## Facts

- Texas enacted H.B. 2 (2013), requiring (1) abortion physicians to have admitting privileges at a hospital within 30 miles and (2) abortion facilities to meet ambulatory surgical center (ASC) standards.
- Abortion providers and physicians sued state health officials in an as-applied challenge based on conditions after enforcement began.
- After trial, the district court found the admitting-privileges rule contributed to a drop in clinics from roughly 40 to roughly 20, increasing travel distances, delays, and logistical costs.
- The district court found that if the ASC rule took full effect, statewide clinics would likely fall to about seven or eight, leaving fewer than ten clinics for a large, geographically dispersed population.
- The district court found abortion was very safe, that existing Texas law already imposed substantial clinic regulations, and that the challenged requirements provided little medical benefit.
- The district court enjoined enforcement of both provisions as imposing an undue burden under the Fourteenth Amendment.
- The Fifth Circuit reversed in substantial part, holding many claims barred by res judicata and concluding the providers had not shown an undue burden.

## Issues

1. Whether res judicata barred the providers’ as-applied, post-enforcement challenge given earlier litigation over H.B. 2.
2. Whether the admitting-privileges requirement violates the Fourteenth Amendment by imposing an undue burden on access to pre-viability abortion.
3. Whether the ASC requirement violates the Fourteenth Amendment by imposing an undue burden on access to pre-viability abortion.
4. Whether the undue-burden analysis requires courts to weigh the law’s asserted benefits against the burdens it imposes.

## Decision

- The Supreme Court reversed the Fifth Circuit.
- The Court held the challenge was not barred by res judicata because it rested on materially different, post-enforcement facts and evidence.
- The Court held the admitting-privileges requirement imposed an undue burden and was unconstitutional.
- The Court held the ASC requirement imposed an undue burden and was unconstitutional.
- The Court held courts must consider the burdens a law imposes on abortion access together with the benefits the law confers, based on the evidentiary record rather than legislative assertions alone.

## Legal Principles

- A pre-viability abortion regulation is unconstitutional if it has the purpose or effect of placing a substantial obstacle in the path of a person seeking an abortion.
- Undue-burden review requires judicial evaluation of the evidentiary record, including assessment of claimed health benefits and real-world access burdens.
- Courts should not treat legislative statements of medical justification as dispositive where the record shows minimal benefits and substantial obstacles.
- A law that yields little or no health benefit yet predictably closes clinics, increases travel distances, and causes delays can constitute a substantial obstacle and fail the undue-burden standard.

## Conclusion

The Court invalidated Texas’s admitting-privileges and ASC requirements because, on the trial record, they conferred at most minimal health benefits while substantially reducing clinic availability and increasing travel, delay, and cost, thereby creating unconstitutional obstacles to pre-viability abortion access under the undue-burden standard.


Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016)