Whole Woman's Health v. Hellerstedt
579 U. S. ____ (2016) (2016)
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Rule of Law:
A state law regulating abortion constitutes an unconstitutional undue burden if its purpose or effect is to place a substantial obstacle in the path of a woman seeking a pre-viability abortion. To determine this, courts must weigh the law's asserted health benefits against the burdens it imposes on abortion access.
Facts:
- In 2013, the Texas Legislature enacted House Bill 2 (H.B. 2).
- One provision of H.B. 2, the 'admitting-privileges requirement,' mandated that a physician performing an abortion must have active admitting privileges at a hospital located within 30 miles of the facility.
- Another provision, the 'surgical-center requirement,' required that all abortion facilities meet the minimum standards for ambulatory surgical centers (ASCs), which are extensive and costly.
- Prior to H.B. 2's enactment, Texas had more than 40 licensed abortion facilities.
- After the admitting-privileges requirement took effect, the number of abortion facilities in Texas dropped by almost half, to approximately 20.
- If the surgical-center requirement were fully enforced, the number of facilities was projected to fall further to only seven or eight, all located in major metropolitan areas.
- Evidence presented showed that abortion in Texas was an extremely safe procedure before H.B. 2, and that the new requirements did not confer significant health benefits for women.
- The cost for existing clinics to upgrade to ASC standards was estimated to be between $1 million and over $3 million per facility.
Procedural Posture:
- Whole Woman's Health and other abortion providers sued Texas state officials in the U.S. District Court for the Western District of Texas.
- The providers sought to enjoin enforcement of the admitting-privileges and surgical-center requirements of H.B. 2.
- After a bench trial, the District Court found both provisions unconstitutional on their face and as applied, and permanently enjoined their enforcement.
- The State of Texas, the defendant, appealed to the U.S. Court of Appeals for the Fifth Circuit.
- The Fifth Circuit reversed the District Court's judgment, largely upholding both challenged provisions as constitutional.
- The providers, as petitioners, filed a petition for a writ of certiorari, which the U.S. Supreme Court granted.
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Issue:
Do the admitting-privileges and surgical-center requirements of Texas's House Bill 2 place a substantial obstacle in the path of women seeking a pre-viability abortion, thus imposing an undue burden on their constitutional right under the Fourteenth Amendment?
Opinions:
Majority - Justice Breyer
Yes, the challenged provisions of H.B. 2 violate the Fourteenth Amendment. A law imposes an undue burden, and is therefore unconstitutional, if its burdens on abortion access outweigh its purported benefits. Here, neither the admitting-privileges requirement nor the surgical-center requirement confers medical benefits sufficient to justify the substantial obstacles they place in the path of women seeking a pre-viability abortion. The Court found that abortion in Texas was already a very safe procedure and the state failed to provide any credible evidence that these requirements advanced women's health. In contrast, the evidence overwhelmingly showed that the admitting-privileges requirement caused half the state's clinics to close, and the surgical-center requirement would close half of the remainder, forcing women to travel long distances and face long wait times. This constitutes a substantial obstacle and an undue burden on the constitutional right to abortion established in Roe v. Wade and affirmed in Planned Parenthood v. Casey.
Concurring - Justice Ginsburg
Yes. The stated purpose of H.B. 2—protecting women's health—is not credible because complications from abortion are rare and far less dangerous than many other medical procedures, including childbirth, that are not subject to such stringent regulations. It is 'beyond rational belief' that H.B. 2 could genuinely protect women's health. Instead, the law's clear effect is to make it more difficult for women to obtain safe, legal abortions, which may lead them to resort to unlicensed and unsafe practitioners. Laws like H.B. 2 that 'do little or nothing for health, but rather strew impediments to abortion,' cannot withstand judicial scrutiny.
Dissenting - Justice Thomas
No. The Court's decision exemplifies a tendency to create special rules for abortion cases. The Court should not have allowed the clinics to sue on behalf of their patients (third-party standing). Furthermore, the majority improperly re-writes the 'undue burden' test from Casey into a free-form balancing test that resembles strict scrutiny, which Casey rejected. This practice of applying different, made-up standards to different constitutional rights undermines the rule of law and shows that the Court's decisions are based on policy preferences rather than legal principle.
Dissenting - Justice Alito
No. The Court disregards basic procedural rules to reach its desired outcome. The petitioners' facial challenge to the admitting-privileges requirement should have been barred by the doctrine of res judicata, as they had already lost on this exact claim in a prior case and failed to appeal. The challenge to the surgical-center requirement should also be barred because it arises from the same 'transaction' (the passage of H.B. 2) and should have been brought in the first lawsuit. On the merits, the petitioners failed to prove that H.B. 2 actually caused the clinic closures or that the remaining clinics lack capacity. Finally, the Court failed to apply the law's explicit and extremely broad severability clause, which should have preserved at least some of the law's valid applications, such as basic fire safety regulations.
Analysis:
This decision significantly clarified and strengthened the undue burden test from Planned Parenthood v. Casey. It firmly established that courts must engage in a factual, evidence-based balancing of a regulation's asserted health benefits against the burdens it imposes on abortion access, rejecting a more deferential standard of review. By striking down these key TRAP (Targeted Regulation of Abortion Providers) law provisions, the Court set a powerful precedent that has been used to challenge similar laws nationwide. The ruling effectively requires states to provide credible evidence that such regulations actually protect patient health, rather than merely stating that as a purpose, before they can impose significant obstacles on abortion access.
