Pennsylvania’s Commonwealth Court ruled 4-3 that the state’s 44-year ban on Medicaid funding for abortion is unconstitutional. The decision found that the ban violates the Equal Rights Amendment in Pennsylvania’s Constitution and that “the Pennsylvania Constitution guarantees a fundamental right to reproductive autonomy.”
The ban had been in place since the Pennsylvania Abortion Control Act of 1982.
What the court said
The Commonwealth Court held that blocking Medicaid coverage for abortion while covering all other pregnancy-related care is sex discrimination under the state ERA. The logic: only people who can become pregnant need abortions, and denying coverage for a procedure that only affects one sex violates equal protection.
The court went further. It declared a “fundamental right to reproductive autonomy” under the Pennsylvania Constitution. That language, if upheld, would give abortion rights stronger protection in Pennsylvania than they have under federal law.
Who this affects
Twenty percent of Pennsylvania women ages 15-49 have Medicaid insurance. Nationally, half of all patients who obtain abortions have incomes below the federal poverty line.
A first-trimester abortion in Pennsylvania costs an average of $500. For a Medicaid-eligible family of three, that is almost a third of their monthly income. A second-trimester abortion averages $1,195.
Without Medicaid coverage, low-income patients face a choice the court called unconstitutional: deplete savings, delay care into later and more expensive stages of pregnancy, or carry an unwanted pregnancy to term.
Governor Shapiro’s position
Governor Josh Shapiro did not defend the ban in court. His 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 appeal
Attorney General Dave Sunday appealed the ruling. The case now goes to the Pennsylvania Supreme Court, where three justices have previously signaled willingness to rule that abortion access is a constitutional right.
If the Supreme Court upholds the Commonwealth Court, Pennsylvania would join 16 states that use their own Medicaid dollars to cover most medically necessary abortions. If it reverses, the 44-year ban continues.
Why this matters beyond Pennsylvania
The ruling used the state’s Equal Rights Amendment to protect abortion rights. Thirty-eight states have some form of ERA in their constitution. If the Pennsylvania approach holds, it creates a roadmap for challenging Medicaid abortion bans in other ERA states — a strategy that does not depend on the federal courts.
Abortion remains legal in Pennsylvania through 23 weeks. The question is whether income determines who can access it.