Appellees brought a class action in Federal District Court under
42 U.S.C. § 1983 to enjoin, on both federal statutory and
constitutional grounds, enforcement of an Illinois statute
prohibiting state medical assistance payments for all abortions
except those necessary to save the life of the woman seeking the
abortion. The District Court, granting injunctive relief, held that
Title XIX of the Social Security Act, which established the
Medicaid program, and the regulations promulgated thereunder
require a participating State under such program to provide funding
for all medically necessary abortions, and that the so-called Hyde
Amendment prohibiting the use of federal funds to reimburse the
costs of certain medically necessary abortions does not relieve a
State of its independent obligation under Title XIX to provide
Medicaid funding for all medically necessary abortions. The Court
of Appeals reversed, holding that the Hyde Amendment altered Title
XIX in such a way as to allow States to limit funding to the
categories of abortions specified in that Amendment, but that a
participating State may not, consistent with Title XIX, withhold
funding of those medically necessary abortions for which federal
reimbursement is available under the Hyde Amendment, and the case
was remanded to the District Court for modification of its
injunction and with directions to consider the constitutionality of
the Hyde Amendment. The District Court then held that both the
Illinois statute and the Hyde Amendment violate the equal
protection guarantee of the Constitution insofar as they deny
funding for "medically necessary abortions prior to the point of
fetal viability."
Held:
1. The District Court lacked jurisdiction to consider the
constitutionality of the Hyde Amendment, for the court acted in the
absence of a case or controversy sufficient to permit an exercise
of judicial power under Art. III of the Constitution. None of the
parties ever challenged the validity of the Hyde Amendment, and
appellees could have been awarded all the relief sought entirely on
the basis of the District Court's
Page 448 U. S. 359
ruling as to the Illinois statute. The constitutionality of the
Hyde Amendment was interjected as an issue only by the Court of
Appeals' erroneous mandate, which could not create a case or
controversy where none otherwise existed. P.
448 U. S.
367.
2. Notwithstanding that the District Court had no jurisdiction
to declare the Hyde Amendment unconstitutional, this Court has
jurisdiction under 28 U.S.C. § 1252 over the "whole case," and thus
may review the other issues preserved by these appeals.
McLucas
v. DeChamplain, 421 U. S. 21. Pp.
448 U. S.
367-368.
3. 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.
Harris
v. McRae, ante at
448 U. S.
306-311. P.
448 U. S.
369.
4. The funding restrictions in the Illinois statute, comparable
to those in the Hyde Amendment, do not violate the Equal Protection
Clause of the Fourteenth Amendment.
Harris v. McRae, ante
at
448 U. S.
324-326. P.
448 U. S.
369.
469 F.
Supp. 1212, vacated and remanded.
STEWART, J., delivered the opinion of the Court, in which
BURGER, C.J., and WHITE, POWELL, and REHNQUIST, JJ., joined.
BRENNAN, J., filed a dissenting opinion, in which MARSHALL and
BLACKMUN, JJ., joined,
ante p.
448 U. S. 329.
MARSHALL, J.,
ante p.
448 U. S. 337,
BLACKMUN, J.,
ante p.
448 U. S. 348,
and STEVENS, J.,
ante p.
448 U. S. 349,
filed dissenting opinions.
Page 448 U. S. 360
MR. JUSTICE STEWART delivered the opinion of the Court.
This suit was brought as a class action under 42 U.S.C. § 1983
in the District Court for the Northern District of Illinois to
enjoin the enforcement of an Illinois statute that prohibits state
medical assistance payments for all abortions except those
"necessary for the preservation of the life of the woman seeking
such treatment." [
Footnote 1]
The plaintiffs were
Page 448 U. S. 361
two physicians who perform medically necessary abortions for
indigent women, a welfare rights organization, and Jane Doe, an
indigent pregnant woman who alleged that she desired an abortion
that was medically necessary, but not necessary to save her life.
The defendant was the Director of the Illinois Department of Public
Aid, the agency charged with administering the State's medical
assistance programs. [
Footnote
2] Two other physicians intervened as defendants.
The plaintiffs challenged the Illinois statute on both federal
statutory and constitutional grounds. They asserted, first, that
Title XIX of the Social Security Act, commonly known as the
"Medicaid" Act, 42 U.S.C. § 1396
et seq. (1976 ed. and
Supp. II), requires Illinois to provide coverage in its Medicaid
plan for all medically necessary abortions, whether or not the life
of the pregnant woman is endangered. Second, the plaintiffs argued
that the public funding by the State of medically necessary
services generally, but not of certain medically necessary
abortions, violates the Equal Protection Clause of the Fourteenth
Amendment.
Page 448 U. S. 362
The District Court initially held that it would abstain from
considering the complaint until the state courts had construed the
challenged statute. [
Footnote
3] The plaintiffs appealed, and the Court of Appeals for the
Seventh Circuit reversed.
Zbaraz v. Quern, 572 F.2d 582.
The appellate court held that abstention was inappropriate under
the circumstances, and remanded the case for further proceedings,
including consideration of the plaintiffs' motion for a preliminary
injunction. On remand, the District Court certified two plaintiff
classes -- (1) a class of all pregnant women eligible for the
Illinois medical assistance programs who desire medically
necessary, but not life-preserving, abortions, and (2) a class of
all Illinois physicians who perform medically necessary abortions
for indigent women and who are certified to obtain reimbursement
under the Illinois medical assistance programs. Addressing the
merits of the complaint, the District Court concluded that Title
XIX and the regulations promulgated thereunder require a
participating State under the Medicaid program to provide funding
for all medically necessary abortions. According to the District
Court, the so-called "Hyde Amendment" -- under which Congress has
prohibited the use of federal funds to reimburse the costs of
certain medically necessary abortions [
Footnote 4] -- does not relieve a State of its
independent
Page 448 U. S. 363
obligation under Title XIX to provide Medicaid funding for all
medically necessary abortions. Thus, the District Court permanently
enjoined the enforcement of the Illinois statute insofar as it
denied payments for abortions that are
"medically necessary or medically indicated according to the
professional medical judgment of a licensed physician in Illinois,
exercised in light of all factors affecting a woman's health."
The Court of Appeals again reversed.
Zbaraz v. Quern,
596 F.2d 196. Reaching the same conclusion as had the Court of
Appeals for the First Circuit in
Preterm, Inc., v.
Dukakis, 591 F.2d 121, the court held that the Hyde Amendment
"alters Title XIX in such a way as to allow states to limit funding
to the categories of abortions specified in that amendment." 596
F.2d at 199. It further held, however, that a participating State
may not, consistent with Title XIX, withhold funding for those
medically necessary abortions for which federal reimbursement is
available under the Hyde Amendment. [
Footnote 5] Accordingly, the case was remanded to the
District
Page 448 U. S. 364
Court with instructions that the permanent injunction be
modified so as to require continued state funding only "for those
abortions fundable under the Hyde Amendment." [
Footnote 6]
Id. at 202. The Court of
Appeals also directed the District Court to proceed expeditiously
to resolve the constitutional questions it had not reached. The
District Court was specifically directed to consider
"whether the Hyde Amendment, by limiting funding for abortions
to certain circumstances even if such abortions are medically
necessary, violates the Fifth Amendment."
Ibid. (footnote omitted).
On the second remand, the District Court notified the Attorney
General of the United States that the constitutionality of an Act
of Congress had been drawn into question, and the United States
intervened, pursuant to 28 U.S.C. § 2403(a), to defend the
constitutionality of the Hyde Amendment. [
Footnote 7]
Page 448 U. S. 365
Zbaraz v. Quern, 469 F.
Supp. 1212, 1215, n. 3. In view of the fact that the plaintiffs
had not challenged the Hyde Amendment, but rather only the Illinois
statute, the District Court expressed misgivings about the
propriety of passing on the constitutionality of the federal law.
But noting that the same reasoning would apply in determining the
constitutional validity of both the Illinois statute and the Hyde
Amendment, the District Court observed:
"Although we are not persuaded that the federal and state
enactments are inseparable and would hesitate to inject into the
proceeding the issue of the constitutionality of a law not directly
under attack by plaintiffs, we are obviously constrained to obey
the Seventh Circuit's mandate. Therefore, while our discussion of
the constitutional questions will address only the Illinois
statute, the same analysis applies to the Hyde Amendment and the
relief granted will encompass both laws."
Ibid.
The District Court then concluded that both the Illinois statute
and the Hyde Amendment are unconstitutional insofar as they deny
funding for "medically necessary abortions prior to the point of
fetal viability."
Id. at 1221. If the public funding of
abortions were restricted to those covered by the Hyde Amendment,
the District Court thought that the effect would "be to increase
substantially maternal morbidity and mortality among indigent
pregnant women."
Id. at 1220. The District Court held that
the state and federal funding restrictions violate the
constitutional standard of equal protection because
"a pregnant woman's interest in her health so outweighs any
possible state interest in the life of a nonviable fetus that, for
a woman medically in need of an abortion, the state's interest is
not legitimate. At the point of viability, however, 'the relative
weights of the respective interests involved' shift, thereby
legitimizing the state's interests. After that point, therefore, .
. a state may withhold funding for medically necessary abortions
that
Page 448 U. S. 366
are not life-preserving, even though it funds all other
medically necessary operations."
Id. at 1221. Accordingly the District Court enjoined
the Director of the Illinois Department of Public Aid from
enforcing the Illinois statute to deny payment under the state
medical assistance programs for medically necessary abortions prior
to fetal viability. [
Footnote
8] The District Court did not, however, enjoin any action by
the United States.
The intervening defendant physicians, the Director of the
Illinois Department of Public Aid, and the United States each
appealed directly to this Court, averring jurisdiction under 28
U.S.C. 1252. This Court consolidated the appeals and postponed
further consideration of the question of jurisdiction until the
hearing on the merits. 444 U.S. 962.
I
The asserted basis for this Court's jurisdiction over these
appeals is 28 U.S.C. 1252, which provides in relevant part:
"Any party may appeal to the Supreme Court from an interlocutory
or final judgment, decree or order of any court of the United
States . . . holding an Act of Congress unconstitutional in any
civil action, suit, or proceeding to which the United States or any
of its agencies, or any officer or employee thereof as such officer
or employee, is a party."
It is quite obvious that the literal requirements of § 1252 are
satisfied in the present cases, for these appeals were taken from
the final judgment of a federal court declaring unconstitutional an
Act of Congress -- the Hyde Amendment -- in a
Page 448 U. S. 367
civil action to which the United States was a party by reason of
its intervention pursuant to 28 U.S.C. § 2403(a).
It is equally clear, however, that the appellees and the United
States are correct in asserting that the District Court in fact
lacked jurisdiction to consider the constitutionality of the Hyde
Amendment, for the court acted in the absence of a case or
controversy sufficient to permit an exercise of judicial power
under Art. III of the Constitution. None of the parties to these
cases ever challenged the validity of the Hyde Amendment, and the
appellees could have been awarded all the relief they sought
entirely on the basis of the District Court's ruling with regard to
the Illinois statute. [
Footnote
9] The constitutional validity of the Hyde Amendment was
interjected as an issue in these cases only by the erroneous
mandate of the Court of Appeals. But, even though the District
Court was simply following that mandate, the directive of the Court
of Appeals could not create a case or controversy where none
otherwise existed. It is clear, therefore, that the District Court
exceeded its jurisdiction under Art. III in declaring the Hyde
Amendment unconstitutional.
The question thus arises whether the District Court's lack of
jurisdiction in declaring the Hyde Amendment unconstitutional
divests this Court of jurisdiction over these appeals. We think
not. As the Court in
McLucas v. DeChamplain, 421 U. S.
21,
421 U. S. 31-32,
observed:
"Our previous cases have recognized that this Court's
jurisdiction under § 1252 in no way depends on whether the district
court had jurisdiction. On the contrary, an appeal under § 1252
brings before us not only the constitutional question, but the
whole case, including threshold
Page 448 U. S. 368
issues of subject matter jurisdiction, and whether a three-judge
court was required."
(Citations omitted.) Thus, in the
McLucas case, which
involved an appeal under § 1252 from a single-judge District Court,
this Court pretermitted the question whether the single-judge
District Court had had jurisdiction to enter the challenged
preliminary injunction, and instead resolved the appeal on the
merits. It follows from
McLucas that, notwithstanding the
fact that the District Court was without jurisdiction to declare
the Hyde Amendment unconstitutional, this Court has jurisdiction
over these appeals, and thus may review the "whole case." [
Footnote 10]
II
Disposition of the merits of these appeals does not require
extended discussion. Insofar as we have already concluded that the
District Court lacked jurisdiction to declare the Hyde Amendment
unconstitutional, that portion of its judgment must be vacated.
See, e.g., United States v. Johnson, 319 U.
S. 302;
Muskrat v. United States, 219 U.
S. 346. The remaining questions concern the Illinois
statute. The appellees argue that (1) Title XIX requires Illinois
to provide coverage in its state Medicaid plan for all medically
necessary abortions, whether or not the life of the pregnant woman
is endangered, and (2) the funding by Illinois of medically
necessary services generally, but not of certain medically
necessary
Page 448 U. S. 369
abortions, violates the Equal Protection Clause of the
Fourteenth Amendment. [
Footnote
11] Both arguments are foreclosed by our decision today in
Harris v. McRae, ante p.
448 U. S. 279.
As to the appellees' statutory argument, we have concluded 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. As
to their constitutional argument, we have concluded in
McRae 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. 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.
Accordingly, the judgment of the District Court is vacated,
Page 448 U. S. 370
and the cases are remanded to that court for further proceedings
consistent with this opinion.
It is so ordered.
[For dissenting opinion of MR. JUSTICE BRENNAN,
see
ante, p.
448 U. S.
329.]
[For dissenting opinion of MR. JUSTICE MARSHALL,
see
ante, p.
448 U. S.
337.]
[For dissenting opinion of MR. JUSTICE BLACKMUN,
see
ante, p.
448 U. S.
348.]
[For dissenting opinion of MR. JUSTICE STEVENS,
see
ante, p.
448 U. S.
349.]
* Together with No. 79-5,
Miller, Acting Director,
Department of Public Aid of Illinois, et al. v. Zbaraz et al.,
and No. 79-491,
United States v. Zbaraz et al., also on
appeal from the same court.
[
Footnote 1]
The statute is codified as Ill.Rev.Stat., ch. 23 (1979). It
provides in relevant part:
"§ 5-5. [Medical services.] The Illinois Department, 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. . .
."
"§ 6-1. 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. . . ."
"§ 7-1. 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. . .
."
[
Footnote 2]
The medical assistance programs at issue here are the Illinois
Medicaid plan, which is jointly funded by the Federal Government
and the State of Illinois, and two fully state-funded programs, the
Illinois General Assistance and Local Aid to Medically Indigent
Programs.
[
Footnote 3]
All opinions of the District Court other than that now under
review are unreported.
[
Footnote 4]
Since September, 1976, Congress has prohibited -- by means of
the "Hyde Amendment" to the annual appropriations for the
Department of Health, Education, and Welfare (now divided into the
Department of Health and Human Services and the Department of
Education) -- the use of any federal funds to reimburse the cost of
abortions under the Medicaid program except under certain specified
circumstances. The current version of the Hyde Amendment,
applicable for fiscal year 1980, provides:
"[N]one of the funds provided by this joint resolution shall be
used to perform abortions except where the life of the mother would
be endangered if the fetus were carried to term; or except for such
medical procedures necessary for the victims of rape or incest when
such rape or incest has been reported promptly to a law enforcement
agency or public health service."
Pub.L. 96-123, § 109, 93 Stat. 926.
See also Pub.L.
96-86, § 118, 93 Stat. 662. This version of the Hyde Amendment is
broader than that applicable for fiscal year 1977, which did not
include the "rape or incest" exception, Pub.L. 94-439, § 209, 90
Stat. 1434, but narrower than that applicable for most of fiscal
year 1978 and all of fiscal year 1979, which had an additional
exception for
"instances where severe and long-lasting physical health damage
to the mother would result if the pregnancy were carried to term
when so determined by two physicians,"
Pub.L. 95-205, § 101, 91 Stat. 1460; Pub.L. 95-480, § 210, 92
Stat. 1586. In this opinion, the term "Hyde Amendment" is used
generically to refer to all three versions, except where indicated
otherwise.
[
Footnote 5]
Neither the Director of the Illinois Department of Public Aid
nor the intervening physicians sought review of the judgment of the
Court of Appeals. The District Court in the proceedings now on
appeal proceeded on the premise that Title XIX obligates Illinois
to fund all abortions reimbursable under the Hyde Amendment. That
issue, therefore, is not before us on these appeals.
[
Footnote 6]
Although the medical assistance programs funded exclusively by
the State are not governed directly by either Title XIX or the Hyde
Amendment, the Court of Appeals concluded that the modified
injunction requiring state payments for abortions fundable under
the Hyde Amendment should apply to all three Illinois medical
assistance programs,
see n 2,
supra. 596 F.2d at 202-203. Relying on a
statement in the State's brief, the Court of Appeals held that the
challenged Illinois statute was intended to represent the State's
understanding of the congressional purpose reflected in the
original Hyde Amendment.
Id. at 203. The Court of Appeals
thus declined to sever the various funding restrictions in the
Illinois statute.
[
Footnote 7]
Section 2403(a) provides:
"In any action, suit or proceeding in a court of the United
States to which the United States or any agency, officer or
employee thereof is not a party, wherein the constitutionality of
any Act of Congress affecting the public interest is drawn in
question, the court shall certify such fact to the Attorney
General, and shall permit the United States to intervene for
presentation of evidence, if evidence is otherwise admissible in
the case, and for argument on the question of constitutionality.
The United States shall, subject to the applicable provisions of
law, have all the rights of a party and be subject to all
liabilities of a party as to court costs to the extent necessary
for a proper presentation of the facts and law relating to the
question of constitutionality."
[
Footnote 8]
The District Court refused to stay its order, and the Director
of the Illinois Department of Public Aid and the intervening
defendant physicians moved in this Court for a stay pending appeal.
That motion was denied.
442 U. S. 1309
(STEVENS, J., in chambers). A reapplication by the intervening
defendant physicians also was denied. 442 U.S. 915.
[
Footnote 9]
Title XIX does not prohibit
"[a] participating State . . . [from] includ[ing] in its
Medicaid plan those medically necessary abortions for which federal
reimbursement is unavailable [under the Hyde Amendment]."
Harris v. McRae, ante at
448 U. S. 311,
n. 16.
[
Footnote 10]
Although this Court need not pass on the remainder of the
judgment in a case in which an appeal under § 1252 is taken from a
court that lacked jurisdiction to declare a federal statute
unconstitutional,
see FHA v. The Darlington, Inc., 352
U.S. 977, we are empowered to do so because "an appeal under § 1252
brings before us not only the constitutional question, but the
whole case."
McLucas v. DeChamplain, 421 U.S. at
421 U. S. 31.
Here, there is no reason not to resolve the "whole case" on the
merits. The remainder of the case that is properly before this
Court, and which clearly involves a justiciable controversy,
includes both the appellees' federal statutory and constitutional
challenges to the Illinois statute.
[
Footnote 11]
This case was decided by the District Court under the version of
the Hyde Amendment applicable during fiscal year 1979, and Congress
has since narrowed the ambit of the Hyde Amendment for fiscal year
1980,
see n 4,
supra. The recent statutory revision does not, however,
affect the outcome of either issue now before the Court. The
statutory issue is not affected, because we today conclude in
Harris v. McRae, ante, at
448 U. S.
306-311, that Title XIX does not require a participating
State to fund those medically necessary abortions for which federal
reimbursement is unavailable under the Hyde Amendment, including
the version of the Hyde Amendment applicable for fiscal year 1980.
The constitutional issue is not affected, because, regardless of
whether the State of Illinois is obligated to fund all abortions
for which federal reimbursement is available under the Hyde
Amendment, we conclude in
Harris v. McRae that even the
most restrictive version of the Hyde Amendment -- which is similar
to the Illinois statute at issue here -- does not violate the equal
protection standard of the Constitution. Since the outcome of these
issues is not affected by the recent changes in the Hyde Amendment,
we need not defer review in order to provide the District Court
with an opportunity to evaluate the effects of these changes in the
federal law.