A Pennsylvania appellate court on Monday struck down a four-decade-old law banning the use of state Medicaid funds for abortions, ruling that the state constitution guarantees a right to reproductive autonomy. The seven-judge Commonwealth Court panel’s decision marks the first time Pennsylvania’s constitution is explicitly recognized as protecting abortion access, joining a handful of states that have secured reproductive protections through state constitutional analysis. The case will likely be appealed to Pennsylvania’s Supreme Court.
The decision underscores a broader shift in post-Roe abortion jurisprudence: as federal protections eroded with the U.S. Supreme Court’s 2022 decision overturning Roe v. Wade, abortion rights advocates have increasingly pursued protections through state constitutions. Pennsylvania’s Commonwealth Court joins Wyoming and other states in recognizing state constitutional grounds for abortion access.
The Court’s Ruling and Constitutional Protection
A divided seven-judge panel of Pennsylvania’s Commonwealth Court found that the state constitution protects a right to reproductive autonomy, marking the first explicit constitutional protection of abortion access in the state’s history. The majority opinion rejected the state’s argument that protecting fetal life justified excluding abortion from Medicaid coverage.
“If the state believes certain medical procedures may psychologically harm women, the state can license, regulate, and educate around such care. That is less intrusive than taking an entire medical procedure off the table categorically for some women,” the court’s majority wrote, citing the lack of dispute over the procedure’s medical benefit for some women.
Instead of a categorical ban, the court suggested an alternative approach: the state could invest in maternal and infant health care and other resources if it believes women should carry pregnancies to term.
Susan Frietsche, executive director of the Women’s Law Project, which represented the abortion clinic operators, emphasized the ruling’s scope. “Today, our Commonwealth Court, looking at the Pennsylvania constitution, held that there is a right to reproductive autonomy, and it’s the highest possible level of a right,” she said.
Political Reactions
Governor Josh Shapiro praised the decision in a statement. “I’ve long opposed this unconstitutional ban, and as Governor, I did not defend it — because a woman’s ability to access reproductive care should never be determined by her income,” the Democrat said.
Attorney General David Sunday, a Republican, said his office was reviewing the decision. A spokesman did not commit to whether the state would appeal to Pennsylvania’s Supreme Court, where the case is eligible to go next.
Stacy Garrity, the likely Republican nominee to challenge Shapiro in the fall general election, criticized the court’s action. “To force our tax dollars to pay for abortions is not only misguided, it is immoral,” she said in a statement.
How the Case Developed
Planned Parenthood and abortion clinic operators filed the lawsuit in 2019, arguing that the 1982 law restricting Medicaid coverage violated the equal protection rights of low-income women. A lower court rejected the case in 2021 on standing grounds, but Pennsylvania’s Supreme Court overturned that decision in 2024. The higher court determined that the state constitution’s protections against discrimination were broader than what lower courts had previously considered, warranting a fresh analysis of the Medicaid restriction.
Monday’s Commonwealth Court decision, from the seven-judge appellate panel, largely sided with the plaintiffs on those broader constitutional grounds.
Opposition and Abortion Law in Pennsylvania
Abortion opponents said the court had exceeded its authority. Michael Geer, president of the Pennsylvania Family Institute, which opposes abortion access, said the decision wrongly created a constitutional right not supported by the state’s founding document.
“By declaring a sweeping constitutional ‘right to reproductive autonomy’ and mandating taxpayer-funded abortion through Medicaid, the court has overstepped its authority, ignored the plain text of our state constitution, and forced millions of Pennsylvanians who believe life begins at conception to subsidize the killing of unborn children,” Geer said.
Pennsylvania law currently permits abortion through the 23rd week of pregnancy. The state’s Medicaid program previously could not cover the procedure, regardless of the clinical circumstances.