Simat Corp. v. Arizona Health Care Cost Containment System

56 P.3d 28, 203 Ariz. 454, 385 Ariz. Adv. Rep. 12, 2002 Ariz. LEXIS 180
CourtArizona Supreme Court
DecidedOctober 22, 2002
DocketCV-01-0324-PR
StatusPublished
Cited by21 cases

This text of 56 P.3d 28 (Simat Corp. v. Arizona Health Care Cost Containment System) is published on Counsel Stack Legal Research, covering Arizona Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Simat Corp. v. Arizona Health Care Cost Containment System, 56 P.3d 28, 203 Ariz. 454, 385 Ariz. Adv. Rep. 12, 2002 Ariz. LEXIS 180 (Ark. 2002).

Opinions

OPINION

FELDMAN, Justice.

¶ 1 We granted review to decide whether the state constitution permits the state and the Arizona Health Care Cost Containment System (AHCCCS) to refuse to fund medically necessary abortion procedures for pregnant women suffering from serious illness while, at the same time, funding such procedures for victims of rape or incest or when the abortion is necessary to save the woman’s life.

¶ 2 The court of appeals held that AHCCCS’ funding scheme was constitutionally permitted. Simat Corp. v. Arizona Health Care Cost Containment Sys., 200 Ariz. 506, 512 ¶ 20, 29 P.3d 281, 287 ¶ 20 (App.2001). Having ordered supplemental briefing and heard oral argument, we now conclude, as have the great majority of other states that have considered this question, that insofar as the state scheme permits funding of abortions for one class of pregnant women, the state constitution will not permit it to deny funding for others for whom abortions are medically necessary to save the mother’s health.

¶ 3 We are aware, of course, of the controversy surrounding any issue pertaining to abortion. We therefore think it appropriate to state what this case is not about. It is not about the right to an abortion. The right to choose was established by the United States Supreme Court in Roe v. Wade, 410 U.S. 113, 152-53, 93 S.Ct. 705, 726-27, 35 L.Ed.2d 147 (1973). It is not about whether the Arizona Constitution provides a more expansive abortion choice than the federal constitution — ■ that issue is not presented. It is not about whether the state must fund abortions for non-therapeutic or contraceptive purposes or, for that matter, any purpose — those issues are not presented. The narrow and only question decided is this: Once the state has chosen to fund abortions for one group of indigent, pregnant women for whom abortions are medically necessary to save their lives, may the state deny the same option to another group of women for whom the procedure is also medically necessary to save their health?

FACTS

¶ 4 Appellees (the doctors) are providers of medical services, including abortions, in the field of obstetrics and gynecology. AHCCCS is a state agency that provides Medicaid services to qualified Arizona women with incomes at or below 140 percent of the federally set poverty level. Each of the doctors is a provider to AHCCCS patients, among others. All of the doctors have and have had patients suffering from medical conditions that are serious but not immediately life-threatening. To treat many of these conditions, an abortion must be performed before the necessary therapy can be administered. An example is cancer, for which chemo- or radiation therapy ordinarily cannot be provided if the patient is pregnant, making an abortion necessary before proceeding with the recognized medical treatment. Other conditions for which the administration of drug or other therapy regimens must at times be suspended during pregnancy include heart disease, diabetes, kidney disease, liver disease, chron[456]*456ic renal failure, asthma, sickle cell anemia, Marfan’s syndrome, arthritis, inflammatory bowel disease, gall bladder disease, severe mental illness, hypertension, uterine fibroid tumors, epilepsy, toxemia, and lupus erythe-matosus. In many of the women suffering from these diseases, suspension of recognized therapy during pregnancy will have serious and permanent adverse effects on them health and lessen their life span.1

¶ 5 AHCCCS will not fund abortion services unless the procedure “is necessary to save the life of the woman having the abortion.” A.R.S. § 35-196.02. AHCCCS will, however, fund abortion services for victims of rape or incest. See AHCCCS Medical Policy Manual, Ch. 400 — Medical Policy for Maternal and Child Health, Policy 410 — Maternity Care Services. The regulations are broader than the statute but required by federal law as a condition of obtaining federal funds. AHCCCS does not challenge the validity of the regulations.

PROCEDURAL BACKGROUND

¶ 6 The doctors’ complaint asked for declaratory and injunctive relief on the grounds that the funding policy that prevents medically necessary abortions for AHCCCS patients violates various provisions of the Arizona Constitution. Among these are the privacy clause (art. II, § 8), the due process clause (art. II, § 4), and the equal privileges and immunities clause (art. II, § 13). The doctors and the state filed cross-motions for summary judgment. The trial judge denied, the state’s motion and granted the doctors’ motion. He enjoined AHCCCS from enforcing A.R.S. § 35-196.02 in cases in which the abortion procedure was medically necessary to protect the health of the mother and ordered the state to fund medically necessary abortions to the same extent it funds other services for pregnant women. Minute Entry, May 19, 2000, at 5.

¶ 7 In reaching this result, the judge first noted that the doctors did not claim their patients had a right to state-funded abortions, but stated that once the state did fund necessary medical care for indigents, the Arizona Constitution required it to do so in a neutral manner. Id. at 2. The judge then noted that in the case of abortions, AHCCCS uses “completely different standard[s] of medical necessity.” Id. at 3. Instead of the general definition of certification that services are medically necessary, for abortion procedures there must be certification that the pregnancy is the product of rape or incest or is necessary to save the life of the woman. Id.; AHCCCS Medical Policy Manual, supra. The judge therefore found the AHCCCS program is not neutral with respect to reproductive choice and its policy violates fundamental rights under Arizona’s constitution. Minute Entry at 5.

118 The judge concluded that under our case law, the privacy clause, article II, § 8, gives each Arizona woman the fundamental right to decide on her “own plan of medical treatment.” Id. at 4 (citing Rasmussen v. Fleming, 154 Ariz. 207, 215, 741 P.2d 674, 682 (1987)). Thus, the judge determined, statutes or agency regulations that impair or infringe on such rights must be examined with strict scrutiny and can be upheld only when essential to serve a compelling state interest. Id. Finding that the state had not established that it had “a compelling State [457]*457interest that must be advanced by endangering indigent women” through denial of medical treatment necessary to preserve their health, the judge held the statutory and regulatory provisions at issue unconstitutional. Id. at 4-5.

¶ 9 The court of appeals reversed, holding that the statutory scheme does not violate any Arizona constitutional provision, and remanded the case to the superior court for entry of summary judgment in favor of the state. Simat Corp., 200 Ariz. at 512 ¶ 20, 29 P.3d at 287 ¶ 20. The court relied on Harris v. McRae, a case in which the United States Supreme Court upheld the constitutionality of the so-called Hyde Amendment, a statute that prohibits the use of federal funds under the Medicaid program of Social Security to reimburse states for the cost of abortions.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

State of Arizona v. Christopher Arevalo
470 P.3d 644 (Arizona Supreme Court, 2020)
In the Matter of Lisa M. Aubuchon
309 P.3d 886 (Arizona Supreme Court, 2013)
Paul Isaacson v. Tom Horne
716 F.3d 1213 (Ninth Circuit, 2013)
Feminist Women's Health Center v. Burgess
651 S.E.2d 36 (Supreme Court of Georgia, 2007)
Vanessa H. v. Arizona Department of Economic Security
159 P.3d 562 (Court of Appeals of Arizona, 2007)
Doe v. Arpaio
150 P.3d 1258 (Court of Appeals of Arizona, 2007)
Planned Parenthood v. AG
D. New Hampshire, 2003
Planned Parenthood of Northern New England v. Heed
296 F. Supp. 2d 59 (D. New Hampshire, 2003)
Washburn v. Pima County
81 P.3d 1030 (Court of Appeals of Arizona, 2003)
Standhardt v. Superior Court
77 P.3d 451 (Court of Appeals of Arizona, 2003)
Humphreys v. Clinic for Women, Inc.
796 N.E.2d 247 (Indiana Supreme Court, 2003)
State v. Kaiser
65 P.3d 463 (Court of Appeals of Arizona, 2003)
Bell v. Low Income Women of Texas
95 S.W.3d 253 (Texas Supreme Court, 2002)
Simat Corp. v. Arizona Health Care Cost Containment System
56 P.3d 28 (Arizona Supreme Court, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
56 P.3d 28, 203 Ariz. 454, 385 Ariz. Adv. Rep. 12, 2002 Ariz. LEXIS 180, Counsel Stack Legal Research, https://law.counselstack.com/opinion/simat-corp-v-arizona-health-care-cost-containment-system-ariz-2002.