Abstract

In late summer of 1999, a group of Arizona physicians challenged an Arizona statute restricting Medicaid funding for abortions sought by indigent women. Arizona Health Care Cost Containment System ("AHCCCS") administers Medicaid claims in Arizona and provides services to Medicaid-eligible recipients with incomes at or below 140% of the federal poverty level. The plaintiff-doctors provided services, including abortions, to AHCCCS patients and had other patients who were suffering from illnesses that were serious, though not immediately life-threatening. Medical treatment for many of these conditions requires that pregnant patients first undergo an abortion, as the treatment could be damaging or fatal to the fetus.4 In many cases, postponement of therapy during pregnancy can have serious repercussions for pregnant women, including adverse health effects and decreased life expectancy.

In allocating funds for abortion services, AHCCCS followed a statutory prohibition on payment of abortion services unless "necessary to save the life of the woman having the abortion," 6 but also provided services for victims of rape or incest as a condition necessary to receive federal reimbursement under Medicaid. AHCCCS did not provide abortions to indigent women whose health, but not life, was threatened by pregnancy.

In a decision deviating from those of the United States Supreme Court, the Arizona Supreme Court declared the Arizona statute and accompanying AHCCCS provisions unconstitutional because they did not survive a strict scrutiny analysis under the Privileges and Immunities Clause of the Arizona Constitution. Where the state of Arizona has undertaken to fund abortions for indigent women whose lives are directly threatened by pregnancy, it cannot refuse to pay for abortions for similarly indigent women whose health, but not life, is threatened.

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