Beal v. Doe involved a Pennsylvania law that restricted state Medicaid funding of abortions to physician verified, medically necessary abortion procedures. The question that faced the Supreme Court in Beal was whether Title XIX of the Social Security Act required states to fund “nontherapeutic” abortions. In a six to three decision, the Court ruled that states were not required to fund “nontherapeutic” abortions and could limit abortion coverage in their Medicaid programs.

The majority limited their opinion to statutory interpretation — that is, they considered the text of Title XIX and Congress’ intentions when drafting the law. They did not address the constitutional questions of equal protection and due process raised in the challenge. This provoked a blistering dissent from Justice Thurgood Marshall and a skeptical one from Justice Harry Blackmun, the author of the Roe decision.

The consequences of Beal

The Beal decision was issued on June 20, 1977, on the heels of the Hyde Amendment. Federal funds were already limited to pregnant women who were seeking abortion care because of rape, incest or health. Now, states could add similar restrictions.

The impact of this case has been enormous. Today, 33 states have rape/incest/health restrictions in their Medicaid programs. As a result, people enrolled in Medicaid must seek alternate means in order to pay for an abortion. Depending on the cost of the procedure and the financial resources of the patient, this may mean dipping into hard-earned savings, selling family heirlooms or skipping a utility payment to cover the cost. Many people also turn to abortion funds. Nearly half of the callers who contacted DCAF last fiscal year were on Medicaid or a similar government health insurance plan.

Notable selections

The governmental benefits at issue here, while perhaps not representing large amounts of money for any individual, are nevertheless of absolutely vital importance in the lives of the recipients. The right of every woman to choose whether to bear a child is, as Roe v. Wade held, of fundamental importance. An unwanted child may be disruptive and destructive of the life of any woman, but the impact is felt most by those too poor to ameliorate those effects. If funds for an abortion are unavailable, a poor woman may feel that she is forced to obtain an illegal abortion that poses a serious threat to her health and even her life. If she refuses to take this risk, and undergoes the pain and danger of state-financed pregnancy and childbirth, she may well give up all chance of escaping the cycle of poverty. Absent day-care facilities, she will be forced into full-time child care for years to come; she will be unable to work so that her family can break out of the welfare system or the lowest income brackets. If she already has children, another infant to feed and clothe may well stretch the budget past the breaking point. All chance to control the direction of her own life will have been lost.

— Justice Thurgood Marshall’s dissent

The Court concedes the existence of a constitutional right, but denies the realization and enjoyment of that right on the ground that existence and realization are separate and distinct. For the individual woman concerned, indigent and financially helpless…the result is punitive and tragic. Implicit in the Court’s holdings is the condescension that she may go elsewhere for her abortion. I find that disingenuous and alarming, almost reminiscent of: “Let them eat cake.”

— Justice Harry Blackmun’s dissent

By volunteer Carolyn B.