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Williams v. Zbaraz (1980)

In Depth

Background

An Illinois law prohibited the use of state medical assistance funds to pay for abortions for indigent women under the state Medicaid program (and two other medical assistance programs funded solely with state funds) unless the procedure was necessary to preserve the woman's life.   Two Illinois physicians who performed abortions, an indigent woman who alleged that she sought an abortion that was medically necessary, but not necessary to save her life, and a welfare rights organization brought a lawsuit in federal district court challenging the funding restrictions.  The plaintiffs sued the Director of the Illinois Department of Public Aid.

The lawsuit raised both statutory and constitutional claims.  Plaintiffs alleged that Title XIX of the Social Security Act (commonly known as the Medicaid Act) required Illinois to provide coverage in its Medicaid plan for all medically necessary abortions, whether or not the life of the pregnant woman is endangered.  In the alternative, plaintiffs alleged that the public funding by the State of medically necessary services generally, but not of certain medically necessary abortions, violated the Equal Protection Clause of the Fourteenth Amendment.

After bouncing back and forth several times between the district court and the court of appeals, the district court was directed by the court of appeals to rule on the constitutionality of the Hyde Amendment, which had not been challenged by the plaintiffs, as well as the Illinois law. The district court held that both the Hyde Amendment and the Illinois law denied indigent women seeking abortions the equal protection of the laws because each prohibited funding of "medically necessary abortions," even though all other medically necessary operations are funded.  Zbaraz v. Quern, 469 F.Supp. 1212, 1221 (N.D. Ill. 1979).  Accordingly, both the state law and the Hyde Amendment were declared unconstitutional.  The district court, however, enjoined enforcement only of the state law, not the Hyde Amendment.  Under the law in effect at the time, the district court's judgment was appealed directly to the Supreme Court, bypassing the court of appeals.

The Statute Under Review

The challenged statute consisted of three sections:

[Medical services.]  The Illinois Department [of Public Aid], by rule, shall determine the quantity and quality of the medical assistance for which payment will be authorized, and the medical services to be provided, which may include all or part of the following: [listing 16 categories of medical services], but not including abortions, or induced miscarriages or premature births, unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment. . . .

Ill. Rev. Stat. ch. 23, § 5-5.

Eligibility requirements. . . . Nothing in this Article shall be construed to permit the granting of financial aid where the purpose of such aid is to obtain an abortion, induced miscarriage or induced premature birth unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment. . . .

Ill. Rev. Stat. ch. 23, § 6-1.

Eligibility requirements.  Aid in meeting the costs of necessary medical, dental, hospital, boarding or nursing care, or burial shall be given under this Article [to eligible persons], except where such aid is for the purpose of obtaining an abortion, induced miscarriage or induced premature birth unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment. . . .

Ill. Rev. Stat. ch. 23, § 7-1.

The Court's Holding

The Court unanimously held that the district court lacked jurisdiction to decide the validity of the Hyde Amendment.  By a vote of five-to-four, the Court then held that the State of Illinois could restrict public funding of abortions to those necessary to preserve the life of the mother.

The Court's Reasoning

In the first part of its opinion, the Court held that the district court lacked jurisdiction to decide the constitutionality of the Hyde Amendment because it had not been challenged by the plaintiffs.  Accordingly, the Court vacated that portion of its judgment.  In the second part of its opinion, the Court noted that both plaintiffs' statutory claim (under Title XIX) and their constitutional claim (under the Equal Protection Clause) were foreclosed by the Court's decision the same day in Harris v. McRae, 448 U.S. 279 (1980).  Williams v. Zbaraz, 448 U.S. at 369.  As to the statutory claim, the Court held in McRae that "a participating State is not obligated under Title XIX to pay for those medically necessary abortions for which federal reimbursement is unavailable under the Hyde Amendment."  448 U.S. at 369 (summarizing holding in McRae).  As to the constitutional claim, the McRae Court held that "the Hyde Amendment does not violate the equal protection component of the Fifth Amendment by withholding public funding for certain medically necessary abortions, while providing funding for other medically necessary health services."  Id. (summarizing holding in McRae).  "It follows, for the same reasons, that the comparable funding restrictions in the Illinois statute do not violate the Equal Protection Clause of the Fourteenth Amendment."  Id.  The judgment of the district court declaring the Hyde Amendment and the Illinois statute unconstitutional and enjoining enforcement of the Illinois statute was vacated and the case was remanded to that court for further proceedings consistent with the Court's opinion. Id. at 369-70.  Justices Brennan, Marshall, Blackmun and Stevens dissented.  For an analysis of their dissents, as well as an analysis of the statutory and constitutional issues decided in McRae, please see the summary for that case.

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