State v. Planned Parenthood of the Great Northwest
436 P.3d 984
Alaska2019Background
- Alaska amended its Medicaid abortion coverage via a 2013 DHSS regulation and a 2014 statute (AS 47.07.068 / 7 AAC 160.900(d)(30)) that limited coverage to abortions that were "medically necessary" as defined by a physician’s judgment to avoid a "threat of serious risk" to life or physical health, plus rape/incest exceptions; both included lists of specific conditions and a catch‑all.
- Planned Parenthood sued, arguing the statute and regulation impermissibly singled out abortion for more stringent medical‑necessity standards than other Medicaid services and thus violated the Alaska Constitution’s equal protection guarantee; the superior court enjoined and ultimately struck down both measures.
- The State defended the measures, urging a broader, physician‑discretion interpretation (covering significant but not only catastrophic risks) and invoked fiscal and program‑integrity interests; it argued constitutional avoidance should save the law.
- The Alaska Supreme Court reviewed statutory/regulatory interpretation de novo, found the texts ambiguous but adopted a restrictive (“high‑risk, high‑hazard”) construction consistent with legislative history and ejusdem generis, and concluded the measures discriminate against women who choose abortion.
- Applying Alaska equal protection doctrine, the court held strict scrutiny applied because the measures selectively deny a benefit to those exercising the fundamental right of reproductive choice; the State’s asserted interests failed narrow tailoring and the measures were under‑inclusive or counterproductive.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether statute/regulation’s definition of "medically necessary" for Medicaid abortions is ambiguous and how it should be read | Planned Parenthood: language mandates a very narrow, catastrophic standard (only imminent/realized listed conditions qualify) | State: text allows broad physician discretion to cover heightened (but not necessarily catastrophic) risks; avoid constitutional invalidation | Court: text ambiguous but legislative history and canons support a restrictive "high‑risk/high‑hazard" construction similar to superior court’s reading |
| Whether the statutes/regulation treat abortion differently from other Medicaid services for similarly situated pregnant women | PP: yes — imposes more onerous, abortion‑specific certification that deters exercise of reproductive choice | State: medical‑necessity standard is neutral and comparable to other Medicaid limits; not discriminatory | Court: treatment is discriminatory in effect and deters exercise of reproductive choice; thus classification triggers strict scrutiny |
| Appropriate level of scrutiny under Alaska Constitution | PP: strict scrutiny — measures selectively deny benefits to those exercising fundamental reproductive right | State: argued broad interests and deference; also urged avoiding strict scrutiny through broad statutory construction | Court: strict scrutiny applies because of coercive subsidy effect and binary choice between abortion and childbirth |
| Whether State’s interests (fiscal viability, program integrity) justify the measures under strict scrutiny | PP: State did not show compelling, narrowly tailored interests; measures under‑inclusive/ineffective | State: preserving Medicaid funds and preventing improper payments are compelling and legitimate | Court: even assuming compelling interest, measures are not narrowly tailored; fiscal record weak and restrictions under‑inclusive/over‑inclusive, so fail strict scrutiny; statute and regulation unconstitutional |
Key Cases Cited
- State, Dept. of Health & Social Servs. v. Planned Parenthood of Alaska, Inc., 28 P.3d 904 (Alaska 2001) (prior Alaska decision invalidating an abortion‑funding restriction under equal protection and applying strict scrutiny)
- Planned Parenthood of The Great Northwest v. State, 375 P.3d 1122 (Alaska 2016) (Alaska Supreme Court equal protection framework and discussion of scrutiny levels)
- Harris v. McRae, 448 U.S. 297 (U.S. 1980) (U.S. Supreme Court upholding Hyde Amendment; famous dissent on coercive subsidy effect for indigent women)
- Valley Hosp. Ass'n v. Mat‑Su Coalition for Choice, 948 P.2d 963 (Alaska 1997) (discussion of reproductive rights and equal protection context)
- Estate of Kim ex rel. Alexander v. Coxe, 295 P.3d 380 (Alaska 2013) (doctrine of constitutional avoidance as a tool to choose between plausible statutory interpretations)