Court Opinion

ID: 9927558
Source: CourtListenerOpinion
Date Created: 2024-01-29 14:09:54.752152+00
Date Added: 2024-06-11T09:24:19.029223
License: Public Domain

[J-65-2022] [MO: Donohue, J.]
                IN THE SUPREME COURT OF PENNSYLVANIA
                              MIDDLE DISTRICT

ALLEGHENY REPRODUCTIVE HEALTH     :    No. 26 MAP 2021
CENTER, ALLENTOWN WOMEN'S         :
CENTER, DELAWARE COUNTY           :    Appeal from the Orders of the
WOMEN'S CENTER, PHILADELPHIA      :    Commonwealth Court at No. 26 MD
WOMEN'S CENTER, PLANNED           :    2019 dated January 28, 2020, and
PARENTHOOD KEYSTONE, PLANNED      :    March 26, 2021.
PARENTHOOD SOUTHEASTERN           :
PENNSYLVANIA, AND PLANNED         :    ARGUED: October 26, 2022
PARENTHOOD OF WESTERN             :
PENNSYLVANIA,                     :
                                  :
                Appellants        :
                                  :
                                  :
           v.                     :
                                  :
                                  :
PENNSYLVANIA DEPARTMENT OF        :
HUMAN SERVICES, VALERIE A.        :
ARKOOSH, IN HER OFFICIAL CAPACITY :
AS SECRETARY OF THE PENNSYLVANIA :
DEPARTMENT OF HUMAN SERVICES,     :
ANDREW BARNES, IN HIS OFFICIAL    :
CAPACITY AS EXECUTIVE DEPUTY      :
SECRETARY FOR THE PENNSYLVANIA    :
DEPARTMENT OF HUMAN SERVICES’     :
OFFICE OF MEDICAL ASSISTANCE      :
PROGRAMS, AND SALLY KOZAK, IN HER :
OFFICIAL CAPACITY AS DEPUTY       :
SECRETARY FOR THE PENNSYLVANIA    :
DEPARTMENT OF HUMAN SERVICES’     :
OFFICE OF MEDICAL ASSISTANCE      :
PROGRAMS,                         :
                                  :
                Appellees         :

                 CONCURRING AND DISSENTING OPINION

JUSTICE MUNDY                             DECIDED: January 29, 2024
                                      I. Stare Decisis

       This case is not about anyone’s right to obtain an abortion. It is about an alleged

right to obtain taxpayer money to pay for it.        We decided this issue in Fischer v.

Department of Public Welfare, 502 A.2d 114 (Pa. 1985), and ruled unanimously that there

is no state constitutional right to public funding for abortions. Notwithstanding our ordinary

adherence to precedent, abortion providers (Plaintiffs) now ask this Court to overrule that

unanimous decision, presumably because the composition of the Court has changed. I

join Chief Justice Todd’s thoughtful concurring and dissenting opinion to the extent it

concludes the limited exception to stare decisis is not implicated in this case. 1

       Plaintiffs disagree with Fischer but their contention that Fischer is so deeply flawed

as to warrant overruling is exaggerated at best. Plaintiffs mainly seem to want to re-argue

the same points put forward, and rejected, in Fischer – e.g., that the decision in Cerra v.

East Stroudsburg Area School District, 299 A.2d 277 (Pa. 1973), supports their position.

See Brief at 35-36. Fischer used straightforward logic to assess the way medicine

necessarily treats men and women differently in the arena of childbearing due to their

biological differences. This reasoning is not unsound, nor has it been rendered obsolete

by legal developments since Fischer. “As the United States Supreme Court recently

stated, ‘To reverse a decision, we demand a special justification, over and above the

1 The two threshold issues are standing by Plaintiffs and intervention by the legislative

defendants. I agree with my colleagues that Plaintiffs have standing.

In relation to the Commonwealth Court’s ruling allowing the legislative parties to intervene
as additional defendants, I would hold that that tribunal acted within its discretion. In
these unusual circumstances, participation by the legislative parties is especially needed
for the sake of a fair process, or at least the appearance of a fair process, because the
only other party supporting the government’s interest in this matter – the Department of
Human Services – is on record stating the executive branch disagrees with the underlying
legislative policy. See Brief for Appellee Department of Human Services at 22. This is
notable because the government’s entire task on remand is to defend the very policy it
disagrees with as that policy undergoes the strictest form of judicial scrutiny.

                             [J-65-2022] [MO: Donohue, J.] - 2
belief that the precedent was wrongly decided.’” Commonwealth v. Alexander, 243 A.3d

177, 196 (Pa. 2020) (quoting Allen v. Cooper, 140 S. Ct. 994, 1003 (2020)).

       No “special justification” exists here for overruling the unanimous holding of this

Court on the same claims simply because 38 years have passed since Fischer was

decided and Plaintiffs disagree with Fischer. Yet, the majority overrules unanimous

precedent on this politically sensitive topic which is best resolved by the political

branches. 2 In so doing, it relies on the proposition that stare decisis is weakest in the

constitutional arena. See Majority Op. at 54, 116, 213. But as the majority recognizes,

that principle is based on the Legislature’s inability to correct judicial errors in relation to

such matters. See id. at 212 (quoting Alexander, 243 A.3d at 197); accord Veith v.

Jubelirer, 541 U.S. 267, 305 (2004) (“[T]he claims of stare decisis are at their weakest in

that field, where our mistakes cannot be corrected by Congress.”) (citing Payne v.

Tennessee, 501 U.S. 808, 828 (1991)). The stare-decisis-is-weakest precept is itself

weakest where, as here, the prior interpretation gave the legislative branch more latitude

to craft legislation pursuant to its own policy determinations, not less. Nothing in Fischer

prevents the General Assembly from passing legislation favorable to Plaintiffs, and thus,

any supposed error in our prior interpretation is of little relevance to the stare decisis

precept relied on by the majority.

       Additionally, I ultimately do not find Plaintiffs’ merits arguments persuasive. In their

petition for review, Plaintiffs raised two counts. In Count I, they claimed the coverage

exclusion violates the Equal Rights Amendment (ERA). See PA. CONST. art. I, § 28 (1971)

(prohibiting government discrimination based on sex). In Count II, they claimed it violates

equal protection. See PA. CONST. art. I, §§ 1, 26 (respectively acknowledging the inherent

rights of life, liberty, property, and reputation, and prohibiting discrimination in the exercise

2 It may be observed that in this matter three Justices are overruling seven Justices.

                             [J-65-2022] [MO: Donohue, J.] - 3
of civil rights), and PA. CONST. art. III, § 32 (prohibiting local or special laws). These two

causes of action are addressed below, as is the effect on this case of Dobbs v. Jackson

Women’s Health Organization, 142 S. Ct. 2228 (2022), the Supreme Court’s recent

decision overruling Roe v. Wade, 410 U.S. 113 (1973). Finally, I elaborate on why this

case is only about funding, and not about the infringement of a fundamental right.

                                          II. Merits

A. Count I – The Equal Rights Amendment (ERA)

        Pennsylvania’s Equal Rights Amendment prohibits sex-based discrimination by

the Commonwealth. See PA. CONST. art. I, § 28 (1971). But it a stretch to argue the

coverage exclusion constitutes discrimination based on sex. The exclusion does not

distinguish between men and women, but between two groups of women: those who

choose childbirth and those who choose abortion. Although it is true that only women

can become pregnant and have to make that choice about their own health care, that is

not a result of the coverage exclusion, it the result of biology, and it is one of the factors

that makes men and women non-interchangeable:

       The mere fact that only women are affected by this statute does not
       necessarily mean that women are being discriminated against on the basis
       of sex. In this world there are certain immutable facts of life which no
       amount of legislation may change. As a consequence there are certain laws
       which necessarily will only affect one sex.
Fischer, 502 A.2d at 125.

       Ultimately there is simply no reference point pertaining to men from which to argue

the coverage exclusion, relating exclusively to pregnancy, treats men as a class more

favorably than women so as to bring it within the scope of the ERA. Plaintiffs attempt to

suggest one, proposing that Medical Assistance (MA) would discriminate against men if

it covered treatments for uterine cancer but not prostate cancer. See Brief at 35-36. But

                             [J-65-2022] [MO: Donohue, J.] - 4
both of those treatments involve cancer, which either sex can get. The challenged

exclusion here is qualitatively different as it deals only with pregnancy and funds one

pregnancy outcome but not another – based on a legitimate governmental interest.

Plaintiffs’ two-types-of-cancer hypothetical is thus inapt. It would be more appropriate to

identify a medical condition unique to men which has two treatment options, one that

enhances fertility and the other that reduces it. If the Commonwealth made public funds

available only for the first option, it would be difficult to conclude men were thereby being

treated worse than women. That would be a non-sequitur. 3

       But this appears to be what Plaintiffs are arguing: that funding pregnancy care

leading to birth while not funding abortions treats women worse than men. And with the

coverage exclusion here at issue, the state is on solider ground than in the above example

because it serves the state’s recognized interest in protecting the already-extant

biological life of the fetus – sometimes referred to a bit awkwardly as “potential life.” Cf.

Commonwealth v. Bullock, 913 A.2d 207, 213 (Pa. 2006) (“[T]o accept that a fetus is not

biologically alive until it can survive outside of the womb would be illogical.”). Even during

an era when there was a federally-guaranteed right to abortion under Roe v. Wade, 410

U.S. 113 (1973), the United States Supreme Court recognized that a state’s interest in

3 In a footnote the majority recasts Plaintiffs’ ERA claim by suggesting that the actual sex-

based discrimination reflected in the coverage exclusion follows from the circumstance
that all male reproductive health procedures are allegedly covered, whereas not all female
ones are. See Majority Op. at 84 n.49 (citing Petition for Review at ¶ 54). If that were
truly the substance of the complaint, the General Assembly could resolve it simply by
terminating coverage for one randomly-selected male procedure, and then supposedly
Plaintiffs’ entire ERA claim would evaporate. Clearly, that is not what Plaintiffs are
arguing. The gravamen of their complaint is that MA covers childbirth but not abortion.
This is reflected by, inter alia, their argumentative allegation contained in the ERA count
itself proposing that the coverage exclusion violates the ERA because it “reinforces
gender stereotypes about the primacy of women’s reproductive function and the maternal
role.” Petition for Review at ¶ 91. As noted, subsidizing one pregnancy outcome but not
another is plainly not a sex-based distinction.

                             [J-65-2022] [MO: Donohue, J.] - 5
protecting fetal life was significant and that it subsisted throughout pregnancy. Thus, even

in that timeframe states were permitted to take steps to further their legitimate interest in

encouraging childbirth. See Beal v. Doe, 432 U.S. 438, 446 (1976). Recognizing they

have no federal claim, then, Plaintiffs presently advance a non-sequitur under the state

charter which the majority endorses on the false premise that the coverage exclusion

comprises a sex-based distinction. The premise is false because the coverage exclusion

does not “differentiate on the basis of gender” – a necessary feature of a sex-based

distinction. Sessions v. Morales-Santana, 582 U.S. 47, 57 (2017); accord Dobbs, 142 S.

Ct. at 2245 (observing that “a State’s regulation of abortion is not a sex-based

classification”).

       Plaintiffs also go to some length to characterize the coverage exclusion as violating

the ERA on the basis it perpetuates outdated stereotypes about women and childbearing.

They contend pregnancy has historically been invoked to support unfavorable treatment

of women in other contexts such as property ownership or property division in a divorce.

It is true that this Court has invalidated several statutes and common law doctrines based

on gender-based stereotypes. 4 But unlike this case, those matters involved situations

4 For example:  the Adoption Act’s failure to require parental consent of unwed fathers as
well as unwed mothers; the presumption where a husband obtains his wife’s property
without adequate consideration, that a trust is created in his wife’s favor; the doctrine of
“coverture” requiring a presumption that a wife who commits a crime in her husband’s
presence was coerced by her husband; the presumption that a husband is the owner of
household goods used and possessed by both spouses; a statutory scheme under which
women were eligible for parole immediately upon incarceration while men had to serve a
minimum sentence; a statute providing for alimony pendente lite, counsel fees, and
expenses in a divorce action for the wife but not for the husband; the presumption that a
father must bear the principal burden to support minor children; the presumption that the
husband could recover for loss of consortium but the wife could not; the tender years
doctrine which created a presumption requiring the father to overcome its effects; and
unequal automobile insurance rates based on gender. See Hartford Acc. & Indem Co. v.
Ins. Comm’r, 482 A.2d 542, 548 (Pa. 1984).

                            [J-65-2022] [MO: Donohue, J.] - 6
where the two sexes were otherwise able to perform the same task, which is not true with

pregnancy and childbirth.

       Plaintiffs rely largely on ideological expressions contained in law review articles.

See Brief at 35-40. The actual legal authority they present is sparse and their analysis

fails to account for Fischer’s observation that the legislative distinction being drawn here

is not between the sexes, but between the different outcomes of an existing pregnancy –

again, in service of the state’s important interest in promoting maternal health and

protecting fetal life from destruction. See Senate Intervenors’ Brief at 30 (noting the

coverage exclusion “does not focus on the condition of pregnancy, but on the act of

abortion”); accord Bell v. Low Income Women of Tex., 95 S.W.3d 253, 258 (Tex. 2002)

(“The classification here is not so much directed at women as a class as it is abortion as

a medical treatment, which, because it involves a potential life, has no parallel as a

treatment method.”). As the Supreme Court has recognized, “[a]bortion is inherently

different from other medical procedures, because no other procedure involves the

purposeful termination of a potential life.” Harris v. McRae, 448 U.S. 297, 325 (1980).

       Plaintiffs additionally interpret the coverage exclusion as expressing official

disapproval of women who reject the maternal role, which would run counter to the ERA’s

promise of equal treatment of the sexes. See Brief at 40. It is more accurate to say that,

via financial incentives, the state encourages pregnant women to choose childbirth over

abortion. While that type of incentive structure may be construed by some to carry an

implicit disapproval of the non-subsidized option, any such disapproval would stem from

the state’s interest in protecting life, not from an intent to scorn women who elect against

the maternal role. It therefore does not support the concept that the state is promoting

an outdated gender-based stereotype.

                            [J-65-2022] [MO: Donohue, J.] - 7
       Ultimately, Plaintiffs’ position in this litigation is substantially weakened because,

as explained above, abortion rights are not at stake, solely the ability to receive public

money to pay for abortions. 5 And in their brief to this Court, the harm Plaintiffs describe

as a basis for their standing to bring this action is not that their patients are in danger of

losing that legal right, but that they (Plaintiffs) must expend time and effort securing private

funding for the abortions at issue, time and effort they would prefer to spend on other

endeavors, and that they must also spend some time discussing financial matters with

their patients instead of being able to limit those discussions to medical issues. See Brief

at 14-15.

       Yet, despite all this, the plurality today would create an entirely new constitutional

doctrine out of whole cloth, christening it “reproductive autonomy,” which does not appear

anywhere in the Pennsylvania Constitution’s text or history. 6 The majority then overrules

5 It is undisputed that Plaintiffs’ low-income patients can and often do receive private

funding. Plaintiffs themselves allege that this is true in their petition for review.

6 While “autonomy” – literally meaning a law unto oneself or having one’s own laws – may

be attractive to some as a policy matter, this case calls for an exercise in constitutional
interpretation, not social policy creation. The words “reproductive” and “autonomy” do not
appear in the text of the Pennsylvania Constitution, either expressly or by necessary
implication. And the history of abortion regulations in this jurisdiction belies the concept
that the people of this Commonwealth have displaced the Legislature by
constitutionalizing the life and health issues that inevitably arise in connection with a
decision to abort a living human fetus. See infra note 11.

The plurality mischaracterizes the above as “hyperbole” and then slays a straw man by
suggesting I might question the right of privacy given that the word “privacy” does not
appear in the text of our Charter. Majority Op. at 136 n.100 (plurality in relevant part).
This ignores the “necessary implication” facet of the above. As I have emphasized,
moreover, the present controversy is not about the right to choose abortion, it is about
whether taxpayers should be forced to subsidize that choice against their will as
expressed by their elected representatives. The difference between governmental
intrusions upon privacy rights and the funding dispute raised by the instant case is made
clear by the fact that, even when Roe was in force – and long after privacy was enshrined
(continued…)

                             [J-65-2022] [MO: Donohue, J.] - 8
a unanimous decision of this Court that is directly on point, and markedly erodes the

authority of a co-equal branch of government to balance competing public policy concerns

and make judgments by its own lights. 7

beyond question in the constitution at both the state and federal levels – the coverage
exclusion survived constitutional scrutiny as did its federal counterpart, the Hyde
Amendment. The plurality’s further claim that it is acting consistently with centuries of
this Court’s jurisprudence is belied by our unanimous decision in Fischer.

7 I agree with the majority that the ERA applies to individuals.    See Majority Op. at 85
n.51. But in making that observation the majority emphasizes what is not in dispute. The
ERA provides in full: “Equality of rights under the law shall not be denied or abridged in
the Commonwealth of Pennsylvania because of the sex of the individual.” PA. CONST.
art. I, § 28. The operative terms are “equality,” “denied or abridged,” and “because of the
[person’s] sex.” My point is that, to the extent the coverage exclusion treats some women
differently than others, it is not “because of their sex” but because of their actions. And
this is putting aside that the exclusion does not “deny or abridge” anyone’s rights, as it
does not interfere in any way with a woman’s right to obtain an abortion.

The majority also fails to give a satisfactory account of the word “equality,” a term that
necessarily involves a comparison – which in turn raises the question, equal to what? In
light of the clarifying phrase “because of the [person’s] sex,” the obvious answer is the
other sex. All of our ERA cases have recognized this. See, e.g., Commonwealth v.
Butler, 328 A.2d 851, 855 (Pa. 1974); see also Majority Op. at 94-98 (summarizing cases).
Even in Cerra v. East Stroudsburg Area School District, 299 A.2d 277 (Pa. 1973), the
case on which the majority places heaviest reliance, we reasoned that under the
challenged rule “[m]ale teachers, who might well be temporarily disabled from a multitude
of illnesses, have not and will not be so harshly treated. . . . This is sex discrimination
pure and simple.” Id. at 280, quoted in Majority Op. at 97.

Accounting for the meaning of “equality” is necessary to a correct application of the ERA
because, by its terms, the ERA prohibits the abridgement, not of rights as such, but of the
equality of rights. The majority confuses the connotation of the term “equality” by
suggesting it means the government may not “withhold the enjoyment” of a person’s
rights. Majority Op. at 84. State action withholding the enjoyment of certain rights may
indeed be unconstitutional, but it does not violate the ERA unless it withholds that
enjoyment “because of the [person’s] sex” – which the coverage exclusion does not do:
first, because it does not “withhold the enjoyment” of any rights from anyone, and second,
because it does not make any sex-based distinction.

                            [J-65-2022] [MO: Donohue, J.] - 9
B. Count II – Equal Protection

       With regard to equal protection, Plaintiffs’ core position is that, if the state funds

health care relating to pregnancy, it must do so evenhandedly by funding abortions too.

Relying on Article I, Sections 1 and 26, and Article III, Section 32, they argue strict scrutiny

applies to the legislative distinction between abortion and childbirth because abortion,

being based on privacy, is a fundamental right which is burdened by that distinction. They

use language suggesting the state is acting in a coercive manner by invading women’s

“bodily integrity” and in blocking low-income women from obtaining the care they need.

They criticize Fischer for casting the right at issue as the right to state-funded abortions,

whereas in reality, they argue, it is the right to equal treatment of constitutionally-protected

choices. 8

       Initially, Article III, Section 32 is irrelevant. That provision prohibits special or local

laws in any case that can be provided for by general law, and it precludes special laws

on certain enumerated topics such as the regulation of school districts. However, the

Abortion Control Act is not a special law.          It is a general law because it creates

classifications that are “not ‘closed,’ but open for new members to come in.” Harrisburg

Sch. Dist. v. Zogby, 828 A.2d 1079, 1091 (Pa. 2003). Its classifications are women

enrolled in MA who choose childbirth, and women enrolled in MA who choose abortion.

These are not closed classes. Although in some contexts Section 32 has been viewed

as one pillar of the equal protection guarantee under the state Charter, this is not one of

them because, again, this is not a challenge to a special law.

8 Plaintiffs again use an analogy to illustrate their point.      They note the state need not
subsidize voter transportation to the polls, but if it elects to do so it cannot solely subsidize
transportation for registered Democrats but not registered Republicans. See Brief at 57
n.30. This hypothetical is discussed below.

                             [J-65-2022] [MO: Donohue, J.] - 10
       That leaves Article I, Sections 1 and 26. Equal protection under those provisions

has generally been deemed coterminous with the Equal Protection Clause of the

Fourteenth Amendment. The analysis uses the same framework by discerning the level

of judicial scrutiny and then assessing whether the legislative classification survives such

scrutiny. See Love v. Borough of Stroudsburg, 597 A.2d 1137, 1139 (Pa. 1991). To

discern what level of scrutiny to apply, courts ask what legislative classification has been

made, and what interests if any are infringed by it. Just as being able to frame the terms

of a debate gives one an advantage, both sides here seek to frame the classifications

and the interests at issue in terms that favor their position. The legislative intervenors

focus on the funding aspect of the dispute and note indigency is not a suspect

classification, whereas Plaintiffs argue abortion and bodily autonomy are fundamental

rights and suggest the state is acting coercively. They frame the issue as “the right to

equal treatment of constitutionally-protected choices.” Brief at 72.

       Identifying the classification here is aided by Plaintiffs’ subsidized-transportation

example. See supra note 8. Plaintiffs offer that the state need not subsidize voter

transportation to the polls, but if it elects to do so it cannot solely subsidize transportation

for registered Democrats but not registered Republicans. See Brief at 57 n.30. Although

the analogy is ultimately off point, as the state lacks a valid interest to favor electoral

participation by only one political party, whereas it does have a valid interest in protecting

fetal life, the example still highlights that the real classification is not indigent versus non-

indigent women (since the government does not subsidize abortion for either group), but

MA-enrolled pregnant women who choose childbirth versus MA-enrolled pregnant

women who choose abortion. 9 By the same token, the alleged interest at stake is not

9 As discussed in Part III below, even this rendering is imprecise because the coverage

exclusion does not treat persons differently, it treats their actions differently.

                             [J-65-2022] [MO: Donohue, J.] - 11
solely public funding for abortion, but the right to public funding of abortion when public

funds are made available for childbirth. Plaintiffs do not provide any legal authority to

substantiate that this conditional right – or that their suggested freestanding right to “equal

[funding] of constitutionally-protected choices,” Brief at 72 – even exists, let alone is a

fundamental one. The right and classification reflected in the emphasized text above are

two sides of the same coin, and there is no authority to support that either one triggers

strict or intermediate scrutiny. 10 That being the case, the rational-basis standard is

implicated here, and so the question becomes whether the classification is rationally

related to a legitimate state interest.

       The question answers itself, and it was answered in Fischer. There is little dispute

that MA-enrolled women who choose abortion and MA-enrolled women who choose

childbirth are not similarly situated. They have different needs, and by their choices they

actively promote, or actively impede, the government’s interest in protecting fetal life,

which is undoubtedly an important one. See Fischer, 502 A.2d at 122 (“[T]o say that the

Commonwealth’s interest in attempting to preserve a potential life is not important, is to

fly in the face of our own existence”). See generally Zogby, 828 A.2d at 1088 (explaining

that equal protection does not preclude differential treatment of persons having different

needs; the Legislature retains the power to classify, which flows from its general power

to enact regulations for the health, safety, and welfare of the community). The General

Assembly may choose to fund one but not the other because it retains discretion to

allocate the finite social welfare resources of this Commonwealth according to its

legitimate aims. In so doing, providing funding to encourage women to choose childbirth

10 Suspect classes are race and national origin, and, for purposes of state (as opposed

to federal) laws, alienage. Quasi-suspect classes (sensitive classifications) are gender
and legitimacy. See Small v. Horn, 722 A.2d 664, 672 & nn.14-15 (Pa. 1998) (citing
cases).

                            [J-65-2022] [MO: Donohue, J.] - 12
and to help effectuate that choice, while also declining to provide funding to facilitate

abortions, is rationally related to the state’s legitimate interest in protecting life.

C. Effect of Dobbs

       Fischer was decided in an era when Roe was still in force. In that era abortion

rights were protected by the United States Constitution. By the time Fischer was decided,

twelve years after Roe, many of the issues raised here had been addressed and resolved

by the United States Supreme Court in terms of the leeway afforded states by the federal

Constitution. Thus, in Fischer we observed that, per the Supreme Court, a state’s interest

in fetal life was significant and continued throughout pregnancy. States could therefore

take steps to further their legitimate interest in encouraging childbirth. See Fischer, 502

A.2d at 118 (quoting Beal, 432 U.S. at 446). There was no requirement for states to

accord equal treatment to abortion and childbirth, and thus, a state could pay the

expenses of childbirth while declining to pay for most abortions. See id. (quoting Maher

v. Roe, 432 U.S. 464, 470 (1977)). Further, while the right under Roe protected women

from state actions that unduly burdened their freedom to terminate a pregnancy, it implied

no limitation on the authority of the government to make a value judgment favoring

childbirth over abortion, or to implement that judgment through its allocation of public

funds. See id. (quoting Maher, 432 U.S. at 473-74). As a consequence, Congress could

lawfully limit the funding of abortions to life-threatening situations and/or to medically-

necessary abortions in pursuing a policy to encourage childbirth. See id. (citing Harris v.

McRae, 448 U.S. 297 (1980); Williams v. Zbaraz, 448 U.S. 358 (1980)).

       We explained further that the Supreme Court’s decision in Harris dealt with the

Hyde Amendment, which was challenged on due-process and equal-protection grounds.

As for due process, Harris held that: although a state forcibly interfering with abortion

may violate due process, a state merely encouraging an alternative to abortion in the

                             [J-65-2022] [MO: Donohue, J.] - 13
public interest does not. Freedom to choose abortion thus does not equate to a right to

receive public funding for that choice. As well, if a woman is indigent, the government is

not obligated to remove obstacles not of its own making. See id. at 119 (relying on Harris,

448 U.S. at 316-17).

       Finally, regarding equal protection, we noted that the Supreme Court had ruled

that: indigency is not a suspect class, and therefore rational-basis is the test to use;

disparate impact on low-income women is not relevant to the analysis; and the Hyde

Amendment is rationally related to the legitimate government interest in protecting fetal

life. See id. at 119-20 (citing Harris, 448 U.S. at 323-25).

       That was the state of the law when Roe was in force. At this juncture, Roe is no

longer in force, see Dobbs v. Jackson Women’s Health Org., 142 S. Ct. 2228 (2022), and

state legislatures now have greater flexibility under the federal Constitution to enact

abortion regulations than they did before. That being the case, the principles underlying

Fischer as summarized above continue a fortiori. Nonetheless, in view of the sea change

accomplished by Dobbs, we permitted the parties to file supplemental briefs addressing

what impact, in their view, Dobbs should be seen as having on this case.

       Plaintiffs argue Dobbs has nothing to do with this litigation and, if anything, it

highlights that the Pennsylvania Constitution’s protection of reproductive rights is

separate from and more robust than the protection under the federal Constitution. They

also point to an executive order by former Governor Wolf, issued post-Dobbs, reflecting

his view that the Pennsylvania Constitution protects abortion rights. Plaintiffs offer a

policy argument: since the United States Constitution no longer protects abortion rights,

it is that much more important for this Court to do so. This then becomes the basis for a

legal argument that Dobbs comprises a “special justification” to revisit Fischer. Further,

although Dobbs contains language indicating there is no federal Equal Protection Clause-

                            [J-65-2022] [MO: Donohue, J.] - 14
based right to an abortion because abortion restrictions do not constitute a sex-based

classification, see Dobbs, 142 S. Ct. at 2245-46, Plaintiffs characterize that language as

dicta that does not apply under the Pennsylvania Constitution.

       For its part, the Department of Human Services argues Dobbs changes nothing.

It stresses that the narrow issue here is abortion subsidization, not abortion rights. The

Department highlights that Plaintiffs do not contend there is a fundamental right to a state-

funded abortion.

       The Senate intervenors express that Dobbs is the most significant abortion-related

decision in fifty years, but it has nothing to do with abortion funding, which is within the

General Assembly’s exclusive purview under Article II, Section 1, which vests legislative

power in the General Assembly, and Article III, Section 34, which states no money shall

be paid out of the treasury, except on appropriations made by law. They stress that equal

protection under the Pennsylvania Constitution has long been viewed as coterminous

with the Fourteenth Amendment, and hence, Dobbs does not bolster Plaintiffs’ position

that Fischer should be overturned – especially insofar as Dobbs expressly rejected an

equal-protection-based sex discrimination claim in relation to abortion restrictions. They

assert that, since there are now no federal constitutional limits on a state’s authority to

regulate abortion, Plaintiffs’ equal protection claim is less tenable than before Dobbs and

so it is less, not more, appropriate to revisit Fischer. This Court should not “take Plaintiffs’

bait,” they continue, and use this case to address the right to abortion in Pennsylvania.

They reason, as to both counts of the petition for review, that the coverage exclusion does

not treat women differently than men: it treats two categories of women differently – those

who terminate their pregnancy and those who carry it to term. This type of distinction,

they maintain, does not trigger heightened scrutiny and it easily survives rational basis

review.

                            [J-65-2022] [MO: Donohue, J.] - 15
       The House intervenors agree with the above and add that the Roe-based right

formed the backdrop to Pennsylvania abortion law, as no such right was ever original to

the Pennsylvania Constitution and abortion has no historical roots in this Commonwealth.

Unlike New York and California, they stress that this state never enacted laws protecting

abortion; rather, Pennsylvania has enacted laws protecting a mother and her unborn

child. See, e.g., Commonwealth v. Bullock, 913 A.2d 207 (Pa. 2006) (upholding the

constitutional validity of Pennsylvania’s fetal homicide law). Now that the Supreme Court

has returned “the authority to regulate abortion” “to the people and their elected [state]

representatives,” Dobbs, 142 S. Ct. at 2279, the House intervenors submit there can be

no right to a taxpayer-funded abortion.          They contend that at a minimum this

Commonwealth has determined abortion is not an appropriate use of public funds, and

that determination should remain in the legislative sphere. They argue once the Supreme

Court recognized the lack of a federal abortion right it employed rational-basis review in

evaluating the legislation challenged in Dobbs. They contend this Court should use that

same level of scrutiny as well in evaluating the coverage exclusion.

       Dobbs overturned Roe and held abortion is no longer a right protected under the

United States Constitution. In my view, this development can only harm Plaintiffs’ current

litigation position because it removes one basis to claim that abortion is a fundamental

right entitled to mandatory public funding equivalent to childbirth. Plaintiffs may argue

that from a social policy standpoint this Court should fill the gap left by Dobbs and

redouble its efforts to protect the abortion right, but that is an argument for the legislative

arena. From a legal standpoint it is hard to see how Dobbs can strengthen Plaintiffs’

position.

       Dobbs returned abortion regulation to the states, and hence, the state Charter is

now the primary basis for abortion providers and women seeking abortions to claim a

                            [J-65-2022] [MO: Donohue, J.] - 16
constitutional entitlement to public funding equivalent to that for childbirth.          This

development would be more beneficial to Plaintiffs if the abortion right was historically

recognized as fundamental in Pennsylvania. But there is nothing in the history of this

Commonwealth to that effect, notwithstanding that the right of privacy has always been

enshrined in our state Constitution. See, e.g., Mills v. Commonwealth, 13 Pa. 631, 633

(1850) (declaring abortion throughout pregnancy a crime in Pennsylvania, with no

exception for the pre-“quickening” period of gestation). 11 Even after Roe, laws seeking

11 It also bears noting that our charter was rewritten in 1874 after Mills was decided, and

substantially rewritten again in the late 1960s when abortion liberalization was occurring
in other jurisdictions. In both instances, and in the numerous amendments before and
after Fischer and Roe, the people have not seen fit to add text protecting reproductive
autonomy, or in any way directly relating to that concept or to abortion funding.

Additionally, while the plurality highlights the “monumental impact” on the woman making
the abortion decision, an impact I do not deny, Majority Op. at 152 (plurality in relevant
part), it gives little weight to the monumental impact the abortion decision has for the
unborn child, who either lives or dies depending on the mother’s choice – or to the
legislative preference insofar as it is designed to promote the mother’s physical and
mental health. See 18 Pa.C.S. § 3202(a) (reflecting an intent to promote maternal life
and health); see also Brief of Amici American Association of Pro-Life Obstetricians &
Gynecologists, at 4-21 (detailing the adverse health effects of abortion); McCorvey v. Hill,
385 F.3d 846, 850-52 (5th Cir. 2004) (Jones, J., concurring) (summarizing evidence of
record describing serious mental health issues in the post-abortive timeframe).

Nor does the plurality account for the impact of the decision on the fetus whose life is
terminated or for the governmental interest in preserving that life. In dismissing all such
concerns on the grounds that people’s “views of morality may change,” the examples
cited by the lead Justices – such as those dealing with adultery and the like – are
materially distinguishable as none involves the destruction of another extant human life
that has undeniable value.

The plurality does not recognize this distinction, claiming instead it is “not constrained . .
. to determine whether abortion is ‘deeply rooted’ in the ‘history or traditions’ of this
Commonwealth.” It then adds, inconsistently, that only the “text and history” of Article I,
and the intent of the people adopting it, really matter. It gives as the reason that the
(continued…)

                            [J-65-2022] [MO: Donohue, J.] - 17
to protect fetal life were passed in this Commonwealth when the abortion right itself was

largely in the domain of the federal courts. See House Intervenors’ Brief at 53 (listing

laws, including the Crimes Against the Unborn Child Act, Newborn Protection Act (the

safe haven or “baby Moses” law), elimination of the cause of action for wrongful birth or

wrongful life, and barring the defense against a claim for injury sustained in utero).

       Finally, to the extent bodily integrity, decisional autonomy, the right to be the

“master of one’s own fate,” and similar ideological expressions forwarded by Plaintiffs,

see Brief at 63; see also Majority Op. at 129, 137 (plurality in relevant part) (highlighting

these concepts), can be seen as protected by the Pennsylvania Constitution, the

government here is not infringing those rights. Those rights erect a shield against state

subject of abortion must be free of policy debates and of the “deeply held views on both
sides” of the issue.

But those words are insufficient to conceal that in the plurality’s reckoning, the “deeply
held views” of only one side of the debate count. The plurality gives no persuasive
explanation of why that is true, given that there is another life at issue – a circumstance
the General Assembly certainly is allowed to take into account. See Planned Parenthood
of the Heartland v. Reynolds, 975 N.W.2d 710, 740 (Iowa 2022) (finding the Iowa
Constitution does not support abortion as a fundamental right in part because of
“important interests – such as life itself – on both sides”). As illustrated by this case,
moreover, those other lives are particularly vulnerable to destruction and have no voice
of their own in the political process. They must therefore rely on others to be their voice,
and there is little in the lead opinion to suggest it believes the General Assembly may
attend at all to that surrogate voice.

Finally, it is worth noting that in their 219-page opinion, the lead Justices do not once
concede those other lives have inherent value or that a choice to abort them necessarily
involves their involuntary, violent destruction. See Brief for Amicus Democrats for Life of
America, at 13 (discussing technological advances revealing that human fetuses feel
pain, as well as scholarship indicating that “mainstream medicine now recognizes the
fetus as a patient, capable of being treated and worthy of care”). Instead, they invoke
euphemisms drawn from political ideology, such as “reproductive autonomy,” “procreative
choice,” and “control of one’s body” – without acknowledging there is another “body” in
the equation that the Legislature may validly consider, or that adoption exists as an option
for a pregnant woman to avoid expanding her family if she so chooses.

                            [J-65-2022] [MO: Donohue, J.] - 18
intrusion into one’s body and one’s private choices, but they do not entitle women seeking

abortion to the same level of public funding as women pursuing childbirth.

                              III. What this case is not about

       As observed at the outset of this opinion, this case is not about a woman’s right to

choose abortion. It is about the use of taxpayer dollars to subsidize that choice. 12 Yet,

the plurality would use this dispute to fabricate a fundamental right to reproductive

autonomy as a stepping-stone to erecting an all-but-insuperable hurdle for the political

branches to clear in fulfilling their core function to determine how best to allocate taxpayer

funds in the public interest, consistent with their own judgments and determinations about

the appropriate way to balance competing social policy objectives. See Majority Op. at

217 (plurality in relevant part) (“The state bears a heavy burden of justification[.]”). As

reflected in the Abortion Control Act, the legislative branch, fulfilling that role, has already

determined it would best serve the health, safety, and welfare of the citizens of this

Commonwealth, including pregnant women, to structure the financial incentives created

by public monies to encourage the bringing to term of a living human fetus. See generally

18 Pa.C.S. § 3202(a) (expressing legislative intent to protect the life and health of both

the woman and the child subject to abortion). Today, the lead Justices would in essence

override that legislative judgment, and, in doing so they would give no weight at all to the

state’s interest in accommodating the conscience of taxpayers with deeply-held beliefs

opposed to abortion who do not want to be compelled to fund it. See generally Brief for

12 It may be noted that Plaintiffs are not women seeking abortion, but abortion providers

who stand to receive substantial public funds from a ruling in their favor. See generally
Brief for Amici Nationally Recognized Organizations & Leaders in the Black Community,
at 29 (describing this litigation as having been commenced by “the largest abortion
businesses in Pennsylvania to fund elective abortions”).

                            [J-65-2022] [MO: Donohue, J.] - 19
Amicus Democrats for Life of America, at 9-14 (discussing the history and social value of

such legislative accommodations). 13

       Further, establishing the right to reproductive autonomy as both fundamental and

of constitutional provenance is unnecessary to this case: even if one assumes it subsists

as an inherent right, the Abortion Control Act does not penalize women for exercising it.

See McRae, 448 U.S. at 317 n.19 (recognizing that the refusal to fund protected activity

does not equate to the imposition of a penalty on that activity). To the contrary, it leaves

them alone, opting not to grant them money or charge them money – which is the very

basis for the right itself as the plurality conceives it. See, e.g., Majority Op. at 147 (plurality

in relevant part) (grounding the abortion decision in the right to be let alone). “There is a

basic difference between direct state interference with a protected activity and state

encouragement of an alternative activity consonant with legislative policy.” Maher, 432

U.S. at 475.

       One may therefore wonder how the right to be let alone in making personal

decisions can be transformed into the right to receive taxpayer money to fund one

decision if the government funds a different decision. To justify this transformation, the

plurality indicates that not receiving money amounts to “discriminating against [a] person

in the exercise of a fundamental right[.]” Majority Op. at 217 (plurality in relevant part).

13 In overriding the Legislature’s judgment, the plurality would additionally set the stage

for this Commonwealth to become bogged down in virtually limitless abortion litigation, as
all aspects of Pennsylvania’s abortion regulations are now certain to become subject to
lengthy court proceedings in relatively short order. These include such measures as the
required informed-consent counseling and 24-hour waiting period, see 18 Pa.C.S.
§ 3205; parental consent for minors, see id. § 3206; the prohibition on abortions
performed after 24 weeks’ gestation, see id. § 3211; the need to determine gestational
age, see id. § 3210; the prohibition on feticide when an abortion fails, see id. § 3212;
reporting requirements, id. § 3214; the prohibition on sex-selection abortions, see id.
§ 3204(c); limitations on abortions at public health facilities, see id. § 3215(c); limitations
on abortions performed on an ambulatory basis, see 28 Pa. Code § 29.34, and clinic
health and safety standards, see id. §§ 29.33, 29.43.

                             [J-65-2022] [MO: Donohue, J.] - 20
But this is wordplay. In reality, it is not discrimination against a person. It treats no person

differently than any other. Each person faces the exact same conditions: in recognition

of the public interest favoring childbirth – an interest that does not appear to be in dispute

– the government subsidizes that person’s actions only if she decides to bring her

pregnancy to term. This is a far cry from discriminating against a person because of her

sex, which, unlike her actions, she has no control over.

       This type of financial incentive is hardly unique to pregnancy healthcare decisions.

Freedom of speech is a fundamental right, but the government may subsidize some

speech while not subsidizing other speech (such as political lobbying). See Regan v.

Taxation With Representation of Wash., 4611 U.S. 540, 549 (1983) (“We have held in

several contexts that a legislature’s decision not to subsidize the exercise of a

fundamental right does not infringe the right, and thus is not subject to strict scrutiny.”).

This same principle allows the government to require educational institutions receiving

federal monies, and their students, to execute an agreement promising to abide by federal

anti-discrimination laws as a condition of receiving those monies. Such a requirement

does not violate their First Amendment rights as they remain free to decline the funds and

not execute the agreement. See Grove City College v. Bell, 465 U.S. 555, 575-76 (1984).

Thus, when the government provides public funds, it may condition those funds on the

recipient agreeing not to act contrary to the government’s legitimate interests, even if the

recipient has a fundamental, constitutionally-protected right to so act:

       The Government can, without violating the Constitution, selectively fund a
       program to encourage certain activities it believes to be in the public
       interest, without at the same time funding an alternative program which
       seeks to deal with the problem in another way. In so doing, the Government
       has not discriminated . . .; it has merely chosen to fund one activity to the
       exclusion of the other.

                            [J-65-2022] [MO: Donohue, J.] - 21
Rust v. Sullivan, 500 U.S. 173, 193 (1991). 14

       In brief, what the majority overlooks is that there is a material difference between

a person and her actions, and that the funding discrepancy here is not based on who

women are, but on what they do. Moreover, the coverage exclusion works no more of an

intrusion into a woman’s personal decisions than if the General Assembly decided not to

fund any pregnancy-related services at all – or if it decided that the best use of public

funds was to subsidize pregnancy-related medical expenses above a certain dollar

threshold, and that threshold happened to be greater than the cost of most abortions but

less than the cost of medical care associated with bringing a pregnancy to term. As the

Supreme Court has cogently explained:

14 To take another example, some states recognize a fundamental right to private choice

when selecting foods. See MAINE CONST. art. I, § 25 (“All individuals have a natural,
inherent and unalienable right to food . . . including . . . the right to . . . consume the food
of their own choosing[.]”). As with the abortion right, this interest has been cast as one
facet of personal autonomy and the right of privacy. See Farm-to-Consumer Legal
Defense Fund v. Sebelius, 734 F. Supp. 2d 668, 679-80 (N.D. Iowa 2010). See generally
Kammi L. Rencher, Food Choice & Fundamental Rights, 12 NEV. L. J. 418 (2012). Under
the lead opinion, it is plausible that if such a right were recognized in Pennsylvania, any
state-funded nutrition-assistance program designed to assist low-income residents would
be constitutionally suspect to the extent it was limited to healthy foods and did not apply
to other, less healthy foods preferred by some program participants.

There is also a fundamental liberty interest in receiving or declining life-sustaining medical
treatment. See Cruzan by Cruzan v. Director, Mo. Dep’t of Health, 497 U.S. 261 (1990).
The lead opinion’s conclusions would appear to mean that if the state subsidizes
lifesaving medical treatment, it must equally subsidize the costs associated with a
decision to die. In other words, the state cannot incentivize life over death.

Or consider yet another example: parents enjoy a fundamental right to direct the
upbringing and education of their children. See Pierce v. Society of Sisters, 268 U.S. 510
(1925). Today’s ruling could mean that if the state subsidizes parents’ choice to send
their children to public or private schools, it must also subsidize their choice to home
school their children. See Wisconsin v. Yoder, 406 U.S. 205, 232 (1972). The list of
examples is limited only by the imagination.

                            [J-65-2022] [MO: Donohue, J.] - 22
       An indigent woman who desires an abortion suffers no disadvantage as a
       consequence of [a State’s] decision to fund childbirth; she continues as
       before to be dependent on private sources for the service she desires. The
       State may have made childbirth a more attractive alternative, thereby
       influencing the woman's decision, but it has imposed no restriction on
       access to abortions that was not already there.
Maher, 432 U.S. at 474; accord McRae, 448 U.S. at 316 (“It simply does not follow that a

woman’s freedom of choice carries with it a constitutional entitlement to the financial

resources to avail herself of the full range of protected choices.”).

       Finally, the majority’s ill-considered ruling that Article I, Section 26 means that “the

government must maintain a position of [funding] neutrality with regard to citizens’

exercise of their constitutional rights,” Majority Op. at 215-16, will have far-reaching and

unintended consequences as it applies to all manner of governmental funding. Any

number of pursuits involve the exercise of fundamental rights in one way or another, see

supra note 14, and the Commonwealth’s ability to subsidize some while not subsidizing

others in the public interest is inherent to the legislative power as vested in the General

Assembly by Article II, Section 1. See Zogby, 828 A.2d at 1088. Our previous explanation

that Section 26 means citizens cannot “be harassed or punished for the exercise of their

constitutional rights,” Fischer, 502 A.2d at 123, was well-considered, restrained, and

appropriate, as it preserved the delicate balance of power among the coequal branches

while also protecting individuals from unjust legislative classifications, but it did not lead

to the result the majority wants to reach in this case. The majority’s substituted “neutrality”

approach as applied to the public funding arena will assuredly prove destructive to that

balance by seriously undermining the Legislature’s power to advance legitimate state

interests. 15 The best evidence of this is that the lead Justices presently use the precept

15 The lead Justices appear to disparage such legislative choices by referring to our co-

equal branch as “transient legislatures.” Majority Op. at 165 (plurality in relevant part).
The General Assembly is not transient, it is a fixed part of our Commonwealth’s
(continued…)

                            [J-65-2022] [MO: Donohue, J.] - 23
to conclude that the people’s elected representatives are not even allowed to “encourage

childbirth over abortion,” to favor life over death. Majority Op. at 216 (plurality in relevant

part). That is an absurd result that cannot possibly have been the intent of the drafters of

Article I, Section 26, or of the voters who approved it. As such, today’s ruling represents

a political decision that intrudes into the legislative sphere and thereby usurps the

Legislature’s legitimate authority.

                                       IV. Conclusion

       For the reasons given above, I would apply stare decisis, decide this appeal based

on our unanimous and well-supported ruling in Fischer, and affirm the Commonwealth

Court’s order. Insofar as the majority instead overrules Fischer, vacates that order, and

remands, I dissent.

government. If the adjective and use of the plural (“legislatures”) are intended to convey
that the Legislature’s membership changes over time, that does not distinguish it from the
other two branches, including this Court. Indeed, a change in this Court’s membership
has now led to the overruling of a prior unanimous decision of this Court. Ironically, the
majority simultaneously labels as “dangerous” my adverting parenthetically to the fact that
the present majority comprises three Justices whereas the Fischer majority consisted of
seven (an observation that is allegedly also “pedestrian”). Majority Op. at 54 n.30. I
submit that if anything is dangerous, it is this Court’s unjustified interference with
decisions made by the people’s representatives concerning the appropriate use of public
funds.

                            [J-65-2022] [MO: Donohue, J.] - 24