SCOTUS agrees to review Texas abortion case: does Roe v. Wade hang in the balance?


Lyle Denniston at SCOTUSblog reports, Court to rule on abortion clinic restrictions:

ProChoice2Eight years after its last major ruling on abortion rights, the Supreme Court on Friday afternoon agreed to decide the constitutionality of a 2013 Texas law imposing new rules for clinics and doctors.  The earliest that the case would be heard is February.  The Court granted review of one of two appeals on such laws; the other was from Mississippi.

In a second order, the Court said it would hold a hearing on a constitutional test of a new congressional districting map for Virginia, but left open the possibility that the case would be dismissed for a procedural reason.  The case (Wittman v. Personhuballah) involves District 3, the one congressional district in the state that has a majority-black population.  The question is whether race was used unconstitutionally in shaping that district’s lines.

The new abortion case, Whole Woman’s Health v. Cole, is focused on two new restrictions in the Texas law: doctors who perform abortions must have the right to send patients to a full-scale hospital no further than thirty miles from the clinic, and each clinic must have the same facilities as a surgical center.

However, the case has larger implications: the clinics and doctors involved are asking the Court to reaffirm prior rulings that spell out when a new abortion law imposes an “undue burden” on women’s right to end their pregnancies.  That standard stems from a 1992 decision, Planned Parenthood of Southeastern Pennsylvania v. Casey, that reaffirmed much of the abortion right established in Roe v. Wade in 1973.

In addition, they want the Court to order lower courts to judge whether a new restrictions on abortions actually would work to protect women’s health — a test that the U.S. Court of Appeals for the Fifth Circuit refused to undertake in the Whole Woman’s Health case.  The Fifth Circuit ruled that a court must accept the views of the legislature that a new law would serve that interest.

The Court has not ruled on the validity of an abortion law since its 2007 decision in Gonzales v. Carhart, upholding a federal law that banned so-called “partial-birth” abortions.

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The Court had before it at its private Conference earlier in the day Friday the Texas case, along with a second case, from Mississippi — Currier v. Jackson Women’s Health Organization.  Like the Texas case, the Mississippi case involves the hospital admission privileges requirement for doctors who perform abortions, but it does not include the requirement to have facilities capable of handling major surgeries.  The Court apparently has chosen not to review the Mississippi case, but probably will hold it until it rules on the Texas controversy.

The Texas law has already resulted in the closing of a number of clinics in Texas, which at one time recently had forty-one of those facilities.  The number is now down to nineteen, and clinics and doctors argued that the number would drop to ten to serve the entire state, if the Court were to uphold the new restrictions.  In the Mississippi case, it has been argued that, if the admissions privilege requirement is upheld, that would result in the closing of the only clinic now in the state — in Jackson.  Women in Mississippi would have to go out of state to get abortion services.

Linda Greenhouse, the New York Times‘ legal columnist recently analyzed, Abortion at the Supreme Court’s Door:

Despite a near-universal assumption that the Supreme Court will take up an abortion case in its new term, the general chatter hasn’t included much detail about the specific issue, the stakes or the prospects. This column is an effort to address those questions. The stakes couldn’t be higher, either for women who live in the growing number of states governed by anti-abortion politicians or for the court itself.

[T]he justices will decide whether to hear an appeal filed last month by several Texas abortion clinics. The clinics are among those that will be forced to close under a law that the United States Court of Appeals for the Fifth Circuit upheld in a series of decisions culminating in June with Whole Woman’s Health v. Cole.

Before passage of the Texas law, H.B. 2, two years ago, there were more than 40 abortion clinics in 16 Texas cities. Unless the Supreme Court overturns the Fifth Circuit’s decision, there will be at most 10 clinics in a state with 5.4 million women of reproductive age. There will be clinics in Houston, Austin, San Antonio and Dallas-Fort Worth, along with one permitted by the Fifth Circuit to remain open in McAllen under a bizarre condition: The clinic and its one doctor may serve only those women who live in the surrounding four-county area. (Maybe the Fifth Circuit was afraid that women from all over Texas might otherwise flock to the impoverished and remote Rio Grande Valley for their abortions.) There will be no clinics at all in the 500 miles between San Antonio and the New Mexico border.

How do Texas and the appeals court justify such a result? H.B. 2 did not mandate the closing of abortion clinics in so many words. It didn’t have to. Rather, the requirements the law imposes on abortion providers, following a template conveniently provided by a leading anti-abortion think tank, Americans United for Life were intended to bring about that result. The law requires doctors who perform abortions to have admitting privileges at a hospital no farther than 30 miles away. It also requires abortion clinics to be retrofitted as mini-hospitals, a requirement that also applies to clinics that offer only medication abortion, which involves handing a patient two pills to swallow and telling her to go home. Rick Perry, the governor who signed H.B. 2 into law, declared several months earlier that his goal “is to make abortion at any stage a thing of the past.” Addressing an anti-abortion rally, the governor said: “The ideal world is one without abortion. Until then, we will continue to pass laws to ensure that they are rare as possible.”

Governor Perry, not for the first time in his political career, was off-message. The official reason for the new requirements is to protect women’s health — “to raise standards of care and ensure the health and safety of all abortion patients,” as the state told the Supreme Court in the brief it filed last week urging the Supreme Court not to hear the clinics’ appeal. Is Texas suffering from an abortion-related health problem? Not exactly. There were 360,059 abortions performed in Texas from 2009 through 2013 — that is, before H.B. 2 took effect — resulting in no deaths and a minuscule rate of complications requiring a hospital visit. (Nationwide, the major complication rate from first-trimester abortions by the method commonly used in Texas is 0.05 percent.)

The extremely low complication rate is a reason that doctors who limit their practice to abortion can’t get hospital admitting privileges. Many hospitals require doctors to admit a certain number of patients in order to maintain privileges. One Dallas clinic was forced to close in June after 36 years because its medical director, while initially offered admitting privileges, couldn’t meet the requirement to send 48 patients a year to the hospital. Even the more common 10-patient requirement is impossible for abortion providers to meet. (A complication rate of 0.05 percent translates to five complications per 10,000 procedures.)

Laws that single out abortion practice for restrictions that don’t apply to medical procedures of equivalent or greater risk are known as TRAP laws, for “targeted regulation of abortion providers.” There is no doubt that H.B. 2 is a TRAP law; Texas permits doctors practicing in ordinary medical offices to administer general anesthesia, which is not typically used in abortions, and to perform colonoscopies and liposuction, both of which have higher mortality rates than abortion. A friend-of-the-court brief filed by the American College of Obstetricians and Gynecologists, the American Medical Association, and other medical groups asserts that the H.B. 2 requirements “fail to enhance the quality or safety of abortion-related medical care and, in fact, impede women’s access to such care by imposing unjustified and medically unnecessary burdens on abortion providers.”

The medical organizations’ brief makes a telling point about the admitting-privileges requirement. The average Texas county is, currently, 111 miles from an abortion clinic. So a woman who experiences a complication after returning home would go to a nearby hospital for emergency care rather than to a distant hospital where the doctor who performed the abortion might have privileges.

None of these points appear to shake Texas from its “all for women’s health” mantra, but here’s one that should. The state claims in its Supreme Court brief that the absence of an abortion clinic in the entire western half of the state is of no concern because women in El Paso, where the two abortion clinics will have to close, can simply travel one mile across the state line to a clinic in nearby Santa Teresa, N. M. New Mexico, however, has not imposed any TRAP laws. It requires neither admitting privileges nor a hospital-like setting. So Texas’ interest in protecting the health of its abortion patients evidently stops at the state line even as it sends women seeking abortions in West Texas across that line.

So far, I’ve talked only about policy and not about law, and it’s law that we assume the Supreme Court justices will consider. In June, just before the summer recess, the court ordered a stay of the Fifth Circuit decision, preserving the status quo until the justices decided whether to hear the appeal. If the court grants the case, the stay will last until the final decision. If the court turns the appeal down, the stay will dissolve and the clinics will close.

Granting the stay should have been automatic; of course keep things in place when the consequences of doing otherwise are so drastic. A stay requires the votes of five justices and, in fact, there were only five. Four justices noted their dissent: Chief Justice John G. Roberts Jr. and Justices Antonin Scalia, Clarence Thomas, and Samuel A. Alito Jr. Justices who don’t agree with an administrative order like a stay don’t always make their dissent public. It’s a choice, and these four justices chose to go on the record as being willing to let three-quarters of the abortion clinics in Texas shut down without a Supreme Court hearing.

That leaves, of course, the other five: Justices Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor, Elena Kagan and — you guessed it — Anthony M. Kennedy. Justice Kennedy is the only justice left from the majority in Planned Parenthood v. Casey, the 1992 decision that by a vote of 5 to 4 preserved the constitutional right to abortion. The Casey decision, which remains the law, subjected abortion regulations to a new “undue burden” test, defining undue burden as “a state regulation that has the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.”

That’s a definition both wordy and porous. In an article to be published in the Yale Law Journal titled “Casey and the Clinic Closings: When ‘Protecting Health’ Obstructs Choice,” my colleague Reva B. Siegel and I argue that under Casey, as properly understood and as informed by the court’s 2007 decision that upheld the Partial Birth Abortion Ban Act, the H.B. 2 requirements impose an undue burden and the Fifth Circuit was wrong to uphold them. (Five years ago, she and I published a book on the history of the abortion debate, available here as a free download from the Yale Law School library.)

In Casey, the court modified Roe v. Wade to empower the states to act throughout pregnancy — not just in later trimesters as in the earlier case — to protect both unborn life and maternal health. But the court limited the ways in which the state can do both those things, and it applied separate standards for each. To protect the unborn, the state can seek to dissuade a woman from having an abortion through such measures as a waiting period and mandatory counseling, both of which the Casey decision upheld. But at the end of the day, the state cannot prevent a woman from carrying out her decision to terminate a pregnancy; in the words of the opinion, the state can employ methods “calculated to inform the woman’s free choice, not hinder it.”

The court subjected health-related regulations to a separate analysis. “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right,” the court said. Reva Siegel and I argue that this means that health-related regulation of abortion must be consistent with ordinary medical practice and must actually serve the asserted purpose: protecting a pregnant woman’s health. If it serves no demonstrable health-related purpose, then the regulation most likely represents an effort by the state to protect unborn life by means that Casey rules out — means that hinder rather than inform, prevent rather than persuade.

Courts around the country are looking skeptically at health-justified abortion regulations that don’t actually protect health. In upholding an injunction against a new admitting-privileges requirement in Wisconsin, Judge Richard A. Posner of the United States Court of Appeals for the Seventh Circuit found the medical evidence “lacking.” He interpreted the undue-burden standard as requiring courts to weigh the purported justifications for a restriction against the burdens that the restriction would impose on access to abortion. “The feebler the medical grounds, the likelier the burden, even if slight, to be ‘undue’ in the sense of disproportionate or gratuitous,” Judge Posner wrote.

Applying a similar analysis, the United States Court of Appeals for the Ninth Circuit blocked Arizona’s restriction on medication abortion, with Judge William Fletcher writing: “Plaintiffs have introduced uncontroverted evidence that the Arizona law substantially burdens women’s access to abortion services, and Arizona has introduced no evidence that the law advances in any way its interest in women’s health.” (The Supreme Court turned down the state’s appeal.) And in June, the Iowa Supreme Court used similar reasoning to invalidate a rule imposed by the state’s Board of Medicine that required a doctor to be present when a patient received abortion-inducing medication.

ProChoice1Against this background, the Fifth Circuit’s decision in the Texas case, adopting a rule of nearly total deference to the state’s claims, stands out. “In our circuit, we do not balance the wisdom or effectiveness of a law against the burdens the law imposes,” Judge Jennifer Walker Elrod wrote for the circuit in a preliminary phase of the case. The appeals court rebuked Lee Yeakel, the federal district judge who had struck down H.B. 2, for even questioning the validity of the state’s health justifications. Yet questioning and balancing is exactly what a court must do if it is to adhere to the bargain the Supreme Court struck in Casey: States can vindicate their interest in protecting unborn life through means that seek to inform and persuade, but not by destroying the infrastructure that makes it possible for women to exercise the constitutional right to abortion.

So is the future of the right to abortion once again — still — in the hands of Justice Kennedy? It’s nearly impossible to conclude otherwise. Given his vote for the stay, it’s all but certain that he will at least be willing to give the Texas abortion clinics a hearing. The right to abortion, as announced in Roe v. Wade and more or less preserved in Planned Parenthood v. Casey has its origins in Griswold v. Connecticut, the 1965 decision that established the constitutional right to use birth control. The most recent step on the constitutional journey that Griswold initiated 50 years ago came in June with the same-sex marriage decision, Obergefell v. Hodges. Preserving the right to abortion as defined in Casey keeps the court on the path of individual liberty and dignity that Justice Kennedy’s majority opinion in Obergefell celebrated. Permitting the state of Texas to have its way will take us backward.

Ian Millhiser at Think Progress sounds the alarm. BREAKING: Supreme Court Will Hear Case That Could Gut Roe V. Wade:

If the Supreme Court holds that states can use such sham health laws in order to restrict abortion, that could effectively be the end of a constitutional right to abortive care, as the only limit on anti-abortion laws could be lawmakers’ and advocates’ creativity in finding new ways to disguise abortion restrictions as health regulations.

The outcome in this case is likely to come down to the vote of Justice Anthony Kennedy. Though Kennedy typically votes with opponents of abortion, he voted to grant a temporary stay preventing Texas’s anti-abortion law from going into effect. So this case might be one of the rare cases where Kennedy determines that an abortion restriction goes too far.

As Linda Greenhouse noted above, there are other abortion restriction cases from several states in the appellate pipeline. The Court may grant additional cases.

In addition, the Court has also agreed to hear the so-called “religious liberty” challenges to the contraceptive coverage provisions in the Affordable Care Act aka “ObamaCare.”


  1. When you decide the Constitution is a “Living Document” and discover previously unkown rights buried in the penumbra, what is really happening is the government is giving you a new right. And what the government giveth, the government can taketh away. That is why a strict interpretation is better…you can’t take away what the Constitution says belongs to the people.

      • Thank you, Cheri, for sharing that well thought and well reasoned article on the 9th Amendment. It was actually very enjoyable reading it. I was aware of the impact the 9th Amendment has had on our Nation over the years and, to me, the history of the use and abuse of the Amendment only drives home the point I was trying to make about thinking of the Constitution as a “Living Document”. The Constitution needed the 9th Amendment because the Founders realized that a Document written in 1787 would need to change in the future. Between the 9th Amendment and the Amendment Process, they provided for that change.

        But here is the rub: It leaves things to the Supreme Court to create new “rights” and because these new rights are not specifically spelled out in the Constitution, they are subject to the whim of a fickle Supreme Court. This is especially true where important and controversial issues are concerned (such as Dread Scott, Brown VS. the Board of Education, and Abortion, to name a few). That is why I say a right given by the government can be taken away as easily as it was bestowed.

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