Supreme Court strikes down a Louisiana law requiring abortion clinics to have admitting privileges at nearby hospitals

• The US Supreme Court on Monday struck down a Louisiana law requiring clinics that perform abortions to obtain admitting privileges at a local hospital within 30 miles.
• The court decided 4-4-1 in June Medical Services v. Russo that the regulation was unconstitutional, with Chief Justice John Roberts concurring in the plurality decision.
• In 2016, the court struck down an almost identical law in Texas, ruling that such restrictions posed an "undue burden" on people's ability to access abortion services.

In a major victory for abortion-access advocates, the US Supreme Court on Monday struck down a Louisiana law requiring clinics that perform abortions to obtain admitting privileges at local hospitals.

Justice Stephen Breyer wrote the plurality opinion, joined by Justices Ruth Bader Ginsburg, Sonia Sotomayor, and Elena Kagan, with Chief Justice John Roberts concurring. Justices Clarence Thomas, Samuel Alito, Brett Kavanaugh, and Neil Gorsuch dissented.

The case, June Medical Services v. Russo, is the first pertaining to abortion rights that the court has ruled on since Gorsuch and Kavanaugh were confirmed.

The court heard arguments in the case in March after the 5th Circuit Court of Appeals upheld Louisiana's law in 2019, overturning a US District Court ruling to strike down the law.

Louisiana's restriction, passed in 2014 as part of Act 620, required abortion providers to have admitting privileges at a hospital within 30 miles. The law is a type of regulation known as a targeted restriction on abortion providers, or "TRAP" law.

Such laws place burdensome requirements on clinics that make it more expensive and difficult to operate; many have closed altogether. The regulations can include requiring that a clinic's hallways be a certain width, that procedure rooms be a certain size or temperature, and that clinics be within a certain distance of a hospital.

Breyer wrote that the Supreme Court must uphold the District Court's "determination that Louisiana's law poses a 'substantial obstacle' to women seeking an abortion; its determination that the law offers no significant health-related benefits; and its determination that the law consequently imposes an 'undue burden' on a woman's constitutional right to choose to have an abortion."

He added: "We also agree with its ultimate legal conclusion that, in light of these findings and our precedents, Act 620 violates the Constitution."

In 2016, the Supreme Court struck down a similar Texas law requiring clinics to secure hospital admitting privileges, ruling in Whole Woman's Health v. Hellerstedt that the law was unconstitutional.

In a 5-3 decision, the court ruled that Texas' law violated the precedent set by the 1992 Supreme Court ruling in Casey v. Planned Parenthood that state-level abortion restrictions must have a medical justification and not place an "undue burden" on patients' ability to access abortion services.

While Roberts did dissent in Whole Woman's Health, he concurred in Monday's plurality decision, citing stare decisis, the doctrine that says the court should respect and uphold legal precedent.

"The legal doctrine of stare decisis requires us, absent special circumstances, to treat like cases alike," Roberts wrote in his concurring opinion. "The Louisiana law imposes a burden on access to abortion just as severe as that imposed by the Texas law, for the same reasons. Therefore Louisiana's law cannot stand under our precedents."

A plurality opinion by the Supreme Court may carry less weight as precedent than a majority opinion, according to Bryan Garner, the editor in chief of "Black's Law Dictionary."

An extremely low percentage of abortions result in complications that require hospitalization. A 2014 study in California found that out of 54,911 patients, only 0.22% had "major complications" requiring hospitalization, surgery, or a blood transfusion, and just 2% had minor complications within six weeks of the procedure.

A 2018 study conducted by some of the same researchers at the University of California San Francisco's Advancing New Standards in Reproductive Health project examined states that enacted admission-privilege requirements and found that the laws did not affect the way people who had abortions received hospital care.

The researchers concluded that admission-privilege laws did not significantly affect hospitalization because "the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital."

The costs that TRAP laws pose to clinics' ability to operate, however, are significant. In Texas, for example, the number of clinics providing abortions fell from 41 in June 2013 to six in September 2014 following the law's implementation. After the Whole Woman's Health decision in 2016, the number of Texas providers increased to 21.

Abortion-access advocates and experts have argued that a decision affirming the constitutionality of Louisiana's law would have given several other states the green light to enact similar restrictions.

The Guttmacher Institute, a research organization that supports abortion access, said in May that admission-privilege requirements were in effect in two states, North Dakota and Missouri.

The institute also said that were the Supreme Court to let Louisiana's law stand, it would allow similar TRAP laws to take effect in seven Southern states and make it easier for legislatures in other states to pass such restrictions.

Abortion-rights groups celebrated the ruling on Monday but expressed concern about the future of abortion access in America given the narrow nature of Roberts' concurrence.

"We're relieved that the Louisiana law has been blocked today but we're concerned about tomorrow," Nancy Northup, the president and CEO of the Center for Reproductive Rights, said in a statement.

"With this win, the clinics in Louisiana can stay open to serve the one million women of reproductive age in the state. But the Court's decision could embolden states to pass even more restrictive laws when clarity is needed if abortion rights are to be protected," she said. "Unfortunately, the Court's ruling today will not stop those hell-bent on banning abortion."

The ruling was a significant setback for anti-abortion-rights groups and advocates. Marjorie Dannenfelser, the president of the Susan B. Anthony List, called the decision "a bitter disappointment."

"It demonstrates once again the failure of the Supreme Court to allow the American people to protect the well-being of women from the tentacles of a brutal and profit-seeking abortion industry," she said. "Today's ruling reinforces just how important Supreme Court judges are to advancing the pro-life cause. It is imperative that we re-elect President Trump and our pro-life majority in the U.S. Senate so we can further restore the judiciary, most especially the Supreme Court."