistance categorically needy respect five general areas medical treatment inpatient hospital services outpatient hospital services laboratory services skilled nursing facilities services periodic screening diagnosis children family planning services services physicians although participating state need provide funding medical treatment falling within five general categories title xix require state medicaid pla establish reasonable standards determining extent medical assistance plan consistent objectives title xix beal doe since september congress prohibited either amendment annual appropriations bill department health education welfare joint resolution use federal funds reimburse cost abortions medicaid program except certain specified circumstances funding restriction commonly known hyde amendment original congressional sponsor representative hyde current version hyde amendment applicable fiscal year provides one funds provided joint resolution shall used perform abortions except life mother endangered fetus carried term except medical procedures necessary victims rape incest rape incest reported promptly law enforcement agency public health service pub stat september day congress enacted initial version hyde amendment consolidated cases filed district eastern district new york plaintiffs cora mcrae new york medicaid recipient first trimester pregnancy wished terminate new york city health hospitals public benefit corporation operates hospitals provide abortion services others sought enjoin enforcement funding restriction abortions alleged hyde amendment violated first fourth fifth ninth amendments constitution insofar limited funding abortions necessary save life mother permitting funding costs associated childbirth although sole named defendant secretary health education welfare district permitted senators james buckley jesse helms representative henry hyde intervene defendants hearing district entered preliminary injunction prohibiting secretary enforcing hyde amendment requiring continue provide federal reimbursement abortions standards applicable funding restriction enacted mcrae mathews supp although stating expressly held funding restriction unconstitutional since preliminary injunction final judgment district noted holding implicit decision granting injunction district also certified mcrae case class action behalf pregnant potentially pregnant women state new york eligible medicaid decide abortion within first weeks pregnancy authorized providers abortion services women secretary brought appeal deciding beal doe maher roe vacated injunction district remanded case reconsideration light decisions califano mcrae remand district permitted intervention several additional plaintiffs including four individual medicaid recipients wished abortions allegedly medically necessary qualify federal funds versions hyde amendment applicable fiscal years several physicians perform abortions medicaid recipients women division board global ministries methodist church women division two individual officers women division amended complaint filed challenging various versions hyde amendment several grounds outset plaintiffs asserted district need address constitutionality hyde amendment view participating state remains obligated title xix fund medically necessary abortions even federal reimbursement unavailable regard constitutionality hyde amendment plaintiffs asserted among things funding restrictions violate religion clauses first amendment due process clause fifth amendment lengthy trial inquired medical reasons abortions diverse religious views subject district filed opinion entered judgment invalidating versions hyde amendment constitutional grounds district rejected plaintiffs statutory argument concluding even though title xix otherwise required participating state fund medically necessary abortions hyde amendment substantively amended title xix relieve state funding obligation turning constitutional issues district concluded hyde amendment though valid establishment clause violates equal protection component fifth amendment due process clause free exercise clause first amendment regard fifth amendment district noted abortion medically necessary safeguard pregnant woman health disentitlement edicaid assistance impinges directly woman right decide consultation physician reliance judgment terminate pregnancy order preserve health mcrae califano supp concluded hyde amendment violates equal protection guarantee view decision congress fund medically necessary services generally certain medically necessary abortions serves legitimate governmental interest free exercise clause first amendment held insofar woman decision seek medically necessary abortion may product religious beliefs certain protestant jewish tenets funding restrictions hyde amendment violate constitutional guarantee well accordingly district ordered secretary ease give effect various versions hyde amendment insofar forbid payments medically necessary abortions directed secretary ontinue authorize expenditure federal matching funds abortions app addition recertified mcrae case nationwide class action behalf pregnant potentially pregnant women eligible medicaid wish medically necessary abortions authorized providers abortions women secretary applied stay judgment pending direct appeal district decision denied stay noted probable jurisdiction appeal ii well settled case may decided either statutory constitutional grounds sound jurisprudential reasons inquire first statutory question practice reflects deeply rooted doctrine pass questions constitutionality unless adjudication unavoidable spector motor service mclaughlin accordingly turn first question whether title xix requires state participates medicaid program continue fund medically necessary abortions federal reimbursement unavailable hyde amendment participating state obligation constitutionality hyde amendment need drawn question present case availability medically necessary abortions medicaid continue participating state shouldering total cost funding abortions appellees assert participating state independent funding obligation title xix hyde amendment terms limitation federal reimbursement certain medically necessary abortions title xix permit participating state exclude medicaid plan medically necessary service solely basis diagnosis condition even federal reimbursement unavailable service thus appellees view effect hyde amendment withhold federal reimbursement certain medically necessary abortions relieve participating state duty title xix provide abortions medicaid plan district rejected argument concluded although title xix otherwise required participating state include medically necessary abortions medicaid program hyde amendment substantively amended title xix relieve state obligation construction hyde amendment said find support decisions two courts appeals preterm dukakis zbaraz quern consistent understanding effect hyde amendment department health education welfare administration medicaid program agree district somewhat different reasons medicaid program created title xix cooperative endeavor federal government provides financial assistance participating aid furnishing health care needy persons system cooperative federalism king smith state agrees establish medicaid plan satisfies requirements title xix include several mandatory categories health services federal government agrees pay specified percentage total amount expended medical assistance state plan cornerstone medicaid financial contribution federal government participating state nothing title xix originally enacted legislative history suggests congress intended require participating state assume full costs providing health services medicaid plan quite contrary purpose congress enacting title xix provide federal financial assistance legitimate state expenditures approved medicaid plan see pt pp since congress enacted title xix intend participating state assume unilateral funding obligation health service approved medicaid plan follows title xix require participating state include plan services subsequent congress withheld federal funding title xix designed cooperative program shared financial responsibility device federal government compel state provide services congress unwilling fund thus congress chooses withdraw federal funding particular service state obliged continue pay service condition continued federal financial support services say congress may depart original design title xix federal government shares financial responsibility expenses incurred approved medicaid plan say absent indication contrary legislative intent subsequent congress title xix obligate participating state pay medical services federal reimbursement unavailable thus normal operation title xix even state otherwise required include medically necessary abortions medicaid plan withdrawal federal funding hyde amendment operate relieve state obligation abortions federal reimbursement unavailable legislative history hyde amendment contains indication whatsoever congress intended shift entire cost services participating see zbaraz quern supra one whether supporting opposing hyde amendment ever suggested state funding required rather legislative history suggests congress always assumed participating state required fund medically necessary abortions federal funding withdrawn pursuant hyde amendment see preterm dukakis supra universal assumption debate amendment passed requirement carry service accord zbaraz quern supra hodgson board county roe casey accordingly conclude title xix require participating state pay medically necessary abortions federal reimbursement unavailable hyde amendment iii determined title xix obligate participating state pay medically necessary abortions congress withheld federal funding must consider constitutional validity hyde amendment appellees assert funding restrictions hyde amendment violate several rights secured constitution right woman implicit due process clause fifth amendment decide whether terminate pregnancy prohibition establishment clause first amendment law respecting establishment religion right freedom religion protected free exercise clause first amendment appellees also contend quite apart substantive constitutional rights hyde amendment violates equal protection component fifth amendment well settled quite apart guarantee equal protection law impinges upon fundamental right explicitly implicitly secured constitution presumptively unconstitutional mobile bolden plurality opinion accordingly turning equal protection issue case examine whether hyde amendment violates substantive rights secured constitution address first appellees argument hyde amendment restricting availability certain medically necessary abortions medicaid impinges liberty protected due process clause recognized roe wade progeny wade case held unconstitutional texas statute making crime procure attempt abortion except medical advice purpose saving mother life constitutional underpinning wade recognition liberty protected due process clause fourteenth amendment includes freedoms explicitly mentioned bill rights also freedom personal choice certain matters marriage family life implicit constitutional liberty wade held includes freedom woman decide whether terminate pregnancy wade also recognized state legitimate interests pregnancy ensuring health mother protecting potential human life state interests found separate distinct gro substantiality woman approaches term pose conflict woman untrammeled freedom choice resolving conflict held end first trimester pregnancy neither state interest sufficiently substantial justify intrusion woman freedom choice second trimester state interest maternal health found sufficiently substantial justify regulation reasonably related concern viability usually third trimester state interest protecting potential life fetus found justify criminal prohibition abortions except necessary preservation life health mother thus inasmuch texas criminal statute allowed abortions necessary save life mother without regard stage pregnancy held wade statute violated due process clause fourteenth amendment maher roe presented question whether scope personal constitutional freedom recognized roe wade included entitlement medicaid payments abortions medically necessary issue maher connecticut welfare regulation medicaid recipients received payments medical services incident childbirth medical services incident nontherapeutic abortions district held regulation violated equal protection clause fourteenth amendment unequal subsidization childbirth abortion impinged fundamental right abortion recognized wade progeny view district misconceived nature scope fundamental right recognized roe doctrine roe wade held maher protects woman unduly burdensome interference freedom decide whether terminate pregnancy severe criminal sanctions issue roe wade supra absolute requirement spousal consent abortion challenged planned parenthood central missouri danforth constitutional freedom recognized wade progeny maher explained prevent connecticut making value judgment favoring childbirth abortion implement ing judgment allocation public funds elaborated connecticut regulation us different kind laws invalidated previous abortion decisions connecticut regulation places obstacles absolute otherwise pregnant woman path abortion indigent woman desires abortion suffers disadvantage consequence connecticut decision fund childbirth continues dependent private sources service desires state may made childbirth attractive alternative thereby influencing woman decision imposed restriction access abortions already indigency may make difficult cases perhaps impossible women abortions neither created way affected connecticut regulation ibid hyde amendment like connecticut welfare regulation issue maher places governmental obstacle path woman chooses terminate pregnancy rather means unequal subsidization abortion medical services encourages alternative activity deemed public interest present case differ factually maher insofar case involved failure fund nontherapeutic abortions whereas hyde amendment withholds funding certain medically necessary abortions accordingly appellees argue hyde amendment affects significant interest present asserted maher interest woman protecting health pregnancy interest lies core personal constitutional freedom recognized wade present case constitutionally different maher appellees view extent hyde amendment withholds funding certain medically necessary abortions clearly impinges constitutional principle recognized wade evident woman interest protecting health important theme wade concluding freedom woman decide whether terminate pregnancy falls within personal liberty protected due process clause wade emphasized fact woman decision carries significant personal health implications physical psychological fact although wade recognized state interest protecting potential life becomes sufficiently compelling period fetal viability justify absolute criminal prohibition nontherapeutic abortions held even fetal viability state may prohibit abortions necessary preserve life health mother even compelling interest state protecting potential life fetal viability held insufficient outweigh woman decision protect life health argued freedom woman decide whether terminate pregnancy health reasons fact lie core constitutional liberty identified wade regardless whether freedom woman choose terminate pregnancy health reasons lies core periphery due process liberty recognized wade simply follow woman freedom choice carries constitutional entitlement financial resources avail full range protected choices reason explained maher although government may place obstacles path woman exercise freedom choice need remove creation indigency falls latter category financial constraints restrict indigent woman ability enjoy full range constitutionally protected freedom choice product governmental restrictions access abortions rather indigency although congress opted subsidize medically necessary services generally certain medically necessary abortions fact remains hyde amendment leaves indigent woman least range choice deciding whether obtain medically necessary abortion congress chosen subsidize health care costs thus persuaded hyde amendment impinges constitutionally protected freedom choice recognized wade although liberty protected due process clause affords protection unwarranted government interference freedom choice context certain personal decisions confer entitlement funds may necessary realize advantages freedom hold otherwise mark drastic change understanding constitution government may prohibit use contraceptives griswold connecticut prevent parents sending child private school pierce society sisters government therefore affirmative constitutional obligation ensure persons financial resources obtain contraceptives send children private schools translate limitation governmental power implicit due process clause affirmative funding obligation require congress subsidize medically necessary abortion indigent woman even congress enacted medicaid program subsidize medically necessary services nothing due process clause supports extraordinary result whether freedom choice constitutionally protected warrants federal subsidization question congress answer matter constitutional entitlement accordingly conclude hyde amendment impinge due process liberty recognized wade appellees also argue hyde amendment contravenes rights secured religion clauses first amendment appellees view hyde amendment violates establishment clause incorporates law doctrines roman catholic church concerning sinfulness abortion time life commences moreover insofar woman decision seek medically necessary abortion may product religious beliefs certain protestant jewish tenets appellees assert funding limitations hyde amendment impinge freedom religion guaranteed free exercise clause well settled legislative enactment contravene establishment clause secular legislative purpose principal primary effect neither advances inhibits religion foster excessive governmental entanglement religion committee public education regan applying standard district properly concluded hyde amendment run afoul establishment clause although neither state federal government constitutionally pass laws aid one religion aid religions prefer one religion another everson board education follow statute violates establishment clause happens coincide harmonize tenets religions mcgowan maryland religions oppose stealing mean state federal government may consistent establishment clause enact laws prohibiting larceny ibid hyde amendment district noted much reflection traditionalist values towards abortion embodiment views particular religion see also roe wade sum convinced fact funding restrictions hyde amendment may coincide religious tenets roman catholic church without contravene establishment clause need address merits appellees arguments concerning free exercise clause appellees lack standing raise free exercise challenge hyde amendment named appellees fall three categories indigent pregnant women sued behalf women similarly situated two officers women division women division named appellees first category lack standing challenge hyde amendment free exercise grounds none alleged much less proved sought abortion compulsion religious belief see mcgowan maryland supra although named appellees second category provide detailed description religious beliefs failed allege either expect pregnant eligible receive medicaid named appellees therefore lack personal stake controversy needed confer standing raise challenge hyde amendment see warth seldin finally although women division alleged membership includes pregnant medicaid eligible women matter religious practice accordance conscientious beliefs choose precluded discouraged obtaining abortions reimbursed medicaid hyde amendment women division satisfy standing requirements organization assert rights membership one requirements neither claim asserted relief requested requires participation individual members lawsuit hunt washington apple advertising since necessary free exercise case one show coercive effect enactment operates practice religion abington school dist schempp claim asserted one ordinarily requires individual participation present case women division concedes permissibility advisability necessity abortion according circumstance matter diversity view within membership determination must ultimately absolutely entrusted conscience individual god thus clear participation individual members women division essential proper understanding resolution free exercise claims accordingly conclude women division along named appellees lack standing challenge hyde amendment free exercise clause remains determined whether hyde amendment violates equal protection component fifth amendment challenge premised fact although federal reimbursement available medicaid medically necessary services generally hyde amendment permit federal reimbursement medically necessary abortions district held appellees argue selective subsidization violates constitutional guarantee equal protection guarantee equal protection fifth amendment source substantive rights liberties rather right free invidious discrimination statutory classifications governmental activity well settled statutory classification impinge right liberty protected constitution validity classification must sustained unless classification rests grounds wholly irrelevant achievement legitimate governmental objective mcgowan maryland presumption constitutional validity however disappears statutory classification predicated criteria constitutional sense suspect principal example classification based race brown board education reasons stated already concluded hyde amendment violates constitutionally protected substantive rights conclude well predicated constitutionally suspect classification reaching conclusion draw guidance decision maher roe whether connecticut welfare regulation providing funds childbirth nontherapeutic abortions discriminated suspect class maher observed indigent woman desiring abortion come within limited category disadvantaged classes recognized cases fact impact regulation falls upon pay lead different conclusion sense every denial welfare indigent creates wealth classification compared nonindigents able pay desired goods services never held financial need alone identifies suspect class purposes equal protection analysis citing san antonio independent school dist rodriguez dandridge williams view present case indistinguishable maher respect maher principal impact hyde amendment falls indigent fact render funding restriction constitutionally invalid held repeatedly poverty standing alone suspect classification see james valtierra maher involved refusal fund nontherapeutic abortions whereas present case involves refusal fund medically necessary abortions bearing factors render classification suspect within meaning constitutional guarantee equal protection remaining question whether hyde amendment rationally related legitimate governmental objective government position hyde amendment bears rational relationship legitimate interest protecting potential life fetus agree wade recognized state important legitimate interest protecting potentiality human life interest found exist throughout pregnancy grow ing substantiality woman approaches term see also beal doe moreover maher held connecticut decision fund costs associated childbirth associated nontherapeutic abortions rational means advancing legitimate state interest protecting potential life encouraging childbirth see also poelker doe follows hyde amendment encouraging childbirth except urgent circumstances rationally related legitimate governmental objective protecting potential life subsidizing medical expenses indigent women carry pregnancies term subsidizing comparable expenses women undergo abortions except whose lives threatened congress established incentives make childbirth attractive alternative abortion persons eligible medicaid incentives bear direct relationship legitimate congressional interest protecting potential life irrational congress authorized federal reimbursement medically necessary services generally certain medically necessary abortions abortion inherently different medical procedures procedure involves purposeful termination potential life conducting extensive evidentiary hearing issues surrounding public funding abortions district concluded interests federal government fetus preserving sufficient weighed balance woman threatened health justify withdrawing medical assistance unless woman consents carry fetus term making independent appraisal competing interests involved district went beyond judicial function decisions entrusted constitution congress courts role courts ensure congressional decisions comport constitution congress neither invaded substantive constitutional right freedom enacted legislation purposefully operates detriment suspect class requirement equal protection congressional action rationally related legitimate governmental interest hyde amendment satisfies standard mission decide whether balance competing interests reflected hyde amendment wise social policy mission every justice subscribed judgment today done name constitution overturn duly enacted statutes simply may unwise improvident harmony particular school thought williamson lee optical quoted dandridge williams rather issue involves policy choices sensitive implicated appropriate forum resolution democracy legislature maher roe supra iv reasons stated opinion hold state participates medicaid program obligated title xix continue fund medically necessary abortions federal reimbursement unavailable hyde amendment hold funding restrictions hyde amendment violate neither fifth amendment establishment clause first amendment also view appellees lack standing raise challenge hyde amendment free exercise clause first amendment accordingly judgment district reversed case remanded proceedings consistent opinion ordered footnotes department health education welfare recently reorganized divided department health human services department education original designation retained purposes opinion appropriations hew october november first two months fiscal year provided joint resolutions continued effect version hyde amendment applicable fiscal year pub stat pub stat opinion term hyde amendment used generically refer three versions hyde amendment except indicated otherwise although appellees secretary direct appeal see rule term appellees used opinion refer parties plaintiffs district trial conducted august september produced record containing documentary film exhibits transcript exceeding pages mcrae califano supp district found establishment clause infirmity view hyde amendment secular legislative purpose principal effect neither advances inhibits religion foster excessive governmental entanglement religion district also apparently concluded hyde amendment operates disadvantage suspect class namely teenage women desiring medically necessary abortions see infra although original class included pregnant women first two trimesters pregnancy recertified class included pregnant women regardless stage pregnancy appellees argue interpretation title xix finds support beal doe considered question whether title xix permits participating state exclude abortions medicaid plan although concluding title xix preclude state refusal fund unnecessary though perhaps desirable medical services observed serious statutory questions might presented state medicaid plan excluded necessary medical treatment coverage emphasis original beal however address possible effect hyde amendment upon operation title xix preterm dukakis opinion judge coffin noted medicaid program one federal state cooperation funding medical assistance complete withdrawal federal prop system intent drop total cost providing service upon runs directly counter basic structure program seriously cripple state attempts provide necessary medical services embraced plan omitted subsequent congresses deviated original structure title xix obligating participating state assume full costs service prerequisite continued federal funding services always expressed intent unambiguous terms see zbaraz quern since title xix provides variations required coverage state medicaid plans depending changes availability federal reimbursement need inquire district whether hyde amendment substantive amendment title xix present case thus different tva hill issue whether continued appropriations tellico dam impliedly repealed substantive requirements endangered species act prohibiting continued construction dam threatened natural habitat endangered species conclusion congress enacted title xix intend participating state assume unilateral funding obligation health service approved medicaid plan corroborated fact subsequent congresses simply assumed withdrawal federal funding hyde amendment certain medically necessary abortions relieve participating state obligation provide services medicaid plan see cases cited text supra participating state free chooses include medicaid plan medically necessary abortions federal reimbursement unavailable see beal doe preterm dukakis supra hold state need include abortions medicaid plan appellees also argue hyde amendment unconstitutionally vague insofar physicians unable understand implement exceptions hyde amendment abortions reimbursable conclusion however hyde amendment void vagueness sanction provision medicaid act contains clear scienter requirement errors penalized see colautti franklin event exceptions hyde amendment set terms ordinary person exercising ordinary common sense sufficiently understand comply without sacrifice public interest broadrick oklahoma wade observed previous decisions recognized liberty protected due process clause extension activities relating marriage loving virginia procreation skinner oklahoma contraception eisenstadt baird white concurring result family relationships prince massachusetts child rearing education pierce society sisters meyer nebraska appellees argue hyde amendment unconstitutional penalizes exercise woman choice terminate pregnancy abortion see memorial hospital maricopa county shapiro thompson argument falls short mark maher found semantic difference argument connecticut refusal subsidize nontherapeutic abortions unduly interfere exercise constitutional liberty recognized wade argument penalized exercise liberty regardless claim characterized maher rejected argument connecticut refusal subsidize protected conduct without impinged constitutional freedom choice reasoning equally applicable present case substantial constitutional question arise congress attempted withhold medicaid benefits otherwise eligible candidate simply candidate exercised constitutionally protected freedom terminate pregnancy abortion analogous sherbert verner held state may consistent first fourteenth amendments withhold unemployment compensation benefits claimant otherwise eligible benefits fact unwilling work one day per week sabbath hyde amendment unlike statute issue sherbert provide broad disqualification receipt public benefits rather hyde amendment like connecticut welfare provision issue maher represents simply refusal subsidize certain protected conduct refusal fund protected activity without equated imposition penalty activity maher observed constitution imposes obligation government pay medical expenses indigent women indeed pay medical expenses indigents since constitutional entitlement physician administers medical care indigent woman broader patient see whalen roe also reject appellees claim funding restrictions hyde amendment violate due process rights physician advises medicaid recipient obtain medically necessary abortion remaining named appellees including individual physicians new york city health hospitals attack hyde amendment basis free exercise clause first amendment named appellees sued behalf class women religious nonreligious persuasions beliefs accordance teaching religion dictates conscience determined abortion necessary since conclude named appellees established standing sue hey represent class part bailey patterson see also littleton example board education allen found free exercise violation since plaintiffs contended statute question way coerce individuals practice religion emphasis added exception statement found reynolds sims progeny although constitution confer right vote state elections see minor happersett wall reynolds held state adopts electoral system equal protection clause fourteenth amendment confers upon qualified voter substantive right participate electoral process equally qualified voters see dunn blumstein although matter free doubt district seems concluded teenage women desiring medically necessary abortions constitute suspect class purposes triggering heightened level equal protection scrutiny regard district observed hyde amendment clearly operate disadvantage one suspect class disadvantage statutory class adolescents high risk pregnancy particularly seventeen statutory class district referring derived adolescent health services pregnancy prevention care act et seq supp ii apparently view district since statistics indicate women years age disproportionately represented among abortion medically necessary hyde amendment invidiously discriminates teenage women hyde amendment facially neutral age restricting funding abortions women ages district erred therefore relying solely disparate impact hyde amendment concluding discriminated basis age equal protection component fifth amendment prohibits purposeful discrimination washington davis facially neutral federal statute challenged equal protection grounds incumbent upon challenger prove congress selected reaffirmed particular course action least part merely spite adverse effects upon identifiable group personnel administrator mass feeney evidence support finding intent present case address constitutionality restrictive version hyde amendment namely applicable fiscal year federal funds unavailable abortions except life mother endangered fetus carried term three versions hyde amendment issue case restrictive version constitutionally valid others fact abortion medically necessary service federal funds medicaid sometimes unavailable otherwise eligible claimants see inpatient hospital care patients institutions tuberculosis mental disease covered title xix justice white concurring join opinion judgment additional remarks roe wade held prior viability fetus governmental interest potential life insufficient justify overriding due process right pregnant woman terminate pregnancy abortion last trimester however state interest fetal life deemed sufficiently strong warrant ban abortions continuing pregnancy threaten life health mother latter event state required respect choice mother terminate pregnancy protect health drawing upon roe wade cases followed justice stevens dissent extrapolates general proposition governmental interest potential life may event pursued expense mother health notes hyde amendment medicaid refuses fund abortions carrying term threatens maternal health finances medically indicated procedures including childbirth dissent submits hyde amendment therefore fails first requirement imposed fifth amendment recognized opinion today challenged official action must serve legitimate governmental goal ante argument certain internal logic legally sound constitutional right recognized roe wade right choose undergo abortion without coercive interference government points roe wade purport adjudicate right abortions funded government free unreasonable official interference private choice appropriate stage pregnancy example abortions prohibited implement governmental interest potential life case damage health mother whose choice suffer abortion rather risk health government forced respect roe wade thus dealt circumstances governmental interest potential life justify official interference abortion choices pregnant women calculus involved government seek interfere impose coercive restraint choice woman abortion woman choice remains unfettered government attempting use interest life justify coercive restraint hence disbursing medicaid funds free implement rationally roe wade recognized legitimate interest potential life covering medical costs childbirth denying funds abortions neither roe wade cases decided wake invalidates legislative preference decided much maher roe rejected claims refusing funds nontherapeutic abortions defraying medical costs childbirth although outright prohibition nevertheless infringed fundamental right choose terminate pregnancy abortion also violated equal protection component fifth amendment abandon maher extend roe wade forbid legislative policy expressed hyde amendment maher successfully distinguished ground involved nontherapeutic abortions government free place outside ambit medicaid program ground maher proceeded maher held government need fund elective abortions withholding funds rationally furthered state legitimate interest normal childbirth sustained policy even though roe wade government interest fetal life inadequate justification coercive interference pregnant woman right choose abortion whether procedure medically indicated already held therefore interest balancing involved roe wade controlling resolving present constitutional issue accordingly satisfied straightforward analysis followed justice stewart opinion sound justice brennan justice marshall justice blackmun join dissenting agree entirely brother stevens state interest protecting potential life fetus justify exclusion financially medically needy women benefits otherwise entitled solely treatment doctor concluded medically necessary involves abortion see post write separately express continuing disagreement mischaracterization nature fundamental right recognized roe wade misconception manner right infringed federal state legislation withdrawing funding medically necessary abortions roe wade held constitutional right personal privacy encompasses woman decision whether terminate pregnancy roe progeny established pregnant woman right free state interference choice abortion right least prior end first trimester absolutely prohibits governmental regulation highly personal decision proposition cases stand thus state affirmative obligation ensure access abortions may desire state must refrain wielding enormous power influence manner might burden pregnant woman freedom choose whether abortion hyde amendment denial public funds medically necessary abortions plainly intrudes upon constitutionally protected decision design effect serves coerce indigent pregnant women bear children otherwise elect viewed context medicaid program appended obvious hyde amendment nothing less attempt congress circumvent dictates constitution achieve indirectly roe wade said directly title xix social security act federal government reimburses participating virtually medically necessary services provides categorically needy sole limitation significance hyde amendment prohibition use federal funds pay costs abortions except life mother endangered fetus carried term brother stevens persuasively demonstrates exclusion medically necessary abortions medicaid coverage justified device rather hyde amendment transparent attempt legislative branch impose political majority judgment morally acceptable socially desirable preference sensitive intimate decision constitution entrusts individual worse yet hyde amendment foist majoritarian viewpoint equal measure upon everyone nation rich poor alike rather imposes viewpoint upon segment society position political powerlessness least able defend privacy rights encroachments morality instant legislation thus calls exacting judicial review cases elected leaders cower public pressure ever must shirk duty enforce constitution benefit poor powerless beal doe marshall dissenting though may mission decide whether balance competing interests reflected hyde amendment wise social policy ante assuredly responsibility vindicate pregnant woman constitutional right decide whether bear children free governmental intrusion moreover clear hyde amendment designed inhibit fact inhibit woman freedom choose abortion childbirth pregnancy unquestionably condition requiring medical services treatment condition may involve medical procedures termination medical procedures bring pregnancy term resulting live birth bortion childbirth stripped sensitive moral arguments surrounding abortion controversy simply two alternative medical methods dealing pregnancy beal doe supra brennan dissenting quoting roe norton supp every pregnancy one two courses treatment medically necessary woman depends medicaid act pay expenses associated procedure hyde amendment government fund procedures incidental childbirth thus injecting coercive financial incentives favoring childbirth decision constitutionally guaranteed free governmental intrusion hyde amendment deprives indigent woman freedom choose abortion maternity thereby impinging due process liberty right recognized roe wade contrary conclusion premised belief financial constraints restrict indigent woman ability enjoy full range constitutionally protected freedom choice product governmental restrictions access abortions rather indigency ante accurate statement may reveals half picture fails appreciate simply woman indigency interferes freedom choice combination poverty government unequal subsidization abortion childbirth poor woman early stages pregnancy confronts two alternatives may elect either carry fetus term abortion abstract course choice alone rightly observes hyde amendment places governmental obstacle path woman chooses terminate pregnancy ante reality situation hyde amendment effectively removed choice indigent woman hands funding expenses associated childbirth none expenses incurred terminating pregnancy government literally makes offer indigent woman afford refuse matters instance government used carrot rather stick critical realization practical matter many woman choose carry pregnancy term simply government provides funds associated medical services even though women chosen abortion government also paid option indeed government stayed picture altogether defrayed costs neither procedure fundamental flaw due process analysis failure acknowledge discriminatory distribution benefits governmental largesse discourage exercise fundamental liberties effectively outright denial rights criminal regulatory sanctions implicit reasoning notion long government obligated provide citizens certain benefits privileges may condition grant benefits recipient relinquishment constitutional rights belabor obvious expound great length illegitimacy state policy interferes exercise fundamental rights selective bestowal governmental favors suffices note heretofore never hesitated invalidate scheme granting withholding financial benefits incidentally intentionally burdens one manner exercising constitutionally protected choice take one example many sherbert verner involved south carolina unemployment insurance statute required recipients accept suitable employment offered even grounds refusal stemmed religious convictions even though recipients possessed entitlement compensation held state cancel benefits adventist refused job requiring work saturdays explanation particularly instructive present case apparent appellant declared ineligibility benefits derives solely practice religion pressure upon forego practice unmistakable ruling forces choose following precepts religion forfeiting benefits one hand abandoning one precepts religion order accept work hand governmental imposition choice puts kind burden upon free exercise religion fine imposed appellant saturday worship may south carolina construction statute saved constitutional infirmity ground unemployment compensation benefits appellant right merely privilege late day doubt liberties religion expression may infringed denial placing conditions upon benefit privilege condition availability benefits upon appellant willingness violate cardinal principle religious faith effectively penalizes free exercise constitutional liberties medicaid program distinguished statutory schemes unconstitutionally burdened fundamental rights sherbert government withholds financial benefits manner discourages exercise due process liberty indigent woman chooses assert constitutional right abortion pain sacrificing benefits otherwise entitled years ago justice sutherland writing frost frost trucking railroad supra made following observation true palpable incongruity strike act state legislation words express divestment seeks strip citizen rights guaranteed federal constitution uphold act result accomplished guise surrender right exchange valuable privilege state threatens otherwise withhold necessary challenge proposition general rule state power deny privilege altogether may grant upon conditions sees fit impose power state respect unlimited one limitations may impose conditions require relinquishment constitutional rights state may compel surrender one constitutional right condition favor may like manner compel surrender inconceivable guaranties embedded constitution may thus manipulated existence opinion applies also williams et al zbaraz et miller acting director illinois department public aid et al zbaraz et zbaraz et post see maher roe brennan dissenting doe bolton planned parenthood central missouri danforth singleton wulff bellotti baird cf carey population services international first trimester state promoting interest mother health may regulate abortion procedure ways reasonably related end even point viability reached state regulation furtherance interest potentiality human life may go far proscribe abortions necessary preserve life health mother see roe wade focus throughout opinion upon coercive impact congressional decision fund one outcome pregnancy childbirth funding abortion believe alone renders hyde amendment unconstitutional dwell upon disparities amendment produces treatment rich poor pregnant nonpregnant concur completely however brother stevens discussion disparities specifically agree congressional decision fund medically necessary procedures except require abortion entirely irrational either means allocating resources otherwise serving legitimate social welfare goals irrationality turn exposes amendment really deliberate effort discourage exercise constitutionally protected right important put congressional decision human terms nonpregnant women may reimbursed medically necessary treatments pregnant women analogous ailments however reimbursed treatment involved happen include abortion since refusal fund significant number cases force patient forgo medical assistance result refuse treatment genuine maladies need treated treated expensive treat relate deliberate choice abort pregnancy merely treating practical matter require termination pregnancy even one view legislative hostility abortions justify decision fund obstetrics child delivery services refusing fund nontherapeutic abortions present statutory scheme saved hostility gone good deal farther consequence leave indigent sick women without treatment simply medical fortuity illness treated unless pregnancy terminated antipathy abortion short permitted ride roughshod woman constitutional right terminate pregnancy fashion chooses also distort nation programs means delivering health services hyde amendment completely irrational means preventing abortions concededly rational brutally latter goal constitutionally forbidden cf singleton wulff supra doctor afford work nothing woman afford pay state refusal fund abortion effective interdiction ever necessary rather summarily rejects argument hyde amendment unconstitutionally penalizes woman exercise right choose abortion comment refusal fund protected activity without equated imposition penalty activity ante begin overlooks fact simple refusal fund protected activity case instead program selectively funds one two choices constitutionally protected decision thereby penalizing election disfavored option moreover answer assert penalty imposed state refusing pay specific costs protected activity rather withholding medicaid benefits recipient entitled taking action readily characterized punitive surely government provide free transportation polling booths citizens vote democratic candidates even though failure provide benefit republicans represents simply refusal subsidize certain protected conduct involve denial governmental benefits whether state withholds special costs disfavored option penalizes individual broadly manner exercises choice interfere constitutionally protected decision coercive use governmental largesse justice marshall dissenting three years ago maher roe upheld state program excluded nontherapeutic abortions welfare program generally subsidized medical expenses incidental pregnancy childbirth time expressed fear decisions invitation public officials already extraordinary pressure carefully orchestrated lobbying campaigns approve restrictions governmental funding abortion dissenting maher roe supra beal doe poelker doe fear proved justified hyde amendment federal funding denied abortions medically necessary necessary avert severe permanent damage health mother opinion studiously avoids recognizing undeniable fact women eligible medicaid poor women denial abortion equivalent denial legal abortion altogether definition women money pay abortion abortion medically necessary funded abortion unavailable must resort butchers attempt induce abortion crude dangerous methods suffer serious medical consequences attempting carry fetus term legal abortion realistic option women predictable result hyde amendment significant increase number poor women die suffer significant health damage inability procure necessary medical services legislation us product effort deny poor constitutional right recognized roe wade even though cost may serious health damage brother stevens demonstrated see post dissenting opinion premise underlying hyde amendment repudiated roe wade made clear state interest protecting fetal life justify jeopardizing life health mother denial medicaid benefits individuals meet statutory criteria eligibility solely treatment medically necessary involves exercise fundamental right chose abortion form discrimination repugnant equal protection laws guaranteed constitution decision today marks retreat roe wade represents cruel blow powerless members society dissent present form hyde amendment restricts federal funding abortion cases life mother endangered fetus carried term medical procedures necessary victims rape incest rape incest reported promptly law enforcement agency public health service see ante federal funding thus unavailable even severe health damage mother virtual certainty federal funds available severe health damage even death result fetus carried term record developed reveals standards set forth hyde amendment exclude majority cases medical profession recommend abortion medically necessary indeed adopted standard restrictive medically necessary test medicaid act number funded abortions decreased app impact hyde amendment indigent women falls four major categories first hyde amendment prohibits federal funding abortions necessary order protect health sometimes life mother numerous conditions cancer rheumatic fever diabetes malnutrition phlebitis sickle cell anemia heart disease substantially increase risks associated pregnancy aggravated pregnancy conditions may make abortion medically necessary judgment physician funded hyde amendment health risks undergoing abortion increase dramatically pregnancy becomes advanced time pregnancy progressed point physician able certify endangers life mother many cases late prevent death abortion longer safe also instances woman life immediately threatened carrying pregnancy term aggravation another medical condition significantly shorten life expectancy cases well fundable hyde amendment second federal funding denied cases severe mental disturbances created unwanted pregnancies result psychological disturbances may suicide attempts child abuse hyde amendment makes provision funding cases third hyde amendment denies funding majority women whose pregnancies caused rape incest prerequisite report within days serves exclude afraid recounting happened fear unsympathetic treatment authorities requirement course especially burdensome indigent may least likely aware rapid report authorities indispensable order able obtain abortion finally federal funding unavailable cases known fetus unable survive number situations possible determine advance fetus suffer early death carried term hyde amendment purportedly designed safeguard legitimate governmental objective protecting potential life ante excludes federal funding cases optimistic estimate indicates many excess deaths may occur year result hyde amendment record contains estimate health damage may occur poor women shows considerable ii resolves equal protection issue case relentlessly formalistic catechism adhering approach equal protection first decides strict scrutiny required hyde amendment violate due process clause predicated constitutionally suspect classification therefore validity classification must sustained unless classification rests grounds wholly irrelevant achievement legitimate governmental objective ante bracketed material original quoting mcgowan maryland observing previous cases recognized legitimate governmental objective protecting potential life ante concludes hyde amendment establishe incentives make childbirth attractive alternative abortion persons eligible medicaid therefore rationally related governmental interest continue believe rigid approach inappropriate constitution requires exacting standard review mere rationality cases one judgment hyde amendment pass constitutional muster even standard review case perhaps dramatic illustration date deficiencies obsolete approach equal protection clause see san antonio independent school dist rodriguez marshall dissenting massachusetts bd retirement murgia marshall dissenting maher roe marshall dissenting vance bradley marshall dissenting deference unable understand afford level scrutiny legislation involved whose cruel impact falls exclusively indigent pregnant women given legislation distinguishing opticians ophthalmologists legislation makes distinctions economic interests able protect political process see ante citing williamson lee optical heightened scrutiny legislative classifications always designed protect groups saddled disabilities subjected history purposeful unequal treatment relegated position political powerlessness command extraordinary protection majoritarian political process san antonio independent school dist rodriguez supra clear traditional strict scrutiny unavailable protect poor classifications disfavor dandridge williams believe legislation imposes crushing burden indigent women treated deference given legislation distinguishing among business interests hyde amendment course distinguishes medically necessary abortions medically necessary expenses explained maher roe supra classifications must assessed weighing importance governmental benefits denied character class asserted state interests quoting massachusetts bd retirement murgia supra approach hyde amendment clearly invalid maher governmental benefits issue absolutely vital importance lives recipients maher roe supra marshall dissenting indigent woman denied governmental funding medically necessary abortion confronted two grotesque choices first may seek obtain illegal abortion poses serious threat health even life alternatively may attempt bear child course may significantly threaten health eliminate chance might control direction life class burdened hyde amendment consists indigent women substantial proportion members minority races observed maher nonwhite women obtain abortions nearly double rate whites ibid view fact burden hyde amendment falls exclusively financially destitute women suggests special condition tends seriously curtail operation political processes ordinarily relied upon protect minorities may call correspondingly searching judicial inquiry carolene products reason continue believe showing state action devastating impact lives minority racial groups must relevant purposes equal protection analysis jefferson hackney marshall dissenting explained maher asserted state interest protecting potential life insufficient outweigh deprivation serious discouragement vital constitutional right especial importance poor minority women maher found permissible state interest encouraging normal childbirth governmental interest present case substantially weaker maher hyde amendment funding refused even cases normal childbirth result one scarcely speak normal childbirth cases fetus die shortly birth mother life shortened health otherwise gravely impaired birth nevertheless hyde amendment denies funding even cases circumstances unable see even minimally rational legislature conclude interest fetal life outweighs brutal effect hyde amendment indigent women moreover legislation maher hyde amendment designed deprive poor minority women constitutional right choose abortion purpose constitutionally permitted roe wade although abandon dichotomy equal protection analysis means necessary reject traditional approach conclude hyde amendment denial equal protection brother brennan demonstrated amendment unconstitutional impermissibly infringes upon individual constitutional right decide whether terminate pregnancy see ante dissenting opinion brother stevens demonstrates see post dissenting opinion government interest protecting fetal life legitimate one conflict preservation life health mother roe wade government effort make serious health damage mother attractive alternative abortion ante rationally promote governmental interest encouraging normal childbirth treats case though controlled maher contrary case mirror image maher result maher turned fact legislation consideration discouraged medically unnecessary abortions view denial medicaid funding nontherapeutic abortions denial equal protection medicaid funds available medically necessary procedures thus plaintiffs seeking benefits available others similarly situated continue believe maher wrongly decided apparent plaintiffs maher seeking benefit available others similarly situated appellees protesting exclusion benefit available others similarly situated need hardly said crucial difference equal protection purposes title xix hyde amendment funding available essentially necessary medical treatment poor appellees met statutory requirements eligibility excluded treatment medically necessary involves exercise fundamental right right choose abortion short appellees deprived governmental benefit otherwise eligible solely attempted exercise constitutional right interest asserted government protection fetal life declared constitutionally subordinate appellees interest preserving lives health obtaining medically necessary treatment roe wade supra finally purpose legislation discourage exercise fundamental right circumstances hyde amendment must invalidated meet even standard review iii consequences today opinion consequences seems oblivious difficult predict pregnant women denied funding necessary procure abortions restricted two alternatives first carry fetus term even though route may result severe injury death mother fetus course appears intolerable resort abortions attempt obtain illegal abortions bearing child inconvenient necessary order protect health result protect describes legitimate governmental objective protecting potential life ante ensure destruction fetal maternal life another world existence either chooses ignore fears recognize beal doe blackmun dissenting view blinding world reach result announces today ultimately result reached today may traced unwillingness apply constraints constitution decisions involving expenditure governmental funds today decision maher roe suggests withholding funding imposes real obstacle woman deciding whether exercise constitutionally protected procreative choice even though government prepared fund medically necessary expenses including expenses childbirth perceives result simply distinction limitation governmental power affirmative funding obligation ante poor person attempting exercise right freedom choice difference imperceptible brother brennan shown see ante dissenting opinion differential distribution incentives concedes present see ante precisely effect outright prohibition sufficient answer roe wade say appropriate forum resolution sensitive policy choices legislature see ante quoting maher roe years ago justice jackson observed task translating majestic generalities bill rights concrete restraints officials dealing problems twentieth century one disturb west virginia state bd education barnette constitutional principles observed grew soil also produced philosophy individual liberty attainable mere absence governmental restraints ibid principles must transplant ed soil concept principle withered least economic affairs social advancements increasingly sought closer integration society expanded strengthened governmental controls case federal government taken upon burden financing practically medically necessary expenditures one category medically necessary expenditure singled exclusion sole basis exclusion premise repudiated purposes constitutional law roe wade consequence devastating impact lives health poor women believe constitution committed equal protection laws tolerate result dissent opinion applies also williams et al zbaraz et miller acting director illinois department public aid et al zbaraz et zbaraz et post see app example number serious complications deriving abortions estimated times number deaths abortions see number individual justices expressed discomfort approach pleased observe hold law may waning see craig boren powell concurring stevens concurring post stevens dissenting adopted intermediate level scrutiny variety classifications see trimble gordon illegitimacy craig boren supra sex discrimination foley connelie alienage cf university california regents bakke opinion brennan white marshall blackmun jj affirmative action reason occasion suggested classifications discriminating poor subject special scrutiny fifth fourteenth amendments see mcdonald board election harper virginia bd elections brother stevens suggests see post dissenting opinion denial funding medically necessary services excluded medicaid program based desire conserve federal funds desire penalize suffer excluded disabilities practical effect approach context dissimilar taken craig boren supra referred intermediate standard review requiring classifications must serve important governmental objectives must substantially related achievement objectives course poor women attempt raise funds necessary obtain lawful abortion recently found fortunate enough resort paying rent utility bills pawning household goods diverting food clothing money journeying another state obtain lower rates fraudulently use relative insurance policy ome patients driven theft women health services maher supp justice blackmun dissenting join dissent justice brennan agree wholeheartedly justice stevens respective observations descriptions latest round abortion cases need add find said dissent beal doe two companion cases maher roe poelker doe continues equally pertinent equally applicable hyde amendment cases condescension holding may go elsewhere abortion disingenuous alarming government punitively impresses upon needy minority concepts socially desirable publicly acceptable morally sound financial argument course specious truly another world existence suspect either chooses ignore fears recognize cancer poverty continue grow lot poorest among us still bettered opinion applies also williams et al zbaraz et miller acting director illinois department public aid et al zbaraz et zbaraz et post justice stevens dissenting federal sovereign like must govern impartially concept equal justice law served fifth amendment guarantee due process well equal protection clause fourteenth amendment hampton mow sun wong sovereign provides special benefit special protection class persons must define membership class neutral criteria may make special exceptions reasons constitutionally insufficient fundamentally different question decided maher roe unlike plaintiffs plaintiffs maher satisfy neutral criterion medical need sought subsidy nontherapeutic abortions medical procedures definition need rejecting claim held constitutional right choose procedure impose duty state subsidize exercise right fact state undertaken pay necessary medical care associated childbirth require state also pay abortions necessary necessary medical procedures satisfied neutral statutory criteria nontherapeutic abortions simply outside ambit medical benefits program thus maher plaintiffs desire exercise constitutional right gave rise neither special access special exclusion pool benefits created title xix cases involve special exclusion women definition confronted choice two serious harms serious health damage one hand abortion competing interests interest maternal health interest protecting potential human life part law pregnant woman decision conflicting interests shall prevail entitled constitutional protection roe wade doe bolton recognized legitimate protectible interest potential human life explicitly held prior fetal viability interest may justify governmental burden woman choice abortion even regulation abortion except furtherance state interest woman health effect held woman freedom elect abortion prior viability absolute constitutional protection subject valid health regulations indeed roe wade held even fetal viability state may regulate even proscribe abortion except necessary appropriate medical judgment preservation life health mother emphasis added duty respect holding simply shirks duty case woman constitutional right place higher value avoiding either serious harm health perhaps abnormal childbirth protecting potential life exercise right provide basis denial benefit otherwise entitled sterile equal protection analysis evades critical though simple point focuses exclusively legitimate interest protecting potential life fetus ante concludes since hyde amendments interest exclusion create rational therefore constitutional misleading speak government legitimate interest fetus without reference context interest held legitimate roe wade squarely held may protect interest conflict interest pregnant woman health exists thus perfectly clear neither federal government may exclude woman medical benefits otherwise entitled solely interest potential life physician appropriate medical judgment certifies abortion necessary preservation life health mother roe wade supra totally fails explain reasoning dispositive denied harm inflicted upon women excluded class grievous comparison differing forms hyde amendment enacted since demonstrates expressly approves exclusion benefits instances severe physical health damage mother predictable consequence carrying pregnancy term indeed solicitor general acknowledged commendable candor logic position justify holding constitutional deny funding medically financially needy person even abortion lifesaving medical procedure available denial benefits medically necessary abortions inevitably causes serious harm excluded women tantamount severe punishment judgment denial justified unless government may effect punish women want abortions unequivocally held roe wade government may argued exclusion type medically necessary treatment indigent justified fiscal grounds especially costly forms treatment may reasonably excluded program order preserve assets pool extend benefits maximum number needy persons fiscal considerations may compel certain difficult choices order improve protection afforded entire benefited class ironically exclusion medically necessary abortions harms entire class well specific victims records mcrae zbaraz demonstrate cost abortion small fraction costs associated childbirth thus decision tolerate harm indigent persons need abortion order avoid serious health damage one financed draining money pool used fund necessary medical procedures unlike invidious classifications discrimination harms direct victims also remainder class needy persons pool designed benefit maher stated constitution imposes obligation pay medical expenses indigent women indeed pay medical expenses indigents state decides alleviate hardships poverty providing medical care manner dispenses benefits subject constitutional limitations omitted respectfully dissent opinion applies also williams et al zbaraz et miller acting director illinois department public aid et al zbaraz et zbaraz et post roe wade held woman right decide whether abort pregnancy entitled constitutional protection decision part law planned parenthood central missouri danforth stevens concurring part dissenting part roe wade involved texas statutes making crime procure abortion except attempted save pregnant woman life doe bolton involved somewhat less onerous georgia statutes making abortion crime circumstances exceptions abortions save pregnant woman life permanent health endangerment cases likely irremediable birth defect child cases pregnancy result rape exceptions subject burdensome prior medical approvals held unconstitutional subsequent cases invalidated burdens pregnant woman free choice abort see planned parenthood central missouri danforth supra consent required husband unmarried woman parent bellotti baird consent required either parent superior judge unmarried woman rests heavily premise recognized roe maher state legitimate interest preserving potential life provides sufficient justification funding medical services necessarily associated normal childbirth without also funding abortions medically necessary maher opinion repeatedly referred policy favoring normal childbirth see case involves refusal fund abortions medically necessary avoid abnormal childbirth cases thus illustrate flaw method equal protection analysis one chooses among alternative levels scrutiny determines whether extent particular legislative measure furthers given governmental objective transcends predetermined threshold see craig boren stevens concurring method may simply bypass real issue relevant question cases whether must attach greater weight individual interest included class governmental interest keeping individual since roe wade squarely held individual interest freedom elect abortion state interest protecting maternal health outweigh state interest protecting potential life prior viability equal protection analysis doubly erroneous responding analysis case justice white described constitutional right recognized roe wade right choose undergo abortion without coercive interference government right free unreasonable official interference private choice ante language found roe opinion rather case squarely held state interference unreasonable attaches greater importance interest potential life interest protecting mother health one equal justification describe right protected first amendment right make speeches without coercive interference government sustain government subsidy medically needy persons except publicly advocate change administration record replete examples serious physical harm see judge dooling opinion mcrae califano supp women particularly young women suffering diabetes likely experience high risks health damage fetuses woman may become blind worsening pregnancy diabetic retinopathy case particularly juvenile diabetic eliot testified evidence series pregnancies advances diabetes faster given aggravated diabetic condition risks increased pregnancy kidney problems vascular problems extremities see also affidavit jane doe years old married four living children following birth third child november developed serious case phlebitis completely recovered carrying another pregnancy term greatly aggravate condition increase risk blood clots lung july went fertility control clinic hospital paul minnesota request abortion informed new law prohibits federal reimbursement abortions except necessary save life mother afford operation free afford pay abortion without medicaid reimbursement obtain safe legal abortion according doctor jane hodgson without abortion might suffer serious permanent health problems app pp see case jane doe nos recounted zbaraz affidavit jane doe years old nine previous pregnancies history varicose veins thrombophlebitis blood clots left leg varicose veins case caused multiple pregnancies weight uterus pelvic veins increased blood pressure veins lower extremities veins dilated circulation impaired resulting thrombophlebitis left leg varicosities lower extremities became severe required partial surgical removal given medical history jane doe varicose veins almost certain recur continues pregnancy recurrence require second operative procedure removal given medical history also risk thrombophlebitis recur pregnancy form deep vein thrombophlebitis surface veins left leg previously partially removed condition impair circulation might require prolonged hospitalization bed rest considering jane doe medical history varicose veins thrombophlebitis particularly background age multiple pregnancies view abortion medically necessary though necessary preserve life app nos question mr solicitor general make rational basis argument hyde amendment contain exception endangering life mother death rather adverse impact health involved mccree think tr oral arg respect cases entirely different maher repeatedly noted refusal subsidize nontherapeutic abortions merely result normal childbirth surely government may properly presume harm ensue normal childbirth rationale may satisfactorily explain exclusions medicaid program noted ante events safe assume exclusions conserve assets pool zbaraz case judge grady found average cost state illinois abortion less compared cost childbirth exceeded app juris statement indeed based estimated cost providing support children indigent parents together estimate number medically necessary abortions funded hyde amendment appellees zbaraz case contend state illinois alone effect hyde amendment impose cost per year public fisc brief appellees nos see also judge dooling conclusion debate hyde amendment years rider departmental appropriations bill quickly established restriction abortion funding economy measure recognized abortion performed medicaid eligible woman medicaid costs childbearing nurture greatly exceed cost abortion opponents funding restriction equally pains however make clear favor funding abortion means reducing government social welfare costs conclusion hyde amendments violate federal government duty impartiality applies equally illinois statute issue zbaraz