DOBBS, STATE HEALTH OFFICER OF THE MISSISSIPPI DEPARTMENT OF HEALTH, et al. v. JACKSON WOMEN’S HEALTH ORGANIZATION et al.

Certiorari To The United States Court Of Appeals For The Fifth Circuit

No. 19–1392. Argued December 1, 2021—Decided June 24, 2022

Mississippi’s Gestational Age Act provides that “[e]xcept in a medical emergency or in the case of a severe fetal abnormality, a person shall not intentionally or knowingly perform . . . or induce an abortion of an unborn human being if the probable gestational age of the unborn human being has been determined to be greater than fifteen (15) weeks.” Miss. Code Ann. §41–41–191. Respondents—Jackson Women’s Health Organization, an abortion clinic, and one of its doctors—challenged the Act in Federal District Court, alleging that it violated this Court’s precedents establishing a constitutional right to abortion, in particular Roe v. Wade, 410 U. S. 113, and Planned Parenthood of Southeastern Pa. v. Casey, 505 U. S. 833. The District Court granted summary judgment in favor of respondents and permanently enjoined enforcement of the Act, reasoning that Mississippi’s 15-week restriction on abortion violates this Court’s cases forbidding States to ban abortion pre-viability. The Fifth Circuit affirmed. Before this Court, petitioners defend the Act on the grounds that Roe and Casey were wrongly decided and that the Act is constitutional because it satisfies rational-basis review.

Held: The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives. Pp. 8–79.

  (a) The critical question is whether the Constitution, properly understood, confers a right to obtain an abortion. Casey’s controlling opinion skipped over that question and reaffirmed Roe solely on the basis of stare decisis. A proper application of stare decisis, however, requires an assessment of the strength of the grounds on which Roe was based. The Court therefore turns to the question that the Casey plurality did not consider. Pp. 8–32.

   (1) First, the Court reviews the standard that the Court’s cases have used to determine whether the Fourteenth Amendment’s reference to “liberty” protects a particular right. The Constitution makes no express reference to a right to obtain an abortion, but several constitutional provisions have been offered as potential homes for an implicit constitutional right. Roe held that the abortion right is part of a right to privacy that springs from the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. See 410 U. S., at 152–153. The Casey Court grounded its decision solely on the theory that the right to obtain an abortion is part of the “liberty” protected by the Fourteenth Amendment’s Due Process Clause. Others have suggested that support can be found in the Fourteenth Amendment’s Equal Protection Clause, but that theory is squarely foreclosed by the Court’s precedents, which establish that a State’s regulation of abortion is not a sex-based classification and is thus not subject to the heightened scrutiny that applies to such classifications. See Geduldig v. Aiello, 417 U. S. 484, 496, n. 20; Bray v. Alexandria Women’s Health Clinic, 506 U. S. 263, 273–274. Rather, regulations and prohibitions of abortion are governed by the same standard of review as other health and safety measures. Pp. 9–11.

   (2) Next, the Court examines whether the right to obtain an abortion is rooted in the Nation’s history and tradition and whether it is an essential component of “ordered liberty.” The Court finds that the right to abortion is not deeply rooted in the Nation’s history and tradition. The underlying theory on which Casey rested—that the Fourteenth Amendment’s Due Process Clause provides substantive, as well as procedural, protection for “liberty”—has long been controversial.    The Court’s decisions have held that the Due Process Clause protects two categories of substantive rights—those rights guaranteed by the first eight Amendments to the Constitution and those rights deemed fundamental that are not mentioned anywhere in the Constitution. In deciding whether a right falls into either of these categories, the question is whether the right is “deeply rooted in [our] history and tradition” and whether it is essential to this Nation’s “scheme of ordered liberty.” Timbs v. Indiana, 586 U. S. ___, ___ (internal quotation marks omitted). The term “liberty” alone provides little guidance. Thus, historical inquiries are essential whenever the Court is asked to recognize a new component of the “liberty” interest protected by the Due Process Clause. In interpreting what is meant by “liberty,” the Court must guard against the natural human tendency to confuse what the Fourteenth Amendment protects with the Court’s own ardent views about the liberty that Americans should enjoy. For this reason, the Court has been “reluctant” to recognize rights that are not mentioned in the Constitution. Collins v. Harker Heights, 503 U. S. 115, 125.

  Guided by the history and tradition that map the essential components of the Nation’s concept of ordered liberty, the Court finds the Fourteenth Amendment clearly does not protect the right to an abortion. Until the latter part of the 20th century, there was no support in American law for a constitutional right to obtain an abortion. No state constitutional provision had recognized such a right. Until a few years before Roe, no federal or state court had recognized such a right. Nor had any scholarly treatise. Indeed, abortion had long been a crime in every single State. At common law, abortion was criminal in at least some stages of pregnancy and was regarded as unlawful and could have very serious consequences at all stages. American law followed the common law until a wave of statutory restrictions in the 1800s expanded criminal liability for abortions. By the time the Fourteenth Amendment was adopted, three-quarters of the States had made abortion a crime at any stage of pregnancy. This consensus endured until the day Roe was decided. Roe either ignored or misstated this history, and Casey declined to reconsider Roe’s faulty historical analysis.

  Respondents’ argument that this history does not matter flies in the face of the standard the Court has applied in determining whether an asserted right that is nowhere mentioned in the Constitution is nevertheless protected by the Fourteenth Amendment. The Solicitor General repeats Roe’s claim that it is “doubtful . . . abortion was ever firmly established as a common-law crime even with respect to the destruction of a quick fetus,” 410 U. S., at 136, but the great common-law authorities—Bracton, Coke, Hale, and Blackstone—all wrote that a post-quickening abortion was a crime. Moreover, many authorities asserted that even a pre-quickening abortion was “unlawful” and that, as a result, an abortionist was guilty of murder if the woman died from the attempt. The Solicitor General suggests that history supports an abortion right because of the common law’s failure to criminalize abortion before quickening, but the insistence on quickening was not universal, see Mills v. Commonwealth, 13 Pa. 631, 633; State v. Slagle, 83 N. C. 630, 632, and regardless, the fact that many States in the late 18th and early 19th century did not criminalize pre-quickening abortions does not mean that anyone thought the States lacked the authority to do so.

  Instead of seriously pressing the argument that the abortion right itself has deep roots, supporters of Roe and Casey contend that the abortion right is an integral part of a broader entrenched right. Roe termed this a right to privacy, 410 U. S., at 154, and Casey described it as the freedom to make “intimate and personal choices” that are “central to personal dignity and autonomy,” 505 U. S., at 851. Ordered liberty sets limits and defines the boundary between competing interests. Roe and Casey each struck a particular balance between the interests of a woman who wants an abortion and the interests of what they termed “potential life.” Roe, 410 U. S., at 150; Casey, 505 U. S., at 852. But the people of the various States may evaluate those interests differently. The Nation’s historical understanding of ordered liberty does not prevent the people’s elected representatives from deciding how abortion should be regulated. Pp. 11–30.

   (3) Finally, the Court considers whether a right to obtain an abortion is part of a broader entrenched right that is supported by other precedents. The Court concludes the right to obtain an abortion cannot be justified as a component of such a right. Attempts to justify abortion through appeals to a broader right to autonomy and to define one’s “concept of existence” prove too much. Casey, 505 U. S., at 851. Those criteria, at a high level of generality, could license fundamental rights to illicit drug use, prostitution, and the like. What sharply distinguishes the abortion right from the rights recognized in the cases on which Roe and Casey rely is something that both those decisions acknowledged: Abortion is different because it destroys what Roe termed “potential life” and what the law challenged in this case calls an “unborn human being.” None of the other decisions cited by Roe and Casey involved the critical moral question posed by abortion. Accordingly, those cases do not support the right to obtain an abortion, and the Court’s conclusion that the Constitution does not confer such a right does not undermine them in any way. Pp. 30–32.

  (b) The doctrine of stare decisis does not counsel continued acceptance of Roe and Casey. Stare decisis plays an important role and protects the interests of those who have taken action in reliance on a past decision. It “reduces incentives for challenging settled precedents, saving parties and courts the expense of endless relitigation.” Kimble v. Marvel Entertainment, LLC, 576 U. S. 446, 455. It “contributes to the actual and perceived integrity of the judicial process.” Payne v. Tennessee, 501 U. S. 808, 827. And it restrains judicial hubris by respecting the judgment of those who grappled with important questions in the past. But stare decisis is not an inexorable command, Pearson v. Callahan, 555 U. S. 223, 233, and “is at its weakest when [the Court] interpret[s] the Constitution,” Agostini v. Felton, 521 U. S. 203, 235. Some of the Court’s most important constitutional decisions have overruled prior precedents. See, e.g., Brown v. Board of Education, 347 U. S. 483, 491 (overruling the infamous decision in Plessy v. Ferguson, 163 U. S. 537, and its progeny).

  The Court’s cases have identified factors that should be considered in deciding when a precedent should be overruled. Janus v. State, County, and Municipal Employees, 585 U. S. ___, ___–___. Five factors discussed below weigh strongly in favor of overruling Roe and Casey. Pp. 39–66.

   (1) The nature of the Court’s error. Like the infamous decision in Plessy v. Ferguson, Roe was also egregiously wrong and on a collision course with the Constitution from the day it was decided. Casey perpetuated its errors, calling both sides of the national controversy to resolve their debate, but in doing so, Casey necessarily declared a winning side. Those on the losing side—those who sought to advance the State’s interest in fetal life—could no longer seek to persuade their elected representatives to adopt policies consistent with their views. The Court short-circuited the democratic process by closing it to the large number of Americans who disagreed with Roe. Pp. 43–45.

   (2) The quality of the reasoning. Without any grounding in the constitutional text, history, or precedent, Roe imposed on the entire country a detailed set of rules for pregnancy divided into trimesters much like those that one might expect to find in a statute or regulation. See 410 U. S., at 163–164. Roe’s failure even to note the overwhelming consensus of state laws in effect in 1868 is striking, and what it said about the common law was simply wrong. Then, after surveying history, the opinion spent many paragraphs conducting the sort of fact-finding that might be undertaken by a legislative committee, and did not explain why the sources on which it relied shed light on the meaning of the Constitution. As to precedent, citing a broad array of cases, the Court found support for a constitutional “right of personal privacy.” Id., at 152. But Roe conflated the right to shield information from disclosure and the right to make and implement important personal decisions without governmental interference. See Whalen v. Roe, 429 U. S. 589, 599–600. None of these decisions involved what is distinctive about abortion: its effect on what Roe termed “potential life.” When the Court summarized the basis for the scheme it imposed on the country, it asserted that its rules were “consistent with,” among other things, “the relative weights of the respective interests involved” and “the demands of the profound problems of the present day.” Roe, 410 U. S., at 165. These are precisely the sort of considerations that legislative bodies often take into account when they draw lines that accommodate competing interests. The scheme Roe produced looked like legislation, and the Court provided the sort of explanation that might be expected from a legislative body. An even more glaring deficiency was Roe’s failure to justify the critical distinction it drew between pre- and post-viability abortions. See id., at 163. The arbitrary viability line, which Casey termed Roe’s central rule, has not found much support among philosophers and ethicists who have attempted to justify a right to abortion. The most obvious problem with any such argument is that viability has changed over time and is heavily dependent on factors—such as medical advances and the availability of quality medical care—that have nothing to do with the characteristics of a fetus.

  When Casey revisited Roe almost 20 years later, it reaffirmed Roe’s central holding, but pointedly refrained from endorsing most of its reasoning. The Court abandoned any reliance on a privacy right and instead grounded the abortion right entirely on the Fourteenth Amendment’s Due Process Clause. 505 U. S., at 846. The controlling opinion criticized and rejected Roe’s trimester scheme, 505 U. S., at 872, and substituted a new and obscure “undue burden” test. Casey, in short, either refused to reaffirm or rejected important aspects of Roe’s analysis, failed to remedy glaring deficiencies in Roe’s reasoning, endorsed what it termed Roe’s central holding while suggesting that a majority might not have thought it was correct, provided no new support for the abortion right other than Roe’s status as precedent, and imposed a new test with no firm grounding in constitutional text, history, or precedent. Pp. 45–56.

   (3) Workability. Deciding whether a precedent should be overruled depends in part on whether the rule it imposes is workable—that is, whether it can be understood and applied in a consistent and predictable manner. Casey’s “undue burden” test has scored poorly on the workability scale. The Casey plurality tried to put meaning into the “undue burden” test by setting out three subsidiary rules, but these rules created their own problems. And the difficulty of applying Casey’s new rules surfaced in that very case. Compare 505 U. S., at 881–887, with id., at 920–922 (Stevens, J., concurring in part and dissenting in part). The experience of the Courts of Appeals provides further evidence that Casey’s “line between” permissible and unconstitutional restrictions “has proved to be impossible to draw with precision.” Janus, 585 U. S., at ___. Casey has generated a long list of Circuit conflicts. Continued adherence to Casey’s unworkable “undue burden” test would undermine, not advance, the “evenhanded, predictable, and consistent development of legal principles.” Payne, 501 U. S., at 827. Pp. 56–62.

   (4) Effect on other areas of law. Roe and Casey have led to the distortion of many important but unrelated legal doctrines, and that effect provides further support for overruling those decisions. See Ramos v. Louisiana, 590 U. S. ___, ___ (Kavanaugh, J., concurring in part). Pp. 62–63.

   (5) Reliance interests. Overruling Roe and Casey will not upend concrete reliance interests like those that develop in “cases involving property and contract rights.” Payne, 501 U. S., at 828. In Casey, the controlling opinion conceded that traditional reliance interests were not implicated because getting an abortion is generally “unplanned activity,” and “reproductive planning could take virtually immediate account of any sudden restoration of state authority to ban abortions.” 505 U. S., at 856. Instead, the opinion perceived a more intangible form of reliance, namely, that “people [had] organized intimate relationships and made choices that define their views of themselves and their places in society . . . in reliance on the availability of abortion in the event that contraception should fail” and that “[t]he ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.” Ibid. The contending sides in this case make impassioned and conflicting arguments about the effects of the abortion right on the lives of women as well as the status of the fetus. The Casey plurality’s speculative attempt to weigh the relative importance of the interests of the fetus and the mother represent a departure from the “original constitutional proposition” that “courts do not substitute their social and economic beliefs for the judgment of legislative bodies.” Ferguson v. Skrupa, 372 U. S. 726, 729–730.

  The Solicitor General suggests that overruling Roe and Casey would threaten the protection of other rights under the Due Process Clause. The Court emphasizes that this decision concerns the constitutional right to abortion and no other right. Nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion. Pp. 63–66.

  (c) Casey identified another concern, namely, the danger that the public will perceive a decision overruling a controversial “watershed” decision, such as Roe, as influenced by political considerations or public opinion. 505 U. S., at 866–867. But the Court cannot allow its decisions to be affected by such extraneous concerns. A precedent of this Court is subject to the usual principles of stare decisis under which adherence to precedent is the norm but not an inexorable command. If the rule were otherwise, erroneous decisions like Plessy would still be the law. The Court’s job is to interpret the law, apply longstanding principles of stare decisis, and decide this case accordingly. Pp. 66–69.

  (d) Under the Court’s precedents, rational-basis review is the appropriate standard to apply when state abortion regulations undergo constitutional challenge. Given that procuring an abortion is not a fundamental constitutional right, it follows that the States may regulate abortion for legitimate reasons, and when such regulations are challenged under the Constitution, courts cannot “substitute their social and economic beliefs for the judgment of legislative bodies.” Ferguson, 372 U. S., at 729–730. That applies even when the laws at issue concern matters of great social significance and moral substance. A law regulating abortion, like other health and welfare laws, is entitled to a “strong presumption of validity.” Heller v. Doe, 509 U. S. 312, 319. It must be sustained if there is a rational basis on which the legislature could have thought that it would serve legitimate state interests. Id., at 320.

  Mississippi’s Gestational Age Act is supported by the Mississippi Legislature’s specific findings, which include the State’s asserted interest in “protecting the life of the unborn.” §2(b)(i). These legitimate interests provide a rational basis for the Gestational Age Act, and it follows that respondents’ constitutional challenge must fail. Pp. 76–78.

  (e) Abortion presents a profound moral question. The Constitution does not prohibit the citizens of each State from regulating or prohibiting abortion. Roe and Casey arrogated that authority. The Court overrules those decisions and returns that authority to the people and their elected representatives. Pp. 78–79.

945 F. 3d 265, reversed and remanded.

 Alito, J., delivered the opinion of the Court, in which Thomas, Gorsuch, Kavanaugh, and Barrett, JJ., joined. Thomas, J., and Kavanaugh, J., filed concurring opinions. Roberts, C. J., filed an opinion concurring in the judgment. Breyer, Sotomayor, and Kagan, JJ., filed a dissenting opinion.


BECERRA, SECRETARY OF HEALTH AND HUMAN SERVICES v. EMPIRE HEALTH FOUNDATION, FOR VALLEY HOSPITAL MEDICAL CENTER

Certiorari To The United States Court Of Appeals For The Ninth Circuit

No. 20–1312. Argued November 29, 2021—Decided June 24, 2022

Once a person turns 65 or has received federal disability benefits for 24 months, he becomes “entitled” to benefits under Part A of Medicare. 42 U. S. C. §§426(a)–(b). Part A provides coverage for, among other things, inpatient hospital treatment. See §1395d(a). Medicare pays hospitals a fixed rate for such treatment based on the patient’s diagnosis, regardless of the hospital’s actual cost and subject to certain adjustments. §§1395ww(d)(1)–(5). One such adjustment is the “disproportionate share hospital” (DSH) adjustment, which provides higher-than-usual rates to hospitals that serve a higher-than-usual percentage of low-income patients. To calculate the DSH adjustment, the Department of Health and Human Services (HHS) adds together two statutorily described fractions: the Medicare fraction—which represents the proportion of a hospital’s Medicare patients who have low incomes—and the Medicaid fraction—which represents the proportion of a hospital’s total patients who are not entitled to Medicare and have low incomes. Together those fractions produce the “disproportionate-patient percentage,” which determines whether a hospital will receive a DSH adjustment, and how large it will be.

  Not all patients who qualify for Medicare Part A have their hospital treatment paid for by the program. Non-payment may occur, for example, if a patient’s stay exceeds Medicare’s 90-day cap per spell of illness, see §1395d, or if a patient is covered by a private insurance plan, see §1395y(b)(2)(A). Such limits on Medicare’s coverage prompt the question raised here: whether patients whom Medicare insures but does not pay for on a given day are patients “who (for such days) were entitled to [Medicare Part A] benefits” for purposes of computing a hospital’s disproportionate-patient percentage. §1395ww(d)(5)(F)(vi)(I).

  A 2004 HHS regulation says yes: If the patient meets the basic statutory criteria for Medicare (i.e., is over 65 or disabled), then the patient counts in the denominator and, if poor, in the numerator of the Medicare fraction. See 69 Fed. Reg. 49098–49099. Respondent Empire Health Foundation challenged that regulation as inconsistent with the statute. The Ninth Circuit agreed. That court focused on the statute’s use of two different phrases: “entitled to [Medicare Part A] benefits” and “eligible for [Medicaid] assistance.” The Ninth Circuit read the latter phrase to mean that a patient qualifies for Medicaid and the former phrase to mean that a patient has an absolute right to payment from Medicare. The Court granted certiorari to resolve a conflict between the Ninth Circuit and two other Circuit Courts, which had approved of HHS’s regulation.

Held: In calculating the Medicare fraction, individuals “entitled to [Medicare Part A] benefits” are all those qualifying for the program, regardless of whether they receive Medicare payments for part or all of a hospital stay. Pp. 7–19.

 HHS’s regulation is consistent with the text, context, and structure of the DSH provisions. The agency has interpreted the phrase “entitled to benefits” in those provisions to mean just what it means throughout the Medicare statute: qualifying for benefits. And counting everyone who qualifies for Medicare benefits in the Medicare fraction—and no one who qualifies for those benefits in the Medicaid fraction—accords with the statute’s attempt to capture, through two separate measurements, two different segments of a hospital’s low-income patient population.

 (a) Empire’s textual argument has a two-part structure. Echoing the Ninth Circuit, Empire primarily contends that the words “entitled” and “eligible” have different meanings. According to Empire, to be “eligible” for a benefit is to be “qualified” to seek it; to be “entitled” to a benefit means instead to have an “absolute right” to its payment. But throughout the Medicare statute, “entitled to benefits” is essentially a term of art meaning “qualifying for benefits,” i.e., being over 65 or disabled. And in the end, Empire basically concedes that point. It must devise a way to give “entitled to benefits” a different meaning in the fraction descriptions than everywhere else in the Medicare statute. So Empire shifts gears, relying now on the parenthetical phrase “(for such days)” to transform the usual statutory meaning of “entitled to benefits” to something different and novel. But those three little words do not accomplish what Empire would like, having the much less radical function of excluding days of a patient’s hospital stay before he qualifies for Medicare (e.g., turns 65). Pp. 8–15.

  (1) The Medicare statute explicitly states that “[e]very individual” who “has attained age 65” and is entitled to ordinary social security payments and “every individual” under age 65 who has been entitled to federal disability benefits for at least 24 months “shall be entitled to” Medicare Part A benefits. §§426(a)–(b). This broad meaning of “entitlement” coexists with limitations on payment. The entitlement to benefits, the statute repeatedly says, is an entitlement to payment under specified conditions. So a person remains entitled to benefits even if he has run into one of the statute’s conditions, such as the 90-day cap on inpatient hospital services. For example, the statute twice refers to patients who are “entitled to benefits under part A but ha[ve] exhausted benefits for inpatient hospital services.” §§1395l(a)(8)(B)(i), 1395l(t)(1)(B)(ii). In thus describing the Part A entitlement, the statute reflects the complexity of health insurance: An insured who hits some limit on coverage for, say, eye care is still insured. His policy will pay for more eye care in the next coverage period and meanwhile will pay for his knee replacement.

 If “entitled to benefits” instead bore Empire’s meaning, Medicare beneficiaries would lose important rights and protections, such as the ability to enroll in other Medicare programs. See §§1395o(a), 1395w-21(a)(3), 1395w–101(a)(3)(A). Empire’s interpretation would also make a hash of provisions designed to inform Medicare beneficiaries of their benefits, see §1395b–2(a), and to protect beneficiaries from misleading marketing materials, see §1395w–21(a)(3). Congress could not have intended to write a statute whose safeguards would apply or not apply, or fluctuate constantly, based on the happenstance of whether Medicare paid for hospital care on a given day. Pp. 9–13.

  (2) Empire concedes that its interpretation cannot be applied throughout the Medicare statute. To get around this, Empire claims that the parenthetical in “patients who (for such days) were entitled to [Part A] benefits,” §1395ww(d)(5)(F)(vi)(I), converts the usual statutory meaning of “entitled to benefits” to something different: actually receiving payment. That slight phrase, however, cannot bear so much interpretive weight. Instead, the parenthetical works as HHS says: hand in hand with the ordinary statutory meaning of “entitled to benefits.” It directs HHS to count only those individuals who qualify for Medicare on a particular day. So if a patient turns 65 on the 15th day of a 30-day hospital stay, HHS will count only 15 days. Pp. 13–15.

 (b) The structure of the relevant statutory provisions reinforces the conclusion that “entitled to benefits” means qualifying for benefits. The statute recompenses hospitals for serving two different low-income populations: low-income Medicare patients and low-income non-Medicare patients. HHS’s reading of “entitled” comports with this structure: a low-income Medicare patient always count in the Medicare fraction. That is so regardless of whether the Medicare program is actually paying for a day of his care—because that fact has no relationship to his financial status. Empire’s interpretation, by contrast, fits poorly with the statutory structure. Its who-paid-for-a-day-of-care test has no relationship to a patient’s financial status. So on Empire’s view, a patient could phase in and out of the Medicare fraction regardless of income. Empire responds by asserting that any low-income person excluded from the Medicare fraction (say, because of exhaustion of benefits) would get counted instead in the Medicaid fraction. But even if that is true, Empire’s scheme would result in patients ping-ponging back and forth between the two fractions based on the happenstance of actual Medicare payments. In any event, Empire is too quick to claim that those who (on its view) are tossed from the Medicare fraction for non-income-based reasons like exhaustion of benefits would still wind up in the Medicaid fraction. Applying Empire’s reading of “for such days,” a low-income patient who has exhausted his coverage would not get counted at all, in either fraction, but he would remain just as low-income and impose just as high costs on the hospital treating him. Empire’s only response is to insist that its interpretation must be right because it usually (though not always) leads to higher DSH payments. But the point of the statute is not to pay hospitals the most money possible; it is to compensate them for serving a disproportionate share of low-income patients. Pp. 15–18.

958 F. 3d 873, reversed and remanded.

 Kagan, J., delivered the opinion of the Court, in which Thomas, Breyer, Sotomayor, and Barrett, JJ., joined. Kavanaugh, J., filed a dissenting opinion, in which Roberts, C. J., and Alito and Gorsuch, JJ., joined.