432 U.S. 464 (1977)
In 1975, the Connecticut Welfare Department regulation restricted Medicaid payments for first trimester abortions to those certified as medically necessary by the attending physician, a term that included psychiatric necessity, and required prior authorization from the Department of Social Services along with a written request from the patient or, for a minor, a parent or guardian.1 Appellant Maher, the Commissioner of Social Services of Connecticut, enforced the limitation through this system of certificates and approvals.2 Appellees Poe, a sixteen-year-old high school junior who had obtained an abortion for which the hospital later sought reimbursement of $244, and Roe, an unwed mother of three unable to obtain the required certificate, filed suit in the United States District Court for the District of Connecticut on behalf of themselves and a certified class of indigent women unable to secure Medicaid assistance for abortions because of the regulation.3
The complaint challenged the regulation as inconsistent with Title XIX of the Social Security Act and as violative of Fourteenth Amendment due process and equal protection guarantees.4 The district court initially held that Title XIX required state funding of nontherapeutic abortions.5 The Court of Appeals for the Second Circuit reversed that statutory ruling, holding that the Act permitted but did not require such funding, and remanded for consideration of the constitutional issues.6
On remand a three-judge district court was convened; it invalidated the regulation and enjoined enforcement of the medical necessity certificate requirement as well as the related prior written request and authorization procedures.7 The Supreme Court noted probable jurisdiction to review the constitutional validity of the Connecticut regulation.8
Whether the Constitution requires a participating State to pay for nontherapeutic abortions when it pays for childbirth?9
The Constitution imposes no obligation on the States to pay the pregnancy-related medical expenses of indigent women, or indeed to pay any of the medical expenses of indigents.10 But when a State decides to alleviate some of the hardships of poverty by providing medical care, the manner in which it dispenses benefits is subject to constitutional limitations.11 The basic framework of equal protection analysis requires deciding first whether legislation operates to the disadvantage of some suspect class or impinges upon a fundamental right explicitly or implicitly protected by the Constitution, thereby requiring strict judicial scrutiny; if not, the scheme must still be examined to determine whether it rationally furthers some legitimate, articulated state purpose and therefore does not constitute an invidious discrimination.12
No. The Connecticut regulation does not impinge upon the fundamental right recognized in Roe v. Wade because it places no obstacles in the pregnant woman's path to an abortion.13 An indigent woman who desires an abortion suffers no disadvantage as a consequence of Connecticut's decision to fund childbirth; she continues as before to be dependent on private sources for the service she desires.14 The regulation rationally furthers the state's strong and legitimate interest in encouraging normal childbirth, a purpose honored over the centuries and rationally advanced by subsidizing the greater medical costs associated with childbirth rather than nontherapeutic abortions.15
The Constitution does not require a participating State to pay for nontherapeutic abortions when it pays for childbirth.16
Related opinions on this issue
Chief Justice Burger joined the Court's opinion. He stated that the holdings in Roe v. Wade and Doe v. Bolton simply require that a State not create an absolute barrier to a woman's decision to have an abortion.17 He observed that these precedents do not suggest that the State is constitutionally required to assist her in procuring it.18
He noted that encouragement of childbirth is not a novel undertaking.19 He added that the decision to provide any one health service does not require, as a matter of federal constitutional law, the provision of another.20
Joined by Justices Marshall And Blackmun
Justice Brennan dissented, joined by Justices Marshall and Blackmun. He argued that the funding disparity clearly operates to coerce indigent pregnant women to bear children they would not otherwise choose to have.21 He maintained that this coercion can only operate upon the poor.22
He contended that the Court's conclusion signals a retreat from Roe v. Wade.23 He asserted that the regulation unconstitutionally impinges upon the fundamental right of privacy derived from the Due Process Clause by bringing financial pressures on indigent women.24
Whether Connecticut's regulation limiting Medicaid funding for first-trimester abortions to those certified as medically necessary, together with its requirements of prior written request and Department authorization, violates the Equal Protection Clause?25
This case involves no discrimination against a suspect class.26 An indigent woman desiring an abortion does not come within the limited category of disadvantaged classes so recognized by our cases, and financial need alone does not identify a suspect class.27 The central question is therefore whether the regulation impinges upon a fundamental right.28 If it does not, the distinction drawn between childbirth and nontherapeutic abortion must be rationally related to a constitutionally permissible purpose.29
No. The regulation does not discriminate against a suspect class. The indigency that may make it difficult for some women to have abortions is neither created nor in any way affected by the Connecticut regulation.30 Because the regulation does not impinge upon the fundamental right recognized in Roe v. Wade, it is subject only to rationality review.31 The distinction drawn between childbirth and nontherapeutic abortion is rationally related to the state's legitimate interest in encouraging normal childbirth.32 The procedural requirements of prior written request and Department authorization are not unreasonable for a State to insist upon to insure that its money is being spent only for authorized purposes.33
Such procedures do not involve the termination of a potential human life in the same manner as other medical procedures.34
Connecticut's regulation limiting Medicaid funding for first-trimester abortions to those certified as medically necessary, together with its requirements of prior written request and Department authorization, does not violate the Equal Protection Clause.35
Related opinions on this issue
Joined by Justices Marshall And Blackmun
Justice Brennan dissented. He maintained that the Connecticut scheme clearly impinges upon the area of privacy surrounding the decision whether or not to carry a pregnancy to term. This occurs by bringing financial pressures on indigent women that force them to bear children they would not otherwise have.36 He argued that the Court erred in ignoring the due process claim.37
He asserted that infringements of fundamental rights are not limited to outright denials, as shown by precedents involving the right to travel, voting, and free exercise of religion.38