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Reproductive Rights and Medicaid at Center of PA Supreme Court Ruling

2024 Pennsylvania Supreme Court

In a complicated 219-page decision, the Pennsylvania Supreme Court overturned a dismissal by the state’s Commonwealth Court and said that the lower court must hear a challenge to the constitutionality of a 1985 state law that limits the use of Medicaid dollars to cover the cost of abortions.

In a 3-2 decision, the Supreme Court put aside a 39-year-old decision that upheld a law banning the use of state Medicaid dollars for abortion, except in cases of rape, incest or to save the life of the mother.

The new ruling does not necessarily find a constitutional right to an abortion in Pennsylvania, where abortion is legal under state law through 23 weeks of pregnancy.

“Preliminarily, I note that this case does not concern the right to an abortion,” wrote Chief Justice Debra Todd in a concurring and dissenting opinion. “Rather, the issue before this Court is whether the Commonwealth, because it provides funds to indigent women who choose to give birth, is also required to provide funds to indigent women for the performance of an abortion when the abortion is not necessary to preserve the life of the mother, or where the pregnancy did not result from rape or incest.”

The lawsuit, brought by Planned Parenthood and other operators of abortion clinics, said the 1982 law unconstitutionally discriminates against poor women.

“The rights of Pennsylvanians are due to all Pennsylvanians, not just those wealthy enough to afford them,” said Planned Parenthood Executive Director Signe Espinoza in a statement. “Seeking essential health care should not be restricted based on your income bracket; 1 in 4 low-income women seeking an abortion are forced to carry unwanted pregnancies to term because of Medicaid coverage bans. Today’s ruling is the first step toward ending discriminatory access to care, and we remain committed to removing every barrier to abortion.”

While the case was focused on a decades-old law barring Medicaid from covering abortion access, abortion providers who challenged the law argued that it should be overturned because of the broader rights guaranteed by the Equal Rights Amendment to the state’s constitution.

Two of the justices concluded that the state’s constitution does establish that right and signaled that the wider court could ultimately establish that right should the case come back to them on appeal.

“The fundamental right of a woman to decide whether to give birth is not subordinate to policy considerations favored by transient legislatures,” Justice Christine L. Donohue wrote for the majority in her 219-page opinion. “We conclude that the Pennsylvania Constitution secures the fundamental right to reproductive autonomy, which includes a right to decide whether to have an abortion or carry a pregnancy to term.”

“Whatever one thinks about the role of history and tradition in affording rights to women under the United States Constitution, the Pennsylvania Constitution’s ERA did away with the antiquated and misogynistic notion that a woman has no say over what happens to her own body,” wrote Justice David N. Wecht in a concurring 71-page opinion. “The right to reproductive autonomy originating in Article I, Section 1 and in the non discrimination guarantee of Article I, Section 26 likewise are not constrained by federal law. These constitutional provisions protect Pennsylvanians from the powers of the state, and the state bears the burden of satisfying the means ends analyses that the Majority articulates.”

“While the Pennsylvania Supreme Court’s ruling is certainly a victory, the future of abortion access remains in jeopardy as long as Republicans hold positions of power in the state legislature,” said Democratic Legislative Campaign Committee Communications Director Abhi Rahman. “Pennsylvanian Republicans already once used their majorities to try to push through a constitutional amendment to ban abortion – we cannot allow that to happen again.”

“Regardless of how one feels on the underlying subject matter, today’s decision by the Pennsylvania Supreme Court is another activist decision that has the court seeking to overstep its authority and change well-settled law,” said House Republican Leader Bryan Cutler (R-Lancaster)

“Pennsylvania law already allows public funds to be used to pay for abortions in case of incest, rape or to protect the life of the mother. This decision, supported by only part of the seven-member court, eviscerates the past, well-established precedent of the Pennsylvania Supreme Court and opens the door for tax dollars to pay for all elective abortions.”

“The vast majority of Pennsylvanians do not want to see their hard-earned tax dollars spent on abortion, which is the taking of an innocent, unrepeatable human life,” said Maria Gallagher, legislative director of the Pennsylvania Pro-Life Federation, the Keystone State affiliate of National Right to Life.

“The women of the Commonwealth and their babies need comprehensive care and support, not a blank check for taxpayer-funded abortions,” Gallagher added.

“Today’s Supreme Court ruling is an important step in reaffirming Pennsylvania’s commitment to personal freedom, including reproductive freedom,” said Pennsylvania House Speaker Joanna McClinton (D-Delaware/Philadelphia). “With other states chipping away at women’s rights, this is a good decision for all Pennsylvanians, but especially for women, who should have the right to make decisions about their own body, including reproductive decisions.”

It seems inevitable that the case will return to the state’s highest court with even the justices signaling that they expect to revisit the issue.

updated to include quotes from McClinton, Cutler and Gallagher

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