Document: 448 U.S. 297 100 S.Ct. 2671 65 L.Ed.2d 784 Patricia R. HARRIS, Secretary of Health and Human Services, Appellant,v.Cora McRAE et al. No. 79-1268. Argued April 21, 1980. Decided June 30, Rehearing Denied Sept. 17, See 917, 101 39. Syllabus Title XIX the Social Security Act established Medicaid program in 1965 to provide federal financial assistance States that choose reimburse certain costs medical treatment for needy persons. Since 1976, versions so-called Hyde Amendment have severely limited use any funds cost abortions under program. Actions were brought Federal District Court by appellees (including indigent pregnant women, who sued on behalf all women similarly situated, New York City Hospitals Corp., which operates hospitals providing abortion services, officers Women's Division Board Global Ministries United Methodist Church (Women's Division), itself), seeking enjoin enforcement grounds it violates, inter alia, Due Process Clause Fifth Religion Clauses First Amendment, that, despite a participating State remains obligated fund medically necessary abortions. Ultimately, Court, granting injunctive relief, held had substantively amended relieve obligation those reimbursement is unavailable, but violates equal protection component Amendment's Free Exercise Amendment. Held : 1. does not require pay unavailable Pp. 306-311. (a) The cornerstone contribution both Government State. Nothing as originally enacted or its legislative history suggests Congress intended assume full health services plan. To contrary, Congress' purpose enacting was legitimate state expenditures an approved 308-309. (b) Nor contain indication shift entire some States, rather has always assumed would be required such once funding withdrawn pursuant 310-311. 2. restrictions do impinge "liberty" protected Roe v. Wade, 410 113, 168, 93 705, 734, 35 147, include freedom woman decide whether terminate pregnancy. 312-318. places no governmental obstacle path chooses her pregnancy, rather, means unequal subsidization other encourages alternative activity deemed public interest. Cf. Maher Roe, 432 464, 97 2376, 53 484. P. 315. Regardless pregnancy reasons lies at core periphery due process liberty recognized supra, follow woman's choice carries with constitutional entitlement resources avail herself range choices. Although government may place obstacles exercise choice, need remove own creation, indigency falls within latter category. opted subsidize generally, abortions, fact leaves least same deciding obtain she if chosen care all. 316-317. (c) translate limitation power implicit into affirmative even services. supports extraordinary result. 317-318. 3. violate Establishment coincide religious tenets Roman Catholic not, without more, contravene Clause. 319-320. 4. Appellees lack standing raise challenge named consisting suing situated because none alleged, much less proved, sought compulsion belief. Division, although they provided detailed description their beliefs, failed allege either are expect eligible receive Medicaid, therefore lacked personal stake controversy needed confer And satisfy requirements organization assert rights membership, since asserted claim one participation individual members proper understanding resolution free claims. 320-321. 5. 321-326. While presumption validity statutory classification itself right Constitution disappears predicated criteria "suspect," constitutionally suspect classification. supra. impact indigent, render invalid, poverty, alone, 322-323. Where, here, neither invaded substantive freedom, nor legislation purposefully detriment class, only requirement congressional action rationally related satisfies standard, since, encouraging childbirth except most urgent circumstances, objective protecting potential life. 324-326. 491 F.Supp. 630, reversed remanded. Sol. Gen. Wade H. McCree, Jr., Washington, D. C., appellant. Rhonda Copelon, City, appellees. Mr. Justice STEWART delivered opinion Court. 1 This case presents questions concerning Act, commonly known "Medicaid" recent annual Appropriations Acts containing 2 [Amicus Curiae Information from page 300 intentionally omitted] "Hyde Amendment." question requires participates question, arises imposes requirement, denying contravenes guarantees 3 * created 1965, when added 79 Stat. 343, amended, 42 U.S.C. § 1396 seq. (1976 ed. Supp. II), entirely optional, elects participate, must comply XIX. 4 One agree "categorically needy"1 respect five general areas treatment: (1) inpatient hospital (2) outpatient (3) laboratory X-ray (4) skilled nursing facilities periodic screening diagnosis children, family planning (5) physicians. §§ 1396a(a)(13)(B), 1396d(a)(1)-(5). "provide falling categories, [Title XIX] [a] pla[n] establish 'reasonable standards . determining extent plan consistent objectives XIX].' 1396a(a)(17)." Beal Doe, 438, 441, 2366, 2369, 464. 5 September prohibited—either amendment appropriations bill Department Health, Education, Welfare2 joint resolution—the specified circumstances. restriction Amendment," after original sponsor, Representative Hyde. current version applicable fiscal year 1980, provides: 6 "[N]one this shall used perform where life mother endangered fetus carried term; procedures victims rape incest been reported promptly law agency service." Pub.L. 96-123, 109, 926. 7 also 96-86, 118, 662. broader than 1977, did "rape incest" exception, 94-439, 209, 90 1434, narrower 1978,3 1979, additional exception "instances severe long-lasting physical damage result term so determined two physicians," 95-205, 101, 91 1460; 95-480, 210, 92 1586.4 8 On day initial these consolidated cases filed Eastern York. plaintiffs—Cora McRae, recipient then first trimester wished terminate, benefit corporation 16 hospitals, 12 others—sought They alleged violated First, Fourth, Fifth, Ninth Amendments insofar save mother, while permitting associated childbirth. sole defendant Welfare, permitted Senators James L. Buckley Jesse A. Helms Henry J. intervene defendants.5 9 After hearing, entered preliminary injunction prohibiting enforcing requiring him continue before enacted. McRae Mathews, 421 533. stating expressly unconstitutional, final judgment, noted holding "implicit" decision injunction. certified class potentially 24 weeks authorized providers women. Id., 543. 10 appeal 2474, 534, we vacated remanded reconsideration light decisions. Califano 433 916, 2993, 1103. 11 remand, intervention several plaintiffs, including four recipients allegedly qualify years 1977 1978, physicians recipients, Division. An complaint filed, challenging various grounds. At outset, plaintiffs address constitutionality HydeAmendment because, view, unavailable. With regard asserted, among things, 13 lengthy trial, inquired diverse views subject,6 judgment invalidating grounds.7 rejected plaintiffs' argument, concluding though otherwise obligation. Turning issues, concluded valid Clause,8 "medically safeguard health, disentitlement [M]edicaid impinges directly decide, consultation physician reliance his order preserve health."9 Califano, 737. court guarantee generally serves As seek product beliefs Protestant Jewish tenets, well. 14 Accordingly, ordered "[c]ease give effect" forbid payments It further directed "[c]ontinue authorize expenditure matching [for abortions]." App. 87. In addition, recertified nationwide wish women.10 15 applied stay pending direct Court's decision. We denied stay, probable jurisdiction appeal. 444 1069, 1010, 62 750. II well settled decided grounds, sound jurisprudential reasons, will inquire question. practice reflects deeply rooted doctrine "that ought pass unless adjudication unavoidable." Spector Motor Service, Inc. McLaughlin, 323 105, 152, 154, 89 L.Ed. 101. turn If obligation, drawn present case, availability continue, shouldering total 17 independent is, terms, permit exclude service solely basis condition, service.11 thus appellees' view effect withhold duty 18 argument. program, construction said find support decisions Courts Appeals, Preterm, Dukakis, 591 F.2d 121 (CA1 1979), Zbaraz Quern, 596 196 (CA7 Welfare administration 19 somewhat different reasons. cooperative endeavor provides aid them furnishing Under system "cooperative federalism," King Smith, 392 309, 316, 88 2128, 2132, 20 1118, agrees XIX, mandatory categories percentage "the amount expended ." 1396b(a)(1). enacted, history, Quite S.Rep.No.404, 89th Cong., 1st Sess., pt. 1, pp. 83-85 (1965); H.R.Rep.No.213, 72-74 (1965), U.S.Code Cong. & Admin.News p. 1943. intend unilateral plan, follows subsequent withheld funding.12 designed shared responsibility, device compel unwilling fund. Thus, withdraw particular service, obliged condition continued say now depart design shares responsibility expenses incurred absent contrary intent Congress, obligate unavailable.13 21 normal operation withdrawal operate unavailable.14 contains whatsoever States. 200 ("no one, supporting opposing ever suggested required"). Rather, Amendment.15 SeePreterm, F.2d, 130 ("[t]he universal assumption debate passed there states carry service"). Accord, 200; Hodgson County Comm'rs, 614 601, 612-613 (CA8 1980); Casey, 623 829, 834-837 (CA3 1980). conclude Amendment.16 III 22 Having funding, consider secured Constitution—(1) woman, prohibition against "law respecting establishment religion," religion contend quite apart rights, Amendment.17 23 protection, "impinges upon fundamental explicitly implicitly [it] presumptively unconstitutional." Mobile Bolden, 446 55, 76, 1490, 1504, 64 47 (plurality opinion). turning issue examine Constitution. argument restricting progeny. 25 unconstitutional Texas statute making crime procure attempt advice saving mother's underpinning recognition Fourteenth includes freedoms mentioned Bill Rights, matters marriage life.18 liberty, held, 26 But interests during ensuring human These interests, found "separate distinct" "gro[w] substantiality approaches term," id., 162-163, S.Ct., 731, pose conflict untrammeled choice. resolving conflict, end interest sufficiently substantial justify intrusion second trimester, maternal regulation reasonably concern. viability, usually third criminal preservation mother. inasmuch allowed stage 27 484, presented scope included necessary. Connecticut welfare received incident childbirth, nontherapeutic Equal Protection impinged "fundamental abortion" 28 misconceived nature Roe." U.S., 471, 2381. Maher, "protects unduly burdensome interference pregnancy," 473-474, 2382, sanctions absolute spousal consent challenged Planned Parenthood Central Missouri Danforth, 428 52, 96 2831, 49 788. 29 progeny, explained, prevent "a value favoring over abortion, implement[ing] allocation funds." 474, 2382. elaborated: 30 "The us kind laws invalidated our previous otherwise—in abortion. desires suffers disadvantage consequence Connecticut's childbirth; continues dependent private sources desires. made more attractive alternative, thereby influencing decision, imposed access already there. make difficult—and cases, perhaps, impossible—for way affected regulation." Ibid. 31 progeny signaled "no retreat" explaining why principle later choice—did cited "basic difference between encouragement consonant policy. Constitutional concerns greatest attempts impose force law; State's encourage actions necessarily far broader." 475-476, 2383 (footnote omitted). favored other, 32 like differ factually involved failure whereas withholds argue affects significant —the pregnancy—and Maher. clearly Wade. 33 evident important theme Clause, emphasized implications psychological. 153, 726. fact, becomes compelling period fetal viability prohibit "necessary mother." 164, 732. Because insufficient outweigh protect could argued lie identified 34 But, regardless simply reason explained creation. Indigency constraints restrict ability enjoy indigency. persuaded Wade.19 affords unwarranted context decisions, realize advantages freedom. hold mark drastic change cannot contraceptives, Griswold Connecticut, 381 479, 85 1678, 510, parents sending child school, Pierce Society Sisters, 268 45 571, 69 1070, government, therefore, ensure persons contraceptives send children schools. result.20 Whether warrants answer, matter entitlement. Wade.21 B 36 incorporates doctrines sinfulness time commences. Moreover, limitations guaranteed 37 enactment secular purpose, principal primary advances inhibits religion, foster excessive entanglement religion." Committee Public Education Regan, 646, 653, 840, 846, 63 94. Applying properly run afoul can "pass religions, prefer another," Everson 330 15, 67 504, 511, 711, "happens harmonize religions." McGowan Maryland, 366 420, 442, 81 1101, 1113, 393. That Judaeo-Christian religions oppose stealing mean enact larceny. noted, reflection "traditionalist" values towards embodiment religion. F.Supp., 741. 138-141, 719-721. sum, convinced 38 merits arguments fall three categories: itself.22 category belief.23 429, 1106. Medicaid. appellees, Warth Seldin, 422 490, 498-499, 95 2197, 2204-2205, 343. 39 Finally, membership "pregnant who, accordance conscientious precluded discouraged obtaining reimbursed membership. "neither relief requested lawsuit." Hunt Washington Apple Advertising Comm'n, 333, 2434, 2441, 383. "it show coercive Abington School Dist. Schempp, 374 203, 223, 83 1560, 1572, 844, here ordinarily participation.24 concedes permissibility, advisability and/or necessity according circumstance about diversity determination ultimately absolutely entrusted conscience God." clear essential along C 40 premised available selective protection. 41 source liberties,25 invidious discrimination classifications activity. Constitution, sustained rests wholly irrelevant achievement [any governmental] objective." 425, 1105. validity, however, are, sense, example based race, e. g., Brown 347 483, 74 686, 98 873. For stated above, rights. reaching conclusion, again draw guidance Roe. discriminated observed: 43 "An desiring come disadvantaged classes cases. lead conclusion. every denial creates wealth compared nonindigents able desired goods never alone identifies purposes analysis." 470-471, 2381, citing San Antonio Independent Rodriguez, 411 29, 1278, 1294, 16; Dandridge Williams, 397 1153, 491. 44 indistinguishable respect. Here, indigent. repeatedly See, g. Valtierra, 402 137, 1331, 678. refusal involves bearing factors "suspect" meaning protection.26 46 remaining objective. Government's position bears rational relationship fetus. agree. "important potentiality life." 162, 731. exist throughout "grow[ing] term." 445-446, 2371. advancing 478-479, 2385. Poelker 519, 520-521, 2391, 2392, 528. 48 By subsidizing pregnancies comparable undergo (except whose lives threatened),27 incentives bear irrational abortions.28 Abortion inherently procedures, procedure purposeful termination conducting extensive evidentiary hearing issues surrounding "[t]he preserving sufficient, weighed balance threatened withdrawing consents appraisal competing went beyond judicial function. Such courts. role courts comport 50 standard. mission reflected wise social mission, subscribed today done so. cannot, name overturn duly statutes "because unwise, improvident, out harmony school thought." Williamson Lee Optical Co., 348 488, 75 461, 99 563, quoted 1161. "when policy choices sensitive implicated [here] , appropriate forum democracy legislature." IV 51 opinion, reversed, proceedings opinion. 52 ordered. WHITE, concurring. 54 I join remarks. 55 147 (1973), prior fetus, overriding last strong warrant ban continuing threaten event, health. 56 Drawing followed it, STEVENS' dissent extrapolates proposition event pursued expense notes refuses carrying threatens finances indicated submits fails today—that official serve goal, ante, 324. 57 internal logic, legally sound. government. points out, purport adjudicate funded unreasonable example, prohibited implement life, suffer risk forced 58 dealt circumstances There calculus here. interfere restraint unfettered, attempting restraint, hence disbursing what covering Neither wake invalidates preference. 484 (1977), claims refusing defraying outright prohibition, nevertheless infringed abandon extend expressed 59 successfully distinguished ground outside ambit proceeded. elective withholding furthered government's inadequate justification indicated. balancing controlling issue. am satisfied straightforward analysis STEWART's 60 BRENNAN, whom MARSHALL BLACKMUN join, dissenting. 61 my Brother STEVENS exclusion financially benefits entitled doctor post, 352-352. write separately express disagreement1 mischaracterization misconception manner privacy encompasses progeny2 abortion—a which, prohibits highly decision.3 stand desire them; refrain wielding enormous influence might burden plainly intrudes coerce elect have.4 When viewed appended, obvious nothing circumvent dictates achieve indirectly directly.5 reimburses virtually categorically needy. significance term). persuasively demonstrates, coverage justified cost-saving device. transparent Legislative Branch political majority's morally acceptable socially desirable preference intimate entrusts individual. Worse yet, foist majoritarian viewpoint measure everyone Nation, rich poor alike; segment society powerlessness, defend encroachments state-mandated morality. instant calls exacting review "When elected leaders cower pressure, ever, shirk enforce powerless." 462, 2398, 464 (1977) (MARSHALL, J., dissenting). Though "to policy," 297, 326, 2671, 2693, 784, assuredly vindicate intrusion. inhibit, inhibit "Pregnancy unquestionably Treatment involve termination, bring term, resulting live birth. '[A]bortion stripped moral controversy, methods dealing .' " doe, 449, 2373 (BRENNAN, dissenting) (quoting Norton, 408 660, 663, n. (Conn.1975)). courses necessary, poverty-stricken depends procedure. incidental injecting intrusion, deprives maternity, impinging conclusion belief indigency." 2688. Accurate statement be, reveals half picture. appreciate interferes combination poverty 66 A early stages confronts alternatives: abstract, course, hers rightly observes "places pregnancy." 315, 2687, reality situation effectively removed hands. terminating literally makes offer afford refuse. instance carrot stick. What critical realization practical matter, many paid option, indeed stayed picture altogether defrayed flaw analysis, then, acknowledge discriminatory distribution largesse discourage liberties just through regulatory sanctions. Implicit reasoning notion long citizens privileges, grant recipient's relinquishment 68 belabor expound great length illegitimacy bestowal favors. suffices note heretofore hesitated invalidate scheme incidentally burdens exercising take many, Sherbert Verner, 398, 1790, 965 (1963), South Carolina unemployment insurance accept suitable employment offered, stemmed convictions. Even possessed compensation, cancel Seventh-Day Adventist refused job work Saturdays. explanation particularly instructive case: "Here apparent appellant's declared ineligibility derives pressure forego unmistakable. ruling forces following precepts forfeiting benefits, hand, abandoning work, hand. Governmental imposition puts fine appellant Saturday worship. 70 "Nor court's saved infirmity compensation 'right' merely 'privilege.' too late doubt expression placing conditions privilege. [T]o willingness cardinal faith penalizes liberties." 404-406, 1794-95. 71 Frost Trucking Co. Railroad 271 583, 605, 1101 (1926); Speiser Randall, 357 513, 78 1332, 1460 (1958); Elfbrandt Russell, 384 11, 86 1238, 321 (1966); Goldberg Kelly, 254, 1011, 287 (1970); U. S. Dept. Agriculture Moreno, 413 528, 2821, 782 (1973); Southeastern Promotions, Ltd. Conrad, 420 546, 1239, (1975). Shapiro Thompson, 394 618, 1322, 600 (1969); Memorial Hospital Maricopa County, 415 250, 94 1076, 306 (1974). 72 schemes unconstitutionally burdened rights.6 Sherbert, discourages liberty: pain sacrificing health-care entitled. Over ago, Sutherland, writing 593-594, 607, observation, true then: 73 "It palpable incongruity strike down act words divestment, seeks strip citizen uphold accomplished guise surrender exchange valuable privilege withhold. rule, state, having deny altogether, sees fit impose. unlimited; favor, may, manner, inconceivable guaranties embedded manipulated existence." respectfully dissent. MARSHALL, 76 Three yeas upheld excluded subsidized time, fear invitation officials, well-financed carefully orchestrated lobbying campaigns, approve restrictions" 2398 (dissenting 528 (1977)). 77 proved justified. avert permanent studiously avoids recognizing undeniable Medicaid—poor women—denial Medicaid-funded equivalent legal altogether. definition, money themselves. resort back-alley butchers, induce themselves crude dangerous methods, serious consequences term. realistic option predictable increase number die inability effort damage. demonstrated, see 349 opinion), premise underlying repudiated jeopardizing individuals meet eligibility, form repugnant marks retreat represents cruel blow powerless society. form, restricts term" "for 302, 2680, 784. virtual certainty. damage, death, 80 record developed below set forth majority profession recommend Indeed, adopted standard restrictive necessary" test decreased 98%. 289. major categories. sometimes Numerous conditions—such cancer, rheumatic fever, diabetes, malnutrition, phlebitis, sickle cell anemia, heart disease substantially risks aggravated physician, Further, undergoing dramatically advanced. progressed point certify endangers death longer safe. instances immediately aggravation another significantly shorten expectancy. fundable 82 Second, mental disturbances unwanted pregnancies. psychological suicide, self-abortion, abuse. provision Third, denies caused incest. prerequisite report days afraid recounting happened unsympathetic authorities. especially likely aware rapid authorities indispensable 84 unable survive. situations possible determine advance purportedly life," 325, 2692, excludes optimistic estimate indicates excess deaths occur each Amendment.1 shows considerable.2 resolves relentlessly formalistic catechism. Adhering "two-tiered" approach decides strict scrutiny Therefore, 'the objective.' 322, 2690-2691 (bracketed material original), quoting 1104, 393 (1961). Observing concludes "establishe[s] Medicaid," ibid., 87 believe rigid inappropriate mere rationality one. muster rational-basis review. perhaps dramatic illustration date deficiencies obsolete 98-110, 1330-1336, (1973) dissenting); Massachusetts Bd. Retirement Murgia, 427 307, 318-321, 2562, 2569-2570, 520 (1976) 457-458, 2396 Vance Bradley, 440 93, 113-115, 939, 951-952, 171 (1979)(MARSHALL, dissenting).3 deference, understand how level here—whose exclusively women—that given distinguishing opticians ophthalmologists, distinctions economic process. 2692-2693, 563 (1955). Heightened groups "saddled disabilities, subjected treatment, relegated powerlessness command process." 28, 1294.4 traditional "strict scrutiny" disfavor them, (1970), crushing treated deference business interests. distinguishes expenses.5 assessed weighing importance denied, character interests,' 458, 2396, 2571. approach, invalid.6 "of vital recipients." confronted grotesque "an illegal poses threat Alternatively, child, course eliminate chance control direction 459, 2397. consists proportion minority races. observed nonwhite nearly double rate whites, ibid.. destitute special tends seriously curtail processes relied minorities, call correspondingly searching inquiry." Carolene Products 304 144, 4, 778, 1234 (1938). reason, showing devastating racial relevant" analysis. Jefferson Hackney, 406 535, 575-576, 1724, 1745, 285 (1972) "outweigh deprivation discouragement especial women." 2398. permissible 477-479, 2384, weaker result: scarcely speak "normal childbirth" shortly birth, shortened gravely impaired Nevertheless, minimally legislature outweighs brutal deprive strict-scrutiny/rational-basis dichotomy reject conclude, do, My BRENNAN demonstrated impermissibly infringes individual's 332-334 350-352 mother," 165, 732, abortion," promote treats controlled mirror image turned consideration nontherapeutic, unnecessary, procedures. Thus others situated. wrongly decided. protesting This, hardly said, crucial purposes. essentially poor. met right, short, deprived eligible, attempted right. Government, subordinate treatment. finally, today's opinion—consequences seems oblivious—are difficult predict. Pregnant restricted alternatives. term—even route injury both. appears intolerable, self-induced abortions—not inconvenient, health.7 describes destruction "There world 'out there,' existence ignore fears recognize." 463, 2399 (BLACKMUN, blinding reach announces today. reached traced unwillingness apply involving funds. real procreative prepared expenses, perceives distinction "limitation power" obligation." 318, 2688-2689. person "right" imperceptible. shown, differential incentives—which 2692—can precisely prohibition. sufficient answer forum' legislature. 2693 More Jackson "task translating majestic generalities Rights concrete restraints officials problems twentieth century, disturb self-confidence." West Virginia Barnette, 319 624, 639, 1178, 1186, 1628 (1943). principles, he "grew soil produced philosophy individual['s] attainable absence restraints." Those principles "transplant[ed] laissez-faire concept withered affairs, advancements increasingly closer integration expanded strengthened controls." 640, 1186. taken financing practically expenditures. singled exclusion, committed tolerate BLACKMUN, wholeheartedly respective observations descriptions doing latest round "abortion cases." add 2394, companion me equally pertinent "condescension" "she go elsewhere abortion"; "disingenuous alarming"; "punitively impresses concepts desirable, publicly acceptable, sound"; "financial specious"; truly "another suspect, recognize"; "cancer grow"; lot poorest us," again, still, bettered. 102 STEVENS, 103 sovereign, govern impartially. justice served process, Hampton Mow Sun Wong, 426 88, 100, 1895, 1903, 495. sovereign persons, define neutral criteria; exceptions insufficient. 104 pool 1965. Individuals criteria—financial need—are pool. need. Our dictate 105 fundamentally Unlike criterion need; subsidy abortions—medical definition rejecting claim, undertaken necessary; criteria. Nontherapeutic gave rise 106 harms: hand other. part conflicting prevail protection.1 107 Doe Bolton, 179, 739, 201, protectible abortion2 furtherance effect, subject regulations. "regulate, proscribe, 732 (emphasis added). holding. shirks case. 108 higher avoiding harm abnormal childbirth3 sterile evades simple point. focuses "legitimate fetus." 324, 2692. interest, create constitutional. misleading reference legitimate. squarely exists. perfectly "in judgment," certifies totally explain dispositive here.4 109 inflicted grievous.5 comparison differing forms 1976 approves mother" Solicitor General acknowledged commendable candor, logic lifesaving available.6 inevitably causes tantamount punishment.7 punish want unequivocally do. 110 type costly assets maximum Fiscal considerations improve afforded benefited class.8 ironically, harms specific victims. records demonstrate small fraction childbirth.9 avoid "serious damage" financed draining classifications, remainder benefit. stated: 111 pregnancy-related indigents. alleviate hardships care, dispenses limitations." 469-470, 2380 112 distributing benefits. Republican, Catholic, Oriental—or spoken furthering. furthering protect. reason; millions dollars thwart inflicting impoverished constitute unjustifiable, blatant, violation sovereign's impartially.10 113 needy" families Aid Families Dependent Children 601 seq., aged, blind, disabled Supplemental Income 1381 1396a(a)(10)(A). permits termed needy." 1396a(a)(10)(C). 1396a(a)(13)(C). recently reorganized divided Services Education. designation retained HEW October November months resolutions 1977. 95-130, 1153; 95-165, 1323. Amendment" generically refer otherwise. intervenor-defendants Secretary's Rule 10(4), "appellees" parties conducted August 400 documentary film exhibits transcript exceeding 5,000 pages. 630. apparently "suspect class," namely, teenage 26, infra. trimesters interpretation finds considered non -therapeutic preclude unnecessary —though desirable—medical services," coverage." 444-445, 2371 original). Beal, 121, 132 Judge Coffin noted: cooperation assistance; complete prop drop states, runs counter basic structure cripple state's embraced plan." (Footnote omitted.) Congresses deviated obligating unambiguous terms. 196, 200, 1979). variations plans depending changes reimbursement, inquire, did, TVA Hill, 437 189-193, 2279, 2299-2301, 117, Tellico Dam impliedly repealed Endangered Species natural habitat species. corroborated text, free, chooses, 447, 2372; 134. vague reimbursable. void vagueness sanction scienter good-faith errors penalized, Colautti Franklin, 439 379, 395, 675, 685, 596; and, (2), "are terms ordinary common sense with, sacrifice interest." Broadrick Oklahoma, 608, 2908, 2914, 830. "has extension activities relating marriage, Loving Virginia, 388 [87 1817, 1823, 1010] (1967); procreation, Skinner 316 541-542 [62 1110, 1113-1114, 1655] (1942); contraception, Eisenstadt Baird, 405 [438,] 453-454 [92 1029, 1038, 1039, 349]; 460, 463-465 1042, 1043-1044] (WHITE, concurring result); relationships, Prince Massachusetts, 158, 166 [64 645] (1944); rearing education, 535 [45 573, 1070] (1925); Meyer Nebraska [262 390, 399, 625, 626, 1042 (1923)]." 152-153, 726-727. "penalizes" 306; 600. short mark. "semantic difference" "unduly interfere[d]" "penalized" liberty. 474 8, 2382 8. And, characterized, conduct, arise candidate exercised analogous 965, Amendments, claimant per week Sabbath. unlike broad disqualification receipt conduct. activity, equated "penalty" [government] indigents." 469, 2380. administers patient, Whalen 429 589, 604, 33, 869, 878, 64, advises attack "women nonreligious persuasions have, teaching necessary." sue, "[t]hey represent part." Bailey Patterson, 369 31, 32-33, 549, 550, 512. O'Shea Littleton, 414 494-495, 669, 674. Allen, 236, 249, 1923, 1929, 1060, "not contended [statute question] coerce[d] (Emphasis added.) Reynolds Sims, 377 533, 1362, 506, vote elections, Minor Happersett, Wall. 178, 627, adopts electoral system, confers qualified voter participate voters. Dunn Blumstein, 330, 336, 995, 999, 274. doubt, class" triggering heightened scrutiny. regard, "clearly operate[s] adolescents high seventeen under." 738. "statutory" referring derived Adolescent Pregnancy Prevention Care 300a-21 ed., II). statistics indicate age disproportionately represented invidiously discriminates facially age, ages. erred, relying disparate age. discrimination, Davis, 229, 2040, 597, incumbent challenger prove "selected reaffirmed 'because of,' 'in spite adverse effects identifiable group." Personnel Administrator Mass. Feeney, 442 256, 279, 2282, 2296, 870. evidence finding "except valid, others. claimants. 1396d(a)(17)(B) (inpatient patients institutions tuberculosis covered XIX). 482-490, 2386-91, E. 201 788 (1976); Singleton Wulff, 106, 2868, 826 Bellotti 622, 3035, 797 (1979); cf. Carey Population International, 431 678, 2010, 675 (1977). State, promoting regulate ways end. reached, proscribe 164-165, 732-733, (1973). focus outcome pregnancy—childbirth—while other—abortion. renders dwell disparities produces poor, nonpregnant. concur completely, discussion disparities. Specifically, allocating serving goals. irrationality exposes really deliberate put Nonpregnant treatments. ailments, happen patient forgo assistance, refuse genuine maladies treated, expensive treat, relate abort treating hostility obstetrics delivery saved. gone good deal farther. Its leave sick fortuity illness terminated. Antipathy ride roughshod fashion distort Nation's programs. delivering completely irrational. preventing concededly rational—brutally goal forbidden. 118-119, 7, 2877, 7. "For nothing, him, effective 'interdiction' summarily rejects comment "[a] 'penalty' activity." 317, n.19, 2688, n.19. begin overlooks "more" case; instead, selectively penalizing election disfavored option. being taking readily characterized "punitive." Surely transportation polling booths Democratic candidates, Republicans "represents conduct," broadly exercises largesse. 294-296. complications deriving estimated times 200. Justices discomfort two-tiered pleased observe waning. Craig Boren, 190, 210-211, 451, 463-464, (POWELL, concurring); 211-212, (STEVENS, 352, "intermediate" variety classifications. Trimble Gordon, 430 762, 1459, (illegitimacy); supra (sex discrimination); Foley Connelie, 435 291, 1067, (1978) (alienage). University California Regents Bakke, 438 265, 2733, 2766, 750 (opinion JJ.) (affirmative action). occasion discriminating Amendments. McDonald Election, 802, 807, 1404, 1407, 739 Harper Elections, 383 668, 1079, 1082, 169 (1966). suggests, 355, few conserve funds, penalize disabilities. dissimilar 197, 457, referred intermediate "must objectives." Of lawful fortunate enough paying rent utility bills, pawning household goods, diverting food clothing money, journeying lower rates fraudulently relative's [S]ome driven theft." 482 725, (Conn.1980). "In [, 147], .." 2856, dissenting part). "procure 117-118, 709-10. Bolton onerous Georgia endangerment, very irremediable birth defect rape. approvals, unconstitutional. Subsequent abort. (consent husband or, unmarried 18, parent); 443 parent superior judge 18). heavily premise—recognized —that childbirth." 477, 478, 2384-85. illustrate method "levels determines furthers transcends predetermined threshold. concurring). bypass relevant attach greater weight keeping out. "equal analysis" doubly erroneous. responding WHITE described government" "only choice." 327, 328, 2694. No language itself. attaches describe speeches sustain advocate administration. replete examples harm. Dooling's 670: "Women, young suffering diabetes experience fetuses; become blind worsening diabetic retinopathy; particularly, juvenile diabetic, Dr. Eliot testified series faster; increased kidney problems, vascular extremities." affidavit Jane 79-1268: "3. old. married living children. Following phlebitis recovered. Carrying greatly aggravate blood clots lung. "4. July Fertility Control Clinic St. Paul-Ramsey Hospital, Paul, Minnesota request informed new me. "5. myself, safe, According doctor, Hodgson, problems." 79-1268, 109-110. Nos. 79-4, 79-5, 79-491, recounted Zbaraz' affidavit: "Jane old nine She varicose veins thrombophlebitis (blood clots) left leg. were, multiple pregnancies: uterus pelvic extremities; dilated circulation impaired, varicosities extremities became partial surgical removal 1973. "2. Given Doe's almost recur recurrence operative removal. 30% 'deep vein' (the surface leg previously partially removed). impair prolonged hospitalization bed rest. Considering thrombophlebitis, background pregnancies, her, 92. "QUESTION: General, you endangering involved? "Mr. McCREE: think would." Tr. Oral Arg. 10. respect, presume ensue rationale satisfactorily exclusions 28. events, safe Grady average Illinois $150 exceeded $1,350. Juris. Statement 14a, together $20,000,000 fisc. Brief 60, conclusion: "While [on Amendment] rider departmental bill, quickly economy measure; performed medicaid childbearing nurture exceed Opponents pains, favor reducing costs." 644. impartiality applies Zbaraz.

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