Full opinion text
Opinion TOBRINER, J. Plaintiffs, representing indigent women throughout the state, challenge the constitutionality under the California Constitution of provisions in the 1978, 1979, and 1980 California Budget Acts that limit Medi-Cal funding for abortions. Although the acts differ in minor respects, all afford full funding of medical expenses incurred by indigent women who decide to bear a child, but, except in a few limited circumstances, deny funding to those indigent women who choose to have an abortion. Plaintiffs contend that this selective or discriminatory public funding scheme violates a number of distinct constitutional guarantees, in particular the women’s rights of privacy, due process, and equal protection of the laws. At the outset, to dispel certain misconceptions that have appeared in this case, we must clarify the precise, narrow legal issue before this court. First, this case does not turn on the morality or immorality of abortion, and most decidedly does not concern the personal views of the individual justices as to the wisdom of the legislation itself or the ethical considerations involved in a woman’s individual decision whether or not to bear a child. Indeed, although in this instance the Legislature has adopted restrictions which discriminate against women who choose to have an abortion, similar constitutional issues would arise if the Legis- * lature—as a population control measure, for example—funded Medi-Cal abortions but refused to provide comparable medical care for poor women who choose childbirth. Thus, the constitutional question before us does not involve a weighing of the value of abortion as against childbirth, but instead concerns the protection of either procreative choice from discriminatory governmental treatment. Second, contrary to the suggestion of the defendants and the dissent, the question presented is not whether the state is generally obligated to subsidize the exercise of constitutional rights for those who cannot otherwise afford to do so; plaintiffs do not contend that the state would be required to fund abortions for poor women if the state had not chosen to fund medical services for poor women who choose to bear a child. Rather, we face the much narrower question of whether the state, having enacted a general program to provide medical services to the poor, may selectively withhold such benefits from otherwise qualified persons solely because such persons seek to exercise their constitutional right of procreative choice in a manner which the state does not favor and does not wish to support. In defending the constitutionality of the provisions in question, the Attorney General relies most prominently upon the recent decision of the United States Supreme Court in Harris v. McRae (1980) 448 U.S. 297 [65 L.Ed.2d 784, 100 S.Ct. 2671] (hereafter McRae). In McRae, the Supreme Court, by a closely divided vote (five to four), upheld restrictions on federal Medicaid funding of abortions similar to those in the state acts before us. As the Attorney General acknowledges, however, the McRae case did not present any question under the California Constitution and consequently the justices of the high court neither addressed nor resolved the question of the compatibility of such a statutory scheme with our state constitutional guarantees. It is this question of state constitutional law, not resolved by McRae, which we must decide in the present case. In addressing this issue, we shall explain initially that the analysis utilized by the majority of the United States Supreme Court in McRae differs substantially from the analysis mandated by the controlling California authorities and thus cannot be followed here. In McRae, the five-justice majority acknowledged that the governmental program provided unequal treatment in the distribution of public benefits solely on the basis of how an individual woman exercised her basic constitutional right of procreative choice. The court concluded, however, that the federal Constitution required no special justification for such discriminatory treatment so long as the program placed no new obstacles in the path of the woman seeking to exercise her constitutional right. (448 U.S. at pp. 315-318 [65 L.Ed.2d at pp. 804-805, 100 S.Ct. at p. 2688].) By contrast, the governing California cases, discussed at length below, have long held that a discriminatory or restricted government benefit program demands special scrutiny whether or not it erects some new or additional obstacle that impedes the exercise of constitutional rights. In a series of cases reaching back more than three decades, this court has developed and applied a three-part test for evaluating the constitutionality of statutory schemes, like the program at issue here, that condition the receipt of benefits upon a recipient’s waiver of a constitutional right or upon his exercise of such right in a manner which the government approves. In order to sustain the constitutionality of such a scheme under the California Constitution, the state must demonstrate (1) “that the imposed conditions relate to the purposes of the legislation which confers the benefit or privilege”; (2) that “the utility of imposing the conditions. . .manifestly outweigh[s] any resulting impairment of constitutional rights”; and (3) that there are no “less offensive alternatives” available for achieving the state’s objective. (Bagley v. Washington Township Hospital Dist. (1966) 65 Cal.2d 499, 505-507 [55 Cal.Rptr. 401, 421 P.2d 409].) As we shall see, when measured against this established standard, the statutory scheme at issue is plainly unconstitutional. First, the Budget Act restrictions are antithetical to the purpose of the Medi-Cal program—to provide indigents with access to medical services comparable to that enjoyed by more affluent persons. Second, the benefits of the funding restrictions do not manifestly outweigh the impairment of the constitutional rights; the fiscal advantages of the restrictions are illusory, and the asserted state interest in protecting fetal life cannot constitutionally claim priority over the woman’s fundamental right of procreative choice. Third, the Medi-Cal program as qualified by the Budget Act restrictions clearly does not aid poor women who choose to bear children in a manner least offensive to the rights of those who choose abortion. Accordingly, we conclude that the challenged restrictions cannot stand. 1. Background of the present litigation. The California Medi-Cal program funds “physician, hospital or clinic outpatient, [and] surgical center” services, as well as “inpatient hospital services,” for “recipients of public assistance [and] medically indigent aged and other persons.” (Welf. & Inst. Code, §§ 14000, 14132, subds. (a) & (b).) No one disputes that abortions performed by a physician, whether in a hospital, clinic, or office, are medical services which, in the absence of special funding restrictions, would be funded under the foregoing provisions. Prior to 1978, the Medi-Cal program paid for legal abortions obtained by Medi-Cal recipients. The California Legislature, however, inserted into the 1978, 1979, and 1980 Budget Acts provisions restricting Medi-Cal funding of abortions. (Stats. 1978, ch. 359, § 2, item 248, pp. 823-825; Stats. 1979, ch. 259, § 2, item 261.5, pp. 644-646; Stats. 1980, ch. 510, § 2, item 287.5, pp. 1146-1148.) Although the 1978 enactment differs slightly from the 1979 and 1980 restrictions, all in essence provide funding for abortions only (1) when pregnancy would endanger the mother’s life; (2) when pregnancy would cause severe and long-lasting physical health damage to the mother; (3) when pregnancy is the result of illegal intercourse (rape, incest, or unlawful intercourse with a minor); or (4) when abortion is necessary to prevent the birth of severely defective infants. Before the 1978 restrictions could take effect, plaintiffs filed this suit against Beverlee A. Myers, Director of the State Department of Health Services, to enjoin her from enforcing the restrictions. The trial court upheld the funding restrictions and refused injunctive relief. Plaintiffs appealed from the judgment, the Court of Appeal affirmed in a two-to-one decision, and we granted a hearing to decide the important constitutional issue presented. While the suit attacking the 1978 Budget Act restrictions was pending before us on petition for hearing, that act expired, to be replaced by the essentially identical provisions of the 1979 Budget Act. Plaintiffs thereupon filed an original petition in this court (Committee to Defend Reproductive Rights v. Cory) seeking mandate to bar enforcement of the 1979 act. We granted an alternative writ and stayed enforcement of the restrictions pending resolution of the merits. The 1979 Budget Act expired June 30, 1980. On July 16 the Legislature enacted the 1980 Budget Act, which imposed restrictions on abortion funding identical to those in the 1979 act. Plaintiffs promptly filed an original petition for mandate (Committee to Defend Reproductive Rights v. Unruh) to restrain enforcement of the 1980 act. We issued an alternative writ and stayed enforcement of the funding restrictions pending resolution of the controversy. 2. Our court bears an independent obligation to resolve plaintiffs’ claims under the California Constitution on the basis of the governing state constitutional principles. In these actions, plaintiffs contend that the statutes violate a number of provisions of both the California and United States Constitutions. As already noted, in defending the challenged budget restrictions the Attorney General relies most heavily on the United States Supreme Court’s recent decision in McRae, in which a five-justice majority concluded that similar funding restrictions in the federal Medicaid program did not violate the provisions of the federal Constitution. McRae, of course, did not resolve or even address the question of the validity of such a statutory scheme under the California Constitution. Under these circumstances, we think it important to reiterate the basic principles of federalism which illuminate our responsibilities in construing our state Constitution. In emphasizing, in People v. Brisendine (1975) 13 Cal.3d 528, 549-550 [119 Cal.Rptr. 315, 531 P.2d 1099], “the incontrovertible conclusion that the California Constitution is, and always has been, a document of independent force,” our court explained that “[i]t is a fiction too long accepted that provisions in state constitutions textually identical to the Bill of Rights were intended to mirror their federal counterpart. The lesson of history is otherwise: the Bill of Rights was based upon the corresponding provisions of the first state constitutions, rather than the reverse.. . .The federal Constitution was designed to guard the states as sovereignties against potential abuses of centralized government; state charters, however, were conceived as the first and at one time the only line of protection of the individual against the excesses of local officials.” Accordingly, we affirmed in Brisendine that state courts, in interpreting constitutional guarantees contained in state constitutions, are “independently responsible for safeguarding the rights of their citizens.” (Italics added.) (Id. at p. 551.) Contrary to the Attorney General’s rhetoric, such independent construction does not represent an unprincipled exercise of power, but a means of fulfilling our solemn and independent constitutional obligation to interpret the safeguards guaranteed by the California Constitution in a manner consistent with the governing principles of California law. As we explained very recently in People v. Chavez (1980) 26 Cal.3d 334, 352 [161 Cal.Rptr. 762, 605 P.2d 401]: “[J]ust as the United States Supreme Court bears the ultimate judicial responsibility for determining matters of federal law, this court bears the ultimate judicial responsibility for resolving questions of state law, including the proper interpretation of provisions of the state Constitution. [Citations.] In fulfilling this difficult and grave responsibility, we cannot properly relegate our task to the judicial guardians of the federal Constitution, but instead must recognize our personal obligation to exercise independent legal judgment in ascertaining the meaning and application of state constitutional provisions.” It is from this perspective that we must analyze plaintiffs’ claims that the statutes in question are invalid under the California Constitution. 3. Although the state has no constitutional obligation to provide medical care to the poor, a long line of California decisions establishes that once the state has decided to make such benefits available, it bears a heavy burden of justification in defending any provision which withholds such benefits from otherwise qualified individuals solely because they choose to exercise a constitutional right. In analyzing the constitutionality of the challenged statutory scheme, we start from the premise, not challenged by the Attorney General, that under article I, section 1 of the California Constitution all women in this state—rich and poor alike—possess a fundamental constitutional right to choose whether or not to bear a child. Our court first recognized the existence of this constitutional right of procreative choice in People v. Belous (1969) 71 Cal.2d 954 [80 Cal.Rptr. 354, 458 P.2d 194], four years before the United States Supreme Court in Roe v. Wade (1973) 410 U.S. 113 [35 L.Ed.2d 147, 93 S.Ct. 705] acknowledged the existence of a comparable constitutional right under the federal Constitution. In 1972, moreover, the people of this state specifically added the right of “privacy” to the other inalienable rights of individuals enumerated in article I, section 1 of the state Constitution. The federal constitutional right of privacy, by contrast, enjoys no such explicit constitutional status. Consequently, in City of Santa Barbara v. Adamson (1980) 27 Cal.3d 123 [164 Cal.Rptr. 539, 610 P.2d 436], this court recently refused to rely on federal precedent to restrict the ambit of the California right of privacy. The federal right, we noted, “appears to be narrower than what the voters approved in 1972 when they added ‘privacy’ to the California Constitution.” (27 Cal.3d at p. 130, fn. 3.) The Attorney General concedes that under article I, section 1 the state has no authority directly to prohibit rich or poor women from exercising their right of procreative choice as they see fit. He argues, however, that the state violates no constitutional precept when it does not directly prohibit the protected activity but simply declines to extend a public benefit—in this case publicly funded medical care—to those who choose to exercise their constitutional right in a manner the state does not approve and does not wish to subsidize. This court faced a nearly identical legal contention in a different factual context over 30 years ago in Danskin v. San Diego Unified Sch. Dist. (1946) 28 Cal.2d 536 [171 P.2d 885], In Danskin the state had established a general program under which private organizations were permitted to utilize public school buildings for public meetings, but had structured the program so as to exclude “subversive elements” from the use of such school property. In defending the statutory scheme, the government argued, as the Attorney General does here, that since the state was under no constitutional obligation to make school buildings available to private organizations, it was free to permit or withhold access to such facilities as it saw fit in order to avoid “subsidizing” the exercise of subversive ideas it did not wish to encourage. In Danskin, Justice Traynor—writing for the court—rejected the state’s argument in no uncertain terms: “The state is under no duty to make school buildings available for public meetings. [Citations.] If it elects to do so, however, it cannot arbitrarily prevent any members of the public from holding such meetings. [Citations.] Nor can it make the privilege of holding them dependent on conditions that would deprive any members of the public of their constitutional rights. A state is without power to impose an unconstitutional requirement as a condition for granting a privilege even though the privilege is use of state property. [Citations.] [11] Since the state cannot compel ‘subversive elements’ directly to renounce their convictions and affiliations, it cannot make such a renunciation a condition of receiving the privilege of free assembly in a school building.” (28 Cal.2d at pp. 545-546.) In the more than three decades that have passed since the Danskin decision, both this court and the California Courts of Appeal have applied the legal principles underlying Danskin in a wide variety of factual settings, involving a host of different “public benefit” programs which conditioned the receipt of benefits on the waiver or forfeiture of a broad range of constitutional rights. As these numerous decisions teach, the Danskin principles apply whether the public benefit program at issue is access to a public forum, public employment, welfare benefits, public housing, unemployment benefits or the use of public property and whether the constitutional right singled out for discriminatory treatment is the right of free speech, or, as in this case, the right of privacy. In these varying contexts, California courts have repeatedly rejected the argument that because the state is not obligated to provide a general benefit, it may confer such a benefit on a selective basis which excludes certain recipients solely because they seek to exercise a constitutional right. Our decision in Bagley v. Washington Township Hospital Dist., supra, 65 Cal.2d 499 served as a touchstone for many of these crucial precedents. (See, e.g., Vogel, supra, 68 Cal.2d 18; Parrish, supra, 66 Cal.2d 260; City of Carmel-by-the-Sea, supra, 2 Cal.3d 259; Finot, supra, 250 Cal.App.2d 189.) In Bagley, plaintiff, a nurse’s aide employed by the defendant hospital district, was discharged when she refused to discontinue her off-duty pamphletting and petition circulating activities in support of an election campaign to recall several of the hospital district’s directors. The district defended the discharge by reference to a Government Code section which provided broadly that “[n]o .. . employee ... of a local agency .. . shall take an active part in any campaign ... for or against any ballot measure relating to the recall of any elected official of the local agency.” (Former Gov. Code, § 3205.) In Bagley, our court rejected the district’s defense and struck down the statute on constitutional grounds. In reaching our conclusion in Bagley, we drew upon the cited prior holdings involving conditional benefit programs and on scholarly legal commentaries to construct a framework for judicial analysis of restrictions, like those here at issue, which exclude from government benefit programs potential recipients solely on the basis of their exercise of constitutional rights. Stressing that the “government bears a heavy burden of demonstrating the practical necessity” for such unequal treatment (65 Cal.2d at p. 505), oiir court in Bagley established a three-part standard that the state must satisfy to justify such a scheme. First, we held that “[the state] must establish that the imposed conditions relate to the purpose of the legislation which confers the benefit or privilege.” (65 Cal.2d at pp. 505-506.) Second, we declared that “[n]ot only must the conditions annexed to the enjoyment of a publicly conferred benefit reasonably tend to further the purpose sought by conferment of that benefit, but also the utility of imposing the conditions must manifestly outweigh any resulting impairment of constitutional rights.” (Id., at p. 506.) Third, and finally, we established that “in imposing conditions upon the enjoyment of publicly conferred benefits, as in the restriction of constitutional rights by more direct means, the state must establish the unavailability of less offensive alternatives and demonstrate that the conditions are drawn with narrow specificity, restricting the exercise of constitutional rights only to the extent necessary to maintain the integrity of the program which confers the benefits.” (Id., at p. 507.) In attempting to avoid the analytical scrutiny mandated in California by the Danskin-Bagley line of decisions, the Attorney General relies on the recent federal decision in McRae. The Attorney General is simply mistaken, however, in suggesting that the federal approach to unconstitutional conditions corresponds to the California standard established by the Danskin-Bagley line of cases. Indeed, a comparison of several recent California and United States Supreme Court decisions demonstrates quite vividly the divergence between state and federal constitutional doctrine in this realm. In Parrish v. Civil Service Commission, supra, 66 Cal.2d 260, for example, this court applied the Bagley standard in evaluating the constitutionality of a government practice of conditioning the receipt of welfare benefits upon a recipient’s waiver of his constitutional right of privacy in his home. Because the government could not satisfy the Bagley test, we held the practice unconstitutional. In Wyman v. James (1971) 400 U.S. 309 [27 L.Ed.2d 408, 91 S.Ct. 381], by contrast, the United States Supreme Court subjected a similar governmental intrusion upon the rights of welfare recipients to a lesser degree of scrutiny, and—contrary to our Parrish decision—upheld the government policy against constitutional challenge. Similarly, in Wirta v. Alameda-Contra Costa Transit Dist., supra, 68 Cal.2d 51, our court, applying the principles of Danskin and Bagley, struck down a discriminatory public transit advertising policy which made advertising space on public buses available for commercial expression but denied this “public benefit” to those who wished to advertise their views upon noncommercial, political subjects. In Lehman v. City of Shaker Heights (1974) 418 U.S. 298 [41 L.Ed.2d 770, 94 S.Ct. 2714], however, the United States Supreme Court, when faced with the identical issue presented in Wirta, declined to engage in the demanding scrutiny called for by the California precedents and sustained the unequal advertising policy under the federal Constitution. Finally, our court, in Bagley itself and in Fort v. Civil Service Commission (1964) 61 Cal.2d 331 [38 Cal.Rptr. 625, 392 P.2d 385], tested the constitutionality of limitations on the political activities of public employees by stringent standards and found broadly worded restrictions on such activities to be unconstitutional. In United States Civil Serv. Comm'n v. National Ass'n of Letter Carriers (1973) 413 U.S. 548 [37 L.Ed.2d 796, 93 S.Ct. 2880], however, the United States Supreme Court applied a less demanding standard and upheld comparably broad restrictions on political activities of federal employees. As these cases indicate, for at least the past decade the federal decisions in this area have not been a reliable barometer of the governing California constitutional principles. Indeed, an examination of McRae itself plainly demonstrates that the McRae majority, in refusing to closely scrutinize the discriminatory Medicaid funding scheme, relied on factors which have no bearing on our task in applying California law. First, the McRae court conceptualized the selective funding program as placing no additional “obstacles in the path of a woman’s exercise of her freedom of choice” (448 U.S. at p. 316 [65 L.Ed.2d at p. 804, 100 S.Ct. at p. 2688]) but simply leaving “an indigent woman with at least the same range of choices in deciding whether to obtain a medically necessary abortion as she would have had if Congress had chosen to subsidize no health care costs at all.” (Id.) This reasoning, which was central to the McRae decision, cannot be reconciled with the analysis adopted in the Danskin-Bagley line of decisions. In Danskin itself, for example, the government, by providing a public forum for nonsubversive groups, did not place any additional obstacle in the path of subversive groups who wanted to hold meetings in private buildings, public parks, or any other previously available forum. Nonetheless, our court held that the discriminatory aspect of the government’s benefit program rendered it unconstitutional. Similarly, in Parrish, the condition which was placed on the receipt of welfare benefits posed no additional threat to the privacy rights of those who did not seek such benefits; we recognized, however, that the limitation would, in fact, impair the constitutional rights of would-be recipients and accordingly tested it by the standard announced in Bagley. Indeed, the entire Danskin-Bagley doctrine is concerned solely with the validity of conditional prerequisites for the receipt of various benefits which the government has no obligation to provide. In all of these cases, it may be said that the limitation or condition at issue creates no “additional” obstacle to the exercise of rights, for a recipient unhappy with any such condition is always free—at least theoretically—to go without the public benefit in question. The California courts, however, have acknowledged both the practical importance of many governmental benefits to individual recipients and the corresponding likelihood that a discriminatory benefit program will effectively nullify important constitutional rights. Thus, California holdings uniformly confirm that the absence of an “additional obstacle” to the exercise of one’s constitutional rights does not eliminate the government’s burden of demonstrating the propriety of the condition or limitation under the Bagley test. The Attorney General finds dictum in McRae on which he erects two additional arguments against our reliance upon the California doctrine of unconstitutional conditions. First, he argues that we should draw a distinction between a measure which denies other governmental benefits to women who choose to have an abortion and one which simply denies funding for the abortion itself. The former measure, he suggests, imposes an unconstitutional penalty; the latter merely withholds funding for actions which the state does not want to subsidize. The proffered distinction does not conform to California precedent. In Danskin itself, for example, the challenged provisions did not broadly disqualify subversive elements from a wide range of benefits, but rather withheld a single benefit—the use of public schools as a forum— from those who wanted to use those facilities to exercise constitutional rights the state did not desire to subsidize. Similarly, under the California cases, the state could not escape application of the Bagley standard if, instead of denying all welfare benefits to recipients who marry someone of another race, the state provided free marriages for poor intraracial couples but declined to extend that “single benefit” to poor interracial couples. (See The Supreme Court, 1976 Term (1977) 91 Harv.L.Rev. 70, 144. See also Binet-Montessori, Inc. v. San Francisco Unified School Dist., supra, 98 Cal.App.3d 991, 995.) Under Danskin-Bagley principles, whenever the state conditions the receipt of a benefit upon the waiver of a constitutional right or discriminatorily withholds such a benefit from individuals who exercise such right, the state must demonstrate the propriety of the condition in terms of the governing three-part test. The Attorney General also draws upon McRae’s analogy (see 448 U.S. at p. 318 [65 L.Ed.2d at p. 805, 100 S.Ct. at pp. 2688-2689]) between the state’s decision to fund childbirth but not abortion and its decision to fund public education but not “private education.” In the decisions recognizing a constitutional right to obtain a private education upon which the ostensible analogy rests, however, the principal question presented was whether the state could compel all children to attend state-run schools; these decisions concluded that the state could not. (See, e.g., Pierce v. Society of Sisters (1925) 268 U.S. 510 [69 L.Ed. 1070, 45 S.Ct. 571, 39 A.L.R. 468].) An analogous medical care case would arise if a state law requiring, for example, that all medical care be obtained from a public hospital clashed with an individual’s asserted constitutional right to reject state-provided medical care in favor of medical care that he himself chooses. In the present case, of course, no such constitutional right is at issue because the statutory scheme in question does not interfere with an individual’s right to go elsewhere for medical care. Thus, the Attorney General’s attempted analogy is misleading. It is obvious, of course, that the state, in providing a benefit such as public education, is not thereby compelled to pay the costs incurred by those who choose to relinquish the public benefit in favor of a comparable privately funded benefit. Danskin itself, for example, does not suggest that the state in making public schools available as a public forum, obligated itself to reimburse those who chose to exercise their First Amendment right by speaking in private meeting halls or, indeed, by refraining from speaking at all. In short, the Danskin-Bagley line of cases is not concerned with a person’s liberty to reject an offered public benefit in favor of a private counterpart—the issue in the private school cases. Instead, Danskin and Bagley hold that when the state implements a general public benefit program, the California Constitution imposes definite limitations on the state’s ability to offer such a benefit in a fashion which discriminates against the exercise of constitutional rights. The statutory program at issue here does afford medical care on just such a selective or discriminatory basis. Accordingly, in evaluating the constitutionality of the challenged statutory provisions under the California Constitution, we employ the test established by the California unconstitutional condition cases. 4. Under the constitutional standard established in Bagley, the statutory provisions which discriminatorily deny generally available medical benefits to poor women solely because they choose to have an abortion are unconstitutional. As noted previously, Bagley posits a threefold inquiry: (1) whether the conditions which are imposed relate to the purposes of the legislation which provide the benefit; (2) whether the utility of the conditions imposed clearly outweighs the resulting impairment of constitutional rights; and (3) whether there are no less offensive alternatives available to achieve the state’s objective. We follow these avenues of inquiry, placing particular emphasis upon the second prong of the test in which we must weigh the utility of the funding restrictions against the resulting impairment to the woman’s right of procreative choice. (a) The restrictions imposed on poor women’s right of procreative choice do not relate to the purposes of the Medi-Cal program. As noted above, Bagley provides that, as an initial matter, the state “must establish that the imposed conditions relate to the purposes of the legislation which confers the benefit or privilege.” (65 Cal.2d at pp. 505-506.) Elaborating on this requirement in Bagley, we quoted with approval Justice Frankfurter’s observation that “Congress may withhold all sorts of facilities for a better life, but if it affords them it cannot make them available in an obviously arbitrary way or exact surrender of freedoms unrelated to the purpose of the facilities.” (Italics added.) (American Communication Assn. v. Douds (1950) 339 U.S. 382, 417 [94 L.Ed. 925, 70 S.Ct. 674] (separate opinion).) In most of the California public benefit cases, the restrictions on constitutional rights adopted as part of the government programs have borne at least some relation to the purpose of the program. Thus, for example, in cases such as Bagley that involved restrictions on the exercise of First Amendment activities by those who obtain the “benefit” of public employment, the restrictions were apparently intended to curtail activities thought to have a potential for interfering with the effective performance of the public employee’s job. Similarly, in Parrish, the restrictions imposed on welfare recipients’ right of privacy related to the elimination of fraud in the welfare system and thus again could be said to further the aims of the benefit program in question. In the instant case, by contrast, the restriction imposed on poor women who seek to exercise their constitutional right to decide whether or not to have a child bears no relation whatsoever to the fundamental purposes of the Medi-Cal program. Welfare and Institutions Code section 14000 declares that “[t]he purpose [of the Medi-Cal program] is to afford health care and related remedial or preventive services to recipients of public assistance and to medically indigent aged and other persons... ”; thus, the program’s primary objective is to alleviate the hardship and suffering incurred by those who cannot afford needed medical care by enabling them to obtain such medical treatment. The restrictions at issue here directly impede this fundamental purpose. Even when an abortion represents the appropriate medical treatment for a poor pregnant woman, the statute virtually bars payment for that treatment and thus subjects the poor woman to significant health hazards and in some cases to death. In this respect, the state’s denial of Medi-Cal funds to otherwise qualified women solely because they choose to have an abortion bears a marked similarity to the Los Angeles Housing Authority’s policy of excluding so-called subversive persons from public-supported low-rent housing projects, a policy that was invalidated by a California decision over 25 years ago in Housing Authority v. Cordova (1955) 130 Cal.App.2d Supp. 883 [279 P.2d 215]. In finding that exclusionary policy unconstitutional, the Cordova court explained: “‘The purpose of the [housing act] is to eradicate slums and provide housing for persons of low-income class. [Citation.] It is evident that the exclusion of otherwise qualified persons solely because of membership in organizations designated as subversive by the Attorney General has no tendency whatever to further such purpose.’” (130 Cal.App.2d Supp., at p. 888.) The state can show a relationship between the Budget Act limitations and the purpose of the Medi-Cal program only by claiming that MediCal seeks not only to provide necessary health care to indigents but also to protect the life and health of the fetus. Any attempt to reconcile Medi-Cal objectives with abortion limitations on the theory that the latter protect the fetus, however, impermissibly denigrates the woman’s right of choice. As we explain in discussing the second part of the Bagley test, both California and federal authorities establish that, at least prior to viability, the state may not subordinate a woman’s own medical interests or her right of procreative choice to the interests of the fetus. We therefore turn to consider the second part of the Bagley test. (b) In light of the fundamental and intimate nature of the constitutional right of procreative choice and the severe impairment of that right that will in practice result from the statutory restrictions at issue, the utility of imposing such restrictions does not “manifestly outweigh [the] resulting impairment of constitutional rights.” Under the second part of Bagley, the state must demonstrate that “the utility of imposing the conditions...manifestly outweigh[s] any resulting impairment of constitutional rights.” (65 Cal.2d at p. 506.) As numerous cases since Bagley have elaborated, a court in undertaking this “weighing” or “balancing” process must realistically assess the importance of the state interest served by the restrictions and the degree to which the restrictions actually serve such interest; further the court must carefully evaluate the importance of the constitutional right at stake and gauge the extent to which the individual’s ability to exercise that right is threatened or impaired, as a practical matter, by the specific statutory restrictions or conditions at issue. (See, e.g., Parrish v. Civil Service Commission, supra, 66 Cal.2d 260, 270-274; City of Carmel-by-the-Sea v. Young, supra, 2 Cal.3d 259, 265-272; Finot v. Pasadena City Bd. of Education, supra, 250 Cal.App.2d 189, 196-202.) We must canvass the various factors on each side of the scale in order to determine whether the utility of the restrictions “manifestly outweighs” the resulting impairment of constitutional rights. (See generally O'Neil, op. cit. supra, 54 Cal.L.Rev. 443, 460-478; Comment, Another Look at Unconstitutional Conditions (1968) 117 U.Pa.L.Rev. 144.) In undertaking this analysis, we begin by examining the nature and importance of the constitutional right at issue, and then consider the degree to which this right is actually threatened by the challenged statutory scheme. In People v. Belous, supra, 71 Cal.2d 954, the seminal California case in this area, we recognized that the constitutional rights at stake are in essence twofold: “The rights involved.. . are the woman’s rights to life and to choose whether to bear children.” (Id., at p. 963.) The first right is implicated because the choice between childbirth and abortion in some instances involves potential risks to the life of the pregnant woman. Moreover, even when a life-threatening condition is not present, the constitutional choice directly involves the woman’s fundamental interest in the preservation of her personal health. As this court stated in Ballard v. Anderson (1971) 4 Cal.3d 873, 879 [95 Cal.Rptr. 1, 484 P.2d 1345, 42 A.L.R.3d 1392]: “In California, law and medicine recognize that therapeutic abortion is a legitimate medical treatment which may be necessary for the preservation of a pregnant woman’s life and health.” Closely related to this fundamental interest in life and health is the basic recognition that, for a woman, the constitutional right of choice is essential to her ability to retain personal control over her own body. As Professor Tribe has observed: “If a man is the involuntary source of a child—if he is forbidden, for example, to practice contraception—the violation of his personality is profound; the decision that one wants to engage in sexual intercourse but does not want to parent another human being may reflect the deepest of personal convictions. But if a woman is forced to bear a child—not simply to provide an ovum but to carry the child to term—the invasion is incalculably greater.... [I]t is difficult to imagine a clearer case of bodily intrusion, even if the original conception was in some sense voluntary.” (Tribe, American Constitutional Law (1977) § 15-10, p. 924.) Moreover, as Belous makes clear, the restriction at issue undermines the right of privacy guaranteed under our California Constitution in that it threatens not only the woman’s interests in life, health, and personal bodily autonomy but also her right to decide for herself whether to parent a child: “The fundamental right of the woman to choose whether to bear children follows from the Supreme Court’s and this court’s repeated acknowledgment of a ‘right of privacy’ or ‘liberty’ in matters related to marriage, family, and sex.” (71 Cal.2d at p. 963.) The Supreme Court has defined the woman’s right to choose as an aspect of the privacy right in even more explicit terms: “[I]f the right of privacy means anything, it is the right of the individual... to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.” (Original italics.) (Eisenstadt v. Baird (1972) 405 U.S. 438, 453 [31 L.Ed.2d 349, 362, 92 S.Ct. 1029].) This right of personal choice is central to a woman’s control not only of her own body, but also to the control of her social role and personal destiny. (See Karst, The Supreme Court, 1976 Term—Forward Equal Citizenship Under the Fourteenth Amendment (1977) 91 Harv.L.Rev. 1, 57-58.) As Professor Karst has recently observed: “The implications of an unwanted child for a woman’s education, employment opportunities and associational opportunities (often including marriage opportunities) are of enormous proportion.” (Karst, The Freedom of Intimate Association (1980) 89 Yale L.J. 624, 641, fn. 90.) Thus, the constitutional rights at issue here are clearly among the most intimate and fundamental of all constitutional rights. With that understanding in mind, we must consider the extent to which the statutory limitations in controversy will actually impair the individual’s exercise of these vitally important constitutional rights. In resolving that issue, we need only consider the nature of the program in question to recognize that the actual impairment of constitutional rights will be severe indeed. The medical benefits provided by the Medi-Cal program are available only to poor persons who are unable to pay for their own health care; by definition, then, the only women affected by the restrictions at issue are those who lack the money or resources to pay for a medically supervised abortion on their own. Although it may be possible for some poor women to obtain medical abortions with the help of private charities, the existence of the Medi-Cal program itself testifies to the fact that private charitable resources do not suffice to meet the medical needs of the poor. Thus, from a realistic perspective, we cannot characterize the statutory scheme as merely providing a public benefit which the individual recipient is free to accept or refuse without any impairment of her constitutional rights. On the contrary, the state is utilizing its resources to ensure that women who are too poor to obtain medical care on their own will exercise their right of procreative choice only in the manner approved by the state. In this respect, the impairment of constitutional rights resulting from the present statutory restrictions is significantly greater than the impairment of rights involved in almost all the past California cases in this field. In Danskin, for example, while the discriminatory benefit scheme denied disfavored persons the use of public school buildings for meetings, it did not effectively preclude them from holding meetings or disseminating their views to the public. Similarly, although the restrictive government employment policy in Bagley directly impinged upon the public employee’s free speech rights in significant respects, it nonetheless left the employee free to engage in much political activity. In the instant case, by contrast, the state’s discriminatory treatment will prevent the vast majority of poor women from exercising their constitutional right to choose whether or not to bear a child. As Justice Brennan has observed, “By funding all of the expenses associated with childbirth and none of the expenses incurred in terminating pregnancy, the government literally makes an offer that the indigent woman cannot afford to refuse.” (McRae, 448 U.S. at pp. 333-334 [65 L.Ed.2d at p. 815, 100 S.Ct. at p. 2704] (dis. opn.).) Having found that the statutory restrictions in question will severely impair or totally deny the actual exercise of this intimate and fundamental constitutional right, we must determine whether the benefits which the state derives from the restrictions “manifestly outweigh” such significant impairment. Obviously, in view of the foregoing discussion, only the most compelling of state interests could possibly satisfy this test. As we shall see, however, it is doubtful whether the restrictions in this case serve any constitutionally legitimate, let alone compelling state interest; furthermore, the interest that the statute does serve is furthered in an underinclusive and discriminatory manner. We begin by identifying the precise state interest that is served by the statutory restrictions at issue. We note that although the restrictions take the form of curtailing state expenditures, they do not in reality serve the state’s legitimate interest in conserving its limited fiscal resources; whatever money is saved by refusing to fund abortions will be spent many times over in paying maternity care and childbirth expenses and supporting the children of indigent mothers. In the first place, the cost of an abortion is much less than the cost of maternity care and delivery. Thus, the present statutory scheme, by withholding funds for abortions, requires the state to pay the more expensive childbirth expenses for every poor woman or teenager who becomes pregnant. Second, because the present statutes frequently deny funding of abortions to women who face special medical risks if they carry a fetus to term, such limitations—under the current comprehensive Medi-Cal scheme—will oblige the state to provide additional and often expensive medical care for such women before, during, and after childbirth. But for the challenged restrictions, such expenses would not have been incurred. Finally, this limitation on poor women’s constitutional rights will prove enormously expensive in terms of long-range economic costs. As Justice Blackmun has observed: “[T]he cost of a[n]... abortion ... holds no comparison whatsoever with the welfare costs that will burden the State for the new indigents and their support in the long, long years ahead.” (Beal v. Doe (1977) 432 U.S. 438, 463 [53 L.Ed.2d 464, 483, 97 S.Ct. 2366] (dis. opn.).) The Attorney General and amici suggest, however, that the restrictions on the funding of abortions through Medi-Cal relate to a state interest alternatively defined as an interest in “encouraging childbirth” or an interest in “protecting the potential life of the fetus.” As far as the interest in “encouraging childbirth” is concerned, the California Legislature has not embraced a general policy of encouraging unwanted children; under the present provisions of the Medi-Cal program, for example, funds are specifically authorized to pay for the medical expense of contraception and sterilization. Furthermore, as we explain in the following section, to the extent that the challenged provisions are defended as simply a method of aiding poor women who want to bear children, the provisions clearly do not serve that interest in a manner least offensive to the rights of women who choose not to bear children. That brings us to the state interest in “protecting the potential life of the fetus,” an objective which we think does realistically underlie the funding restrictions at issue here. There is no question, of course, that phrased in general terms the state has a legitimate interest in protecting the potential life of a fetus. Thus, the state may without doubt legitimately prosecute a person who deliberately injures a fetus, even if no corresponding harm befalls the woman who carries the fetus. In the instant case, however, the state is not merely proposing to protect a fetus from general harm, but rather is asserting an interest in protecting a fetus vis-á-vis the woman of whom the fetus is an integral part. Such a claimed interest, of course, clashes head-on with the woman’s own fundamental right of procreative choice. The argument that the state advances here essentially parallels that presented to the United States Supreme Court in Roe v. Wade, supra, 410 U.S. 113, when the State of Texas argued that its asserted interest in protecting the fetus justified criminal proscriptions on abortion. The high court carefully examined and weighed the interests implicated by this contention: the woman’s interest in deciding for herself a matter which so intimately and fundamentally affects her future life and happiness; her interest in protecting her own life and health; the corresponding state interest in safeguarding the woman’s life and health; and, finally, the state’s interest in protecting the fetus. After an extensive review of the history of abortion laws and consideration of the medical risks of abortion and childbirth, the court held that during the first two trimesters of pregnancy, when the fetus is not viable, the state’s interest in protecting the fetus is not of compelling character. Consequently, the court concluded, the state may not subordinate the woman’s fundamental right of procreative choice to the state’s interest in protecting a nonviable fetus. Roe v. Wade went on to explain the extent and purpose for which state regulation of abortion is permissible. Prior to the third trimester of pregnancy, it held, the state may regulate only to protect the woman’s health—not to protect the fetus. In the third trimester the state may enact restrictions to protect the fetus, but may not proscribe abortions necessary to preserve the woman’s life or health. (410 U.S. at pp. 164-165 [35 L.Ed.2d at p. 183].) The restrictions of the California Budget Act do not conform to the careful calculation of competing rights and interests set out in Roe v. Wade. The Budget Act seeks to limit first and second trimester abortions, not for the permissible purpose of protecting the woman’s health, but to protect the fetus. The act thus inverts the priority of interests established in Roe and improperly subordinates the woman’s right of choice to the lesser state interest in protecting. a nonviable fetus. Furthermore, although Roe v. Wade recognized a compelling interest in protecting a viable fetus, even that interest cannot be invoked to restrict abortions necessary to preserve the woman’s health; the Budget Act, however, gives no consideration to danger to the woman’s health unless the threatened harm is severe, long-lasting, and relates to physical health. In short, Roe v. Wade settled that protection of a nonviable fetus is not a compelling state interest. The subsequent high court decision in McRae does not detract from that holding. McRae did not measure the restrictions at issue against a compelling interest test. Rather, the Supreme Court assumed that a discriminatory withholding of government benefits, because it imposes no new obstacle to abortion, required only minimal justification. That proposition, as we have explained, is inconsistent with California constitutional law. The assumption underlying the high court’s analysis, however—that funding restrictions would fail if required to meet a compelling interest standard—provides further support for our decision today. Neither do California decisions support the Attorney General’s claim. We considered the state’s asserted interest in protecting fetal life in People v. Belous, supra, 71 Cal.2d 954, holding unconstitutionally vague a statute which barred abortions unless necessary to preserve the mother’s life. At the outset, we stressed that a woman’s right to choose may be infringed only by regulations necessary to further a compelling interest. (See 71 Cal.2d at p. 964.) Although the state urged that it had “a compelling interest in the protection of the embryo and fetus and that such interest warrants the limitation on the woman’s constitutional rights” (pp. 967-968), we replied that the asserted state interest derived from statutes and rules which either “require a live birth or reflect the interest of the parents.” (Id.) We have already noted that three years after People v. Belous, the people of California amended our state Constitution to provide explicit protection for the right of privacy, a protection not found in the federal text. We have noted also that the federal right of privacy, the foundation for the decision in Roe v. Wade, supra, 410 U.S. 113, is more limited than the corresponding right in the California Constitution. (See City of Santa Barbara v. Adamson, supra, 27 Cal.3d 123, 130, fn. 3.) We therefore conclude that the protection afforded the woman’s right of procreative choice as an aspect of the right of privacy under the explicit provisions of our Constitution is at least as broad as that described in Roe v. Wade. Consequently, we further conclude that the asserted state’s interest in protecting a nonviable fetus is subordinate to the woman’s right of privacy. Moreover, even if the state could assert a compelling interest in protecting a nonviable fetus, we would have grave doubts that the state could pursue such interest in the discriminatory fashion adopted here. Under the present statutory scheme, the state has not undertaken to protect the potential life of all fetuses by promoting their interests over the constitutional rights of all women. Instead, by implementing this state interest through restrictions on Medi-Cal funds rather than through more broadly applicable legislation, the state has singled out poor women and has subordinated only their constitutional right of procreative choice to the concern for fetal life. In the past, this court has been particularly critical of statutory mechanisms that restrict the constitutional rights of the poor more severely than those of the rest of society. (See, e.g., Serrano v. Priest (1976) 18 Cal.3d 728, 765-767 [135 Cal.Rptr. 345, 557 P.2d 929]; Serrano v. Priest (1971) 5 Cal.3d 584, 597-604 [96 Cal.Rptr. 601, 487 P.2d 1241, 41 A.L.R.3d 1187]; In re Antazo (1970) 3 Cal.3d 100, 108-112 [89 Cal.Rptr. 255, 473 P.2d 999].) Thus, we have implicitly recognized that the indigent poor share many characteristics of other “insular minorities” who may not be adequately protected from discriminatory treatment by the general safeguards of the legislative process. (See generally U.S. v. Carolene Products Co. (1938) 304 U.S. 144, 152-153, fn. 4 [82 L.Ed. 1234, 1241-1242, 58 S.Ct. 778].) Although prior cases have generally considered this factor in connection with equal protection analysis, Professor O’Neil has identified its relevance to the unconstitutional condition doctrine: limitations upon governmental benefits which apply to rich and poor alike are obviously less invidious than conditions, like those at issue here, in which the state effectively tells a poor woman “that because [she] is poor ... [she] must restrict [her exercise of constitutional rights] in ways that the government does not ask self-sufficient people to do.” (O'Neil, Unconstitutional Conditions: Welfare Benefits With Strings Attached, supra, 54 Cal.L.Rev. 443, 472.) From this review of the factors which enter into the Bagley analysis, we conclude that the alleged “benefits” which flow from the statutory restrictions on Medi-Cal funds in no sense “manifestly outweigh” the resulting impairment of constitutional rights. As we have seen, the state is hard-pressed to demonstrate that the restrictions further any constitutionally legitimate interests at all; at the same time, the restrictions effectively nullify the poor woman’s fundamental constitutional right to retain personal control over her own body and her own destiny. The challenged statutory scheme, then, clearly does not pass muster under the second part of the Bagley standard. (c) The statutory scheme does not serve the state interest in providing medical care for indigents in a manner least offensive to the woman’s right of procreative choice. The third and final component of the constitutional standard established in Bagley requires the state to “establish the unavailability of less offensive alternatives and [to] demonstrate that the conditions are drawn with narrow specificity, restricting the exercise of constitutional rights only to the extent necessary to maintain the integrity of the program which confers the benefits.” (65 Cal.2d at p. 507.) In effect, this part of the Bagley test requires the state to adopt the “least offensive alternative” adequate to achieve any legitimate state interest. If we view the Budget Act restrictions as intended to prevent indigent women from obtaining abortions, the doctrine of “least offensive alternative” plays no role; the restrictions fail because the state’s interest in protecting the fetus cannot be pursued by subordinating the woman’s right of procreative choice. In an effort to avoid the unconstitutionality of the funding restrictions, however, the Attorney General suggests an alternative interpretation: he argues that the restrictions should not be considered a legislative attempt to prevent the poor from obtaining abortions, but rather as an effort to aid poor women who have already decided to bear a child but cannot afford the expenses of childbirth. That argument, however, fails the “least restrictive alternative” test, since the state could readily meet the needs of indigent women without burdening their right of procreative choice simply by funding impartially the expenses of childbirth and abortion. Moreover, the legislative background of the statute in question belies the Attorney General’s suggestion that the legislation was aimed solely at aiding poor women who have already chosen to bear a child. The Budget Act provisions do not increase preexisting levels of childbirth-related benefits or provide any additional aid at all to poor women who choose to bear a child. Instead, the statute simply curtails the medical benefits previously available to poor women who desire to have an abortion. Quite clearly, this legislation cannot be defended as aiding poor women who wish to have children by the means least offensive to the constitutional rights of other women. 5. Conclusion. As noted at the outset, our opinion in this case does not rest upon this court’s views as to the morality or immorality of abortion. The morality of abortion is not a legal or constitutional issue; it is a matter of philosophy, of ethics, and of theology. It is a subject upon which reasonable people can, and do, adhere to vastly divergent convictions and principles. By virtue of the explicit protection afforded an individual’s inalienable right of privacy by article I, section 1 of the California Constitution, however, the decision whether to bear a child or to have an abortion is so private and so intimate that each woman in this state —rich or poor—is guaranteed the constitutional right to make that decision as an individual, uncoerced by governmental intrusion. Because a woman’s right to choose whether or not to bear a child is explicitly afforded this constitutional protection, in California the question of whether an individual woman should or should not terminate her pregnancy is not a matter that may be put to a vote of the Legislature. If the state cannot directly prohibit a woman’s right to obtain an abortion, may the state by discriminatory financing indirectly nullify that constitutional right? Can the state tell an indigent person that the state will provide him with welfare benefits only upon the condition that he join a designated political party or subscribe to a particular newspaper that is favored by the government? Can the state tell a poor woman that it will pay for her needed medical care but only if she gives up her constitutional right to choose whether or not to have a child? There is no greater power than the power of the purse. If the government can use it to nullify constitutional rights, by conditioning benefits only upon the sacrifice of such rights, the Bill of Rights could eventually become a yellowing scrap of paper. Once the state furnishes medical care to poor women in general, it cannot withdraw part of that care solely because a woman exercises her constitutional right to choose to have an abortion. Indeed, the statutory scheme before us is all the more invidious because its practical effect is to deny to poor women the right of choice guaranteed to the rich. An affluent woman who desires to terminate her pregnancy enjoys the full right to obtain a medical abortion, regardless of the opposition