Committee To Defend Reproductive Rights v. Myers

Decision Date20 March 1981
Docket NumberS.F. 24069,S,S.F. 24192
Citation172 Cal.Rptr. 866,29 Cal.3d 252,625 P.2d 779,20 ALR4th 1118
CourtCalifornia Supreme Court
Parties, 625 P.2d 779, 20 A.L.R.4th 1118 COMMITTEE TO DEFEND REPRODUCTIVE RIGHTS et al., Plaintiffs and Appellants, v. Beverlee A. MYERS, as Director, etc., et al., Defendants and Respondents. COMMITTEE TO DEFEND REPRODUCTIVE RIGHTS et al., Petitioners, v. Kenneth CORY, as State Controller, et al., Respondents. COMMITTEE TO DEFEND REPRODUCTIVE RIGHTS et al., Petitioners, v. Jesse M. UNRUH, as State Treasurer, etc., et al., Respondents. F. 24053, and

Patti Roberts, Tamara Dahn, Michelle Murphy, Barbara Weiner, Abigail English, Pauline Tesler, Vilma Martinez, Carmen Estrada, Linda Hanten, Nancy L. Davis, Joan Messing Graff, Margaret C. Crosby, Alan L. Schlosser, Amitai Schwartz, San Francisco, Fred Okrand, Mark D. Rosenbaum, Terry Smerling, Los Angeles, and Ralph Santiago Abascal, Sacramento, for plaintiffs and appellants and for petitioners.

Dorothy T. Lang, Sacramento, Sylvia Drew Ivie, Ashburn, Diane Morrison, Roberta Ranstrom, Barbara Steinhardt, Sacramento, William G. Harris, Larson, Weinberg & Harris, James R. Abernathy II, San Francisco, Jan G. Levine, Los Angeles, Alletta d'A. Belin, Timothy B. Flynn, Carlyle W. Hall, Jr., A. Thomas Hunt, John R. Phillips, Los Angeles, David E. Willett and Hassard, Bonnington, Rogers & Huber, San Francisco, as amici curiae for plaintiffs and appellants.

George Deukmejian and Evelle J. Younger, Attys. Gen., Charlton G. Holland and Asher Rubin, Deputy Attys. Gen., for defendants and respondents.

Burton Shamsky, Shamsky & Vreeland, Solana Beach, George D. Crook, Richard J. Morillo, Ochoa, Holderness, Barbosa & Crook, Los Angeles, Robert A. Destro, James Bopp, Jr., and Francis X. Driscoll, Walnut Creek, as amici curiae for defendants and respondents.

TOBRINER, Justice.

Plaintiffs, representing indigent women throughout the state, challenge the constitutionality under the California Constitution of provisions in the 1978, 1979, and 1980 California Budget Acts that limit Medi-Cal funding for abortions. Although the acts differ in minor respects, all afford full funding of medical expenses incurred by indigent women who decide to bear a child, but, except in a few limited circumstances, deny funding to those indigent women who choose to have an abortion. Plaintiffs contend that this selective or discriminatory public funding scheme violates a number of distinct constitutional guarantees, in particular the women's rights of privacy, due process, and equal protection of the laws.

At the outset, to dispel certain misconceptions that have appeared in this case, we must clarify the precise, narrow legal issue before this court. First, this case does not turn on the morality or immorality of abortion, and most decidedly does not concern the personal views of the individual justices as to the wisdom of the legislation itself or the ethical considerations involved in a woman's individual decision whether or not to bear a child. Indeed, although in this instance the Legislature has adopted restrictions which discriminate against women who choose to have an abortion, similar constitutional issues would arise if the Legislature as a population control measure, for example funded Medi-Cal abortions but refused to provide comparable medical care for poor women who choose childbirth. Thus, the constitutional question before us does not involve a weighing of the value of abortion as against childbirth, but instead concerns the protection of either procreative choice from discriminatory governmental treatment.

Second, contrary to the suggestion of the defendants and the dissent, the question presented is not whether the state is generally obligated to subsidize the exercise of constitutional rights for those who cannot otherwise afford to do so; plaintiffs do not contend that the state would be required to fund abortions for poor women if the state had not chosen to fund medical services for poor women who choose to bear a child. Rather, we face the much narrower question of whether the state, having enacted a general program to provide medical services to the poor, may selectively withhold such benefits from otherwise qualified persons solely because such persons seek to exercise their constitutional right of procreative choice in a manner which the state does not favor and does not wish to support.

In defending the constitutionality of the provisions in question, the Attorney General relies most prominently upon the recent decision of the United States Supreme Court in Harris v. McRae (1980), 448 U.S. 297, 100 S.Ct. 2671, 65 L.Ed.2d 784 (hereafter McRae ). In McRae, the Supreme Court, by a closely divided vote (five to four), upheld restrictions on federal Medicaid funding of abortions similar to those in the state acts before us. As the Attorney General acknowledges, however, the McRae case did not present any question under the California Constitution and consequently the justices of the high court neither addressed nor resolved the question of the compatibility of such a statutory scheme with our state constitutional guarantees. It is this question of state constitutional law, not resolved by McRae, which we must decide in the present case.

In addressing this issue, we shall explain initially that the analysis utilized by the majority of the United States Supreme Court in McRae differs substantially from the analysis mandated by the controlling California authorities and thus cannot be followed here. In McRae, the five-justice majority acknowledged that the governmental program provided unequal treatment in the distribution of public benefits solely on the basis of how an individual woman exercised her basic constitutional right of procreative choice. The court concluded, however, that the federal Constitution required no special justification for such discriminatory treatment so long as the program placed no new obstacles in the path of the woman seeking to exercise her constitutional right. (100 S.Ct. at p. 2688.)

By contrast, the governing California cases, discussed at length below, have long held that a discriminatory or restricted government benefit program demands special scrutiny whether or not it erects some new or additional obstacle that impedes the exercise of constitutional rights. In a series of cases reaching back more than three decades, this court has developed and applied a three-part test for evaluating the constitutionality of statutory schemes, like the program at issue here, that condition the receipt of benefits upon a recipient's waiver of a constitutional right or upon his exercise of such right in a manner which the government approves.

In order to sustain the constitutionality of such a scheme under the California Constitution, the state must demonstrate (1) "that the imposed conditions relate to the purposes of the legislation which confers the benefit or privilege"; (2) that "the utility of imposing the conditions ... manifestly outweigh(s) any resulting impairment of constitutional rights"; and (3) that there are no "less offensive alternatives" available for achieving the state's objective. (Bagley v. Washington Township Hospital Dist. (1966) 65 Cal.2d 499, 505-507, 55 Cal.Rptr. 401, 421 P.2d 409.)

As we shall see, when measured against this established standard, the statutory scheme at issue is plainly unconstitutional. First, the Budget Act restrictions are antithetical to the purpose of the Medi-Cal program to provide indigents with access to medical services comparable to that enjoyed by more affluent persons. Second, the benefits of the funding restrictions do not manifestly outweigh the impairment of the constitutional rights; the fiscal advantages of the restrictions are illusory, and the asserted state interest in protecting fetal life cannot constitutionally claim priority over the woman's fundamental right of procreative choice. Third, the Medi-Cal program as qualified by the Budget Act restrictions clearly does not aid poor women who choose to bear children in a manner least offensive to the rights of those who choose abortion. Accordingly, we conclude that the challenged restrictions cannot stand.

1. Background of the present litigation

The California Medi-Cal program funds "physician, hospital or clinic outpatient, (and) surgical center" services, as well as "inpatient hospital services," for "recipients of public assistance (and) medically indigent aged and other persons." (Welf. & Inst. Code, §§ 14000, 14132, subds. (a) & (b).) No one disputes that abortions performed by a physician, whether in a hospital, clinic, or office, are medical services which, in the absence of special funding restrictions, would be funded under the foregoing provisions. Prior to 1978, the Medi-Cal program paid for legal abortions obtained by Medi-Cal recipients.

The California Legislature, however, inserted into the 1978, 1979, and 1980 Budget Acts provisions restricting Medi-Cal funding of abortions. (Stats.1978, ch. 359, § 2, item 248, pp. 823-825; Stats.1979, ch. 259, § 2, item 261.5, pp. ---- - ----; Stats.1980, ch. 510, § 2, item 287.5, pp. ---- - ----.) Although the 1978 enactment differs slightly from the 1979 and 1980 restrictions, all in essence provide funding for abortions only (1) when pregnancy would endanger the mother's life; (2) when pregnancy would cause severe and long-lasting physical health damage to the mother; (3) when pregnancy is the result of illegal intercourse (rape, incest, or unlawful intercourse with a minor); or (4) when abortion is necessary to prevent the birth of severely defective infants. 1

Before the 1978 restrictions could take effect, plaintiffs filed this suit against Beverlee A. Myers, Director of the State Department of Health Services, to enjoin her from enforcing the restrictions. The trial court upheld the funding restrictions and refused injunctive...

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