A wave of reaction swept across the Texas political and health care landscape after the U.S. Supreme Court by a 5-3 struck down parts of the state's controversial HB-2 that severely restricted women's access to abortion.
The legislation, which was upheld by the conservative Fifth Court of Appeal in New Orleans in June last year, requires abortion providers to have admitting privileges at nearby hospitals, and clinics to meet ambulatory surgical center standards.
Politicians and abortion-rights and pro-life activists across the state reacted immediately in a flurry of media statements and planned rallies.
“Today, the Supreme Court affirmed what we at Whole Woman’s Health have known all along—that every woman, no matter where she lives, deserves access to compassionate, respectful, and comprehensive care from a clinic she trusts,” said Amy Hagstrom-Miller, president and CEO of Whole Woman’s Health and lead plaintiff in the case. “Today justice was served."
Justice Stephen G. Breyer wrote the majority opinion on Whole Woman’s Health v. Hellerstedt. Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan joined him. Chief Justice John G. Roberts Jr., Justices Clarence Thomas and Samuel A. Alito Jr. dissented.
“We conclude that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes,” Justice Breyer wrote. “Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the Federal Constitution.”
The part of the Texas law requiring admitting privileges forced about half of the state’s 41 clinics to close, and full enactment of the law, requiring ambulatory surgical standards, slated for enactment in the fall, would have brought that number down to about 10 clinics.
“The ‘two requirements erect a particularly high barrier for poor, rural, or disadvantaged women,'” Justice Breyer wrote.
The only remaining clinics would have been located in or near large metropolitan cities, including Dallas, Houston, San Antonio and Austin, leaving large swaths of the state’s population without a clinic within 300 miles, including distances to the nearest clinics in other states.
During deliberation, an appeals court allowed a clinic in McAllen to remain open, due to the lack of any other abortion provider able to meet the restrictions within approximately 250 miles.
Texas Attorney General Ken Paxton called the decision "disappointing" in a statement posted on his website.
"HB2 was an effort to improve minimum safety standards and ensure capable care for Texas women," Paxton stated. "It’s exceedingly unfortunate that the court has taken the ability to protect women’s health out of the hands of Texas citizens and their duly-elected representatives," Paxton said in the statement.
Governor Greg Abbott echoed this in his statement to the press.
"The decision erodes States’ lawmaking authority to safeguard the health and safety of women and subjects more innocent life to being lost. Texas' goal is to protect innocent life, while ensuring the highest health and safety standards for women," Abbott stated.
Kristine Hopkins, research assistant professor at the Population Research Center at the University of Texas at Austin and an investigator with the Texas Policy Evaluation Project (TxPEP) said in a phone interview that the court's findings are in line with research on the implications HB-2 could and did have on women in Texas.
Specifically, the High Court found that the admitting privileges requirement and the ambulatory surgical center requirement in HB-2 would not improve the safety of abortions in Texas due to the procedure already being very safe without the added restrictions.
Critics of the bill said the legislation purported to fix a problem that does not exist, and used women's health as a ruse to limit abortion by conservative lawmakers who oppose its legality.
"The research at (TxPEP) clearly demonstrated that HB-2 has made it harder for women to access safe abortion care because it closed clinics, it made women travel farther and push them later in pregnancy before they could achieve an abortion. That placed abortion out of reach for some women," Hopkins said. "Our research also showed how some women try to end their pregnancies on their own in Texas when clinic-based care is out of reach. They attempt to self-induce abortion."
Hopkins said that while the decision will allow open clinics to remain open, clinics that were forced to close will not all be able to reopen immediately due to lost leases and employees who now work elsewhere.
President and CEO at the Center for Reproductive Rights Nancy Northup said in a phone press conference that opening new clinics and reopening those that were shuttered will be a long process.
"We have a daunting task ahead of us, determining whether and how we can reopen health centers that were forced to shut their doors over the past several years, and most importantly the communities that we previously served to help us reopen for care," Northup said. "And second, this decision only addressed two of the many restrictions to getting safe abortion care. Now, we must redouble our efforts across the country to end similar state restrictions that push abortions out of reach for too many women."
Providers said that some of the closed clinics will need to be relicensed by the state.
Democratic legislators, who opposed the anti-abortion bill with the same solidarity that Republicans supported it, but with far fewer votes, were among those who voiced their support for the Court's decision.
"Finally, the fight to protect a woman's right to choose is not over,” State Sen. José Menéndez (D26) stated in a press release. “Today's ruling marked a major victory for women's health, but rest assured politicians are already devising the next round of medically unnecessary regulations. We must remain vigilant and stand up for Texas women."
Menéndez’s district includes San Antonio, one of the metropolitan areas that would have likely seen a large influx of women from surrounding areas seeking abortions had the law been enacted.
“This ruling protects millions of Texas women's rights and their access to personal, critical healthcare. Thanks to the Supreme Court's decision, women can receive the care they need in safe facilities with good doctors," Rep. Joaquín Castro (Tex-20) stated in a press release.
State Sen. Carlos Uresti (D19), one of the legislature's leading voices on families and children, echoed those who said HB-2 was having a profound impact on the landscape of women's health in Texas.
"The safety net of providers has been permanently damaged in the three years since the passage of HB2, and we will not get all of those providers back. This ruling casts aside the thinly veiled argument that the State of Texas was pursuing women’s health by establishing exorbitantly expensive modifications to facilities and hospital privileges without providing any sound medical evidence," Uresti stated. "We know that abortion opponents will be back with new restrictions next legislative session."
Monday's ruling was major victory for pro-choice advocates, but some warned that more needs to be done in the political arena and the courts.
Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, said in a phone interview that there are continued roadblocks to reproductive justice, including the High Court 's deadlock last week over President Obama’s immigration plan that would have shielded undocumented immigrants from deportation, and the Hyde Amendment, which prohibits federal dollars, including Medicaid, from being used for abortion services.
“We are thrilled that the Supreme Court … upheld women’s dignity. But our work isn’t over. Many Latinas who are undocumented or who are on Medicaid still do not have access to full abortion rights,” González-Rojas said.
San Antonio Family Association, a pro-family and anti-abortion group, has been active in local efforts to place zoning requirements on abortion clinics in San Antonio. The group will hold a "Pro-Life Muster" Monday evening at the Whole Woman's Health clinic in San Antonio, according to the group's Facebook page.
Board member Mike Knuffke said in a phone interview that the ruling was "a bad decision." Knuffke said that the two provisions in the law were meant to protect women whose abortions had complications and need to be admitted to hospitals. "It's sad that we went backwards. Like I said, it's the true war on women, in my mind," Knuffke said.
Moving forward, Knuffke said that the association will continue to work at the state and local level. "(We're) all about defending, protecting and promoting the family ... and we'll continue to get behind good legislation, good laws and ordinances, that support the family," he said.
Roe v. Wade first recognized a constitutional right to abortion in 1973. In 1992, the Planned Parenthood v. Casey decision said that states may not place undue burdens on the constitutional right to abortion before fetal viability, which included “unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion.”
Despite Monday's ruling, various abortion restrictions remain in place in multiple states around the country. Abortion-rights leaders reiterated in the press phone conference that they will continue their work until restrictive laws in other states are repealed.
"Today is a great day, but we still have so much work to do," Planned Parenthood Federation of America President Cecile Richards said. "Far too many women in this country cannot really make their own decisions about their pregnancies, and we now will take this fight state by state to challenge and repeal other laws across the country."
Top image: San Antonio Planned Parenthood facility at 2140 Babcock Road. Photo by Hagen Meyer.