Here’s What’s At Stake In the Abortion Access Case Before The Supreme Court

The court’s ruling could impact access to reproductive health care for women across the country.

On Wednesday, the Supreme Court will hear arguments in a case that people on both sides of the debate are calling the most important abortion case in decades: Whole Woman’s Health v. Hellerstedt. The outcome has the potential to change the landscape of reproductive health care in not just Texas, where it started, but in states across the country.

“Texas is just the tip of the iceberg,” Jennifer Dalven, director of the ACLU’s Reproductive Freedom Project, told TakePart. “If there’s a majority [opinion], it will set a national precedent.”

The case’s backstory began with House Bill 2, an anti-abortion law that includes restrictions memorably filibustered for 11 hours in 2013 by Sen. Wendy Davis. Though Davis temporarily derailed the restrictions, they were ultimately passed, requiring facilities in the state that provide abortion services to meet onerous standards usually only applied to out-patient surgery facilities, known as ambulatory surgical centers. The law also says that doctors who perform abortions must have admitting privileges at a hospital within 30 miles of an abortion clinic — an extra step for qualified health-care practitioners that has been deemed unnecessary for safety by multiple medical associations, such as the American Academy of Family Physicians.

These restrictions shuttered 23 of the 42 clinics across the state.

If the highest court rules against the clinics’ case, the number of open clinics could dwindle to nine or 10.

“Within the first year of H.B. 2, we lost all of the clinics in West Texas except for in El Paso. Women in Lubbock, Texas, had to drive 300 miles to reach the nearest clinic,” Heather Busby, executive director of NARAL Pro-Choice Texas, told TakePart.

The working clinics, according to Busby, have struggled to fill in as their counterparts have canceled appointments or closed. That means women have had to delay procedures for weeks, waiting until they can travel to a neighboring clinic.

“What we started seeing is an increase in the number of second-trimester abortions. A bill that was allegedly passed to increase health and safety was actually decreasing health and safety in practice,” explained Busby.

In August 2014, a federal district court blocked the enforcement of the clinic restrictions after a lawsuit was filed by the Center for Reproductive Rights on behalf of five clinics and three physicians. But just over a month later, the Court of Appeals for the 5th Circuit ruled that the laws could be enforced while the case’s outcome was pending. In June 2015, the 5th Circuit ruled in favor of the requirements, but later that month, the Supreme Court stopped enforcement of the law. Now the highest court will once again consider the ambulatory-surgical-center stipulation.

Since the Texas law passed, nine other states have passed similar legislation.

While advocates say the law is bad news for all women, those who have been hit hardest are low-income women and women of color, according to Amanda Williams, executive director of the Austin-based Lilith Fund, which provides partial grants to women who need financial assistance to get abortions.

“Our callers are typically underinsured, struggling to gain access to basic and preventive health care and are simply trying to make ends meet and take care of their families,” Williams said. “Two-thirds of our callers are mothers. They are struggling to pay for groceries and rent or maybe even forgoing those expenses.”

In the last year, the Lilith Fund fielded roughly 4,000 calls from women seeking financial help.

“We’ve seen a steady increase in call volume over the past few years,” Williams said. “The fact that more and more people are calling every year is terrifying because we already cannot meet the need, and we know with fewer clinics the need will continue to grow.”

Now advocates are taking aim at Justice Anthony Kennedy, considered the decisive swing vote in abortion cases. Amicus briefs filed on behalf of both the clinics and their anti-abortion proponents have highlighted the personal abortion experiences ofthousands of women, offering intimate narratives to accompany the legal questions at stake.

“To get a favorable outcome, we’re going to need Kennedy’s vote,” Busby said. “Even if it’s a split, it’s going to be a disaster for Texas. We absolutely need his vote to improve the landscape for reproductive health-care access.”

If the court issues a 4–4 decision, the law will stand in Texas, and the ruling would affect other states in the 5th Circuit that have passed similar restrictions, such as Louisiana, which currently has only one operating abortion clinic. A 5–3 ruling against the clinics would have broader implications for states nationwide.

“It would really be a situation where your constitutional rights and your access to abortion depend on where you live, and that’s not how our constitution is supposed to work,” said Dalven. “We’re concerned about sending a green light to the states saying the court won’t intervene and block these restrictions.”