Editor's note: This story has been updated throughout.
Ruling that Texas' 2013 abortion restrictions place an undue burden on a woman's constitutional right to an abortion, the U.S. Supreme Court on Monday handed Texas abortion providers a major victory by overturning the regulations.
In a 5-3 vote, the high court overturned restrictions passed as part of House Bill 2 in 2013 that required all Texas facilities performing abortions to meet hospital-like standards — which include minimum sizes for rooms and doorways, pipelines for anesthesia. The court also struck down a separate provision, which had already gone into effect, that requires doctors to have admitting privileges at a hospital within 30 miles of an abortion clinic.
This means Texas’ 19 remaining clinics — of the more than 40 that were open before HB 2 passed — will continue to provide abortions. Had the court upheld the hospital-like standard requirement, Texas would have been left with as few as 10 abortion clinics — all in major metropolitan areas — to serve 5.4 million women of reproductive age.
In the majority opinion for Whole Woman's Health v. Hellerstedt authored by Justice Stephen Breyer, the court indicated that the facility requirement on abortion clinics does not "benefit patients and is not necessary." In knocking down the admitting privileges requirement, the court said "sufficient evidence" existed to prove that requirement "led to the closure of half of Texas’ clinics, or thereabouts."
"We have found nothing in Texas’ record evidence that shows that, compared to prior law (which required a “working arrangement” with a doctor with admitting privileges), the new law advanced Texas’ legitimate interest in protecting women’s health," Breyer wrote.
During oral arguments in March, the high court appeared to be divided on the constitutionality of the restrictions, with the four liberal justices in the court displaying hostility to the abortion law. Conservatives on the court meanwhile questioned whether abortion providers suing the state had submitted sufficient evidence to prove the restrictions led to the closure of about half of the state's clinics and whether the remaining clinics had the capacity to continue offering the procedure at the same rate if the state is left with fewer clinics.
While Texas has not released details on abortions performed in the state in 2014, state health officials in March noted a 14.2 percent drop in the number of abortions performed in Texas compared to the year before.
Early estimates by state health officials show 54,191 abortions were performed in Texas in 2014 — the first full year since the admitting privileges requirement took effect. That's down from 63,168 in 2013. The state estimates do not include abortions Texas women obtained at facilities outside the state — a number abortion providers say likely increased as Texas tightened its restrictions.
At the time, Justice Anthony Kennedy, the swing vote in the case, offered little indication on his views of the law, but at one point questioned whether the case should be sent back to a lower court to collect more evidence on the law’s impact. On Monday, Kennedy sided with the liberal justices to strike down the restrictions.
Attorneys for the state had argued that the regulations were passed by the Texas Legislature to ensure women’s safety, and insisted that abortion providers had been unable to provide sufficient evidence that they create an undue burden for the majority of Texas women seeking abortions.
But the high court sided with the abortion providers in finding that the two requirements provide "few, if any, health benefits for women." The majority ruled the requirements pose a "substantial obstacle to women seeking abortions" and place an "'undue burden' on their constitutional right to do so."
In a statement, Texas Attorney General Ken Paxton called the ruling "disappointing" and insisted the decision was passed "to improve patient safety and raise the standard of care for women at abortion facilities."
“HB 2 was an effort to improve minimum safety standards and ensure capable care for Texas women," said Paxton, who was a state senator when HB 2 was passed. "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.”
Texas abortion providers and representatives with the Center for Reproductive Rights, which brought the lawsuit on their behalf, hailed the decision as a vindication.
“Every day Whole Woman’s Health treats our patients with compassion, respect and dignity—and today the Supreme Court did the same," said Amy Hagstrom Miller, founder and CEO of Whole Woman’s Health and the lead plaintiff in the case. "We’re thrilled that today justice was served and our clinics stay open.”
The high court's decision was a massive win for the reproductive rights community in and out of Texas. The court’s decision is expected to help overturn similar requirements in other states fighting similar legal challenges.
Two questions were at the heart of the biggest abortion case the nation's highest court has taken up in almost a decade: Do the new Texas restrictions place so much burden on women seeking the procedure that they're effectively denied a constitutional right? And are the courts allowed to question the motives of the GOP-controlled Legislature that passed the laws?
The U.S. 5th Circuit Court of Appeals — which had upheld the Texas abortion restrictions with an exception for Whole Woman's Health in McAllen — rejected the notion that legal precedent requires courts to scrutinize the facts state legislatures use to justify health-related abortion restrictions.
In its decision, the Supreme Court ruled that approach was incorrect. Planned Parenthood v. Casey — the 1992 U.S. Supreme Court case that reaffirmed a woman’s right to an abortion but gave states more power to restrict the procedure to “further the health or safety of a woman" — requires courts to "consider the burdens a law imposes on abortion access together with the benefits those laws confer."
Disclosure: Planned Parenthood has been a financial sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.