Arizona Governor Jan Brewer has just signed into law an omnibus package of abortion restrictions passed by the state legislature, which includes a so called “fetal pain” ban that makes it illegal to have an abortion after 20 weeks gestation, or 18 weeks post-fertilization.
Anti-choice legislators in Pennsylvania recently pulled out all the stops when debating a bill that would be one of the nation's harshest abortion laws if passed. But in the wake of a recent Supreme Court ruling, other state lawmakers are trying to stop that bill and change existing policy.
With the new U.S. Supreme Court abortion ruling, some Pennsylvania lawmakers want to roll back provisions similar to those struck down in Texas—and to head off any new restrictions in a bill debated on the house floor in late June.
Several legislators have called for repeal of Act 122, which was enacted in 2012 and mandates that Pennsylvania abortion clinics meet the standards of ambulatory surgical centers.
The U.S. Supreme Court struck down Texas’ ambulatory surgical center provision in the 5-3 Whole Woman’s Health v. Hellerstedt decision. Justice Stephen Breyer concluded in the opinion that the provision represented a “substantial obstacle in the path of women seeking a previability abortion” and was unconstitutional.
Soon after the decision, Sen. Daylin Leach (D-Montgomery/Delaware), a member of the bipartisan Women’s Health Caucus of the Pennsylvania legislature, wrote a memo recommending repeal of Act 122. And at a June 30 press conference organized by the caucus, Rep. Steven Santarsiero (D-Bucks) introduced legislation to do just that. He weighed in on another bill, HB 1948, discussed in the house on June 21.
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During that debate, “[anti-choice lawmakers] were exposed, they were unmasked,” Rep. Santarsiero said. “They stood one person after another after another in support of [HB 1948], and they came right out and said this is all about the anti-choice movement. They were exposed. They tried 20 years ago to claim it was not about that, but they’re not making any pretense at this point.”
Like Act 122, HB 1948 is an urgent matter. Anti-choice lawmaker Rep. Kathy Rapp (R-Warren) introduced the latter legislation in April, which would be one of the most severe laws in the country if enacted. HB 1948 would ban abortion beginning at 20 weeks. It also includes a “method ban” provision, which would criminalize dilation and evacuation (D and E), often used after miscarriages and for abortions earlier than 20 weeks.
Currently, HB 1948 is still on the schedule of the Pennsylvania Senate Judiciary committee. Though the senate may reconvene this summer, it’s unclear when or whether HB 1948 will move forward.
But advocates must not lose sight of this bill.
A ‘Dangerous Precedent’
HB 1948 inserts the legislature into the doctor-patient relationship, forcing medical professionals, ordinary Pennsylvanians, and even some legislators out of the process. In April, lawmakers twice rejected requests for input on HB 1948 from both medical professionals and the public. When Rep. Dan Frankel (D-Allegheny) spoke out against the bill, his microphone was reportedly cut off.
Struggling to be heard, doctors and relevant medical associations sent open letters and wrote op-eds against the bill. “We are highly concerned that the bill sets a dangerous precedent by legislating specific treatment protocols,” wrote Scott E. Shapiro, president of the Pennsylvania Medical Society, in an April letter sent to legislators.
They are right to be concerned. Around the country, lawmakers with no medical training frequently propose method bans to criminalize the safest, medically proven procedures. They then threaten to imprison doctors if they don’t provide less-than-optimal care for their patients. This kind of legislative coercion brings to mind Donald Trump’s March statement that women who seek abortion should suffer “some form of punishment” for having an abortion.
Punishment, indeed. Under HB 1948, the punishment can go one of two ways: Either women receive less-than-optimal care, or doctors must be incarcerated. While considering the potential fiscal impact of HB 1948, lawmakers discussed how much it would cost to imprison doctors: $35,000 a year, the annual expense to care for an inmate in Pennsylvania.
My colleagues here at the Women’s Law Project, who co-authored a brief cited by Justice Ruth Bader Ginsburg in her Whole Woman’s Health v. Hellerstedt concurrence, have sent an open letter to senate leadership asking them to remove HB 1948 from further consideration.
The letter said:
If enacted, HB 1948 would inflict even greater harm on the health of Pennsylvania women than House Bill 2 would have inflicted on Texas women. Relevant medical experts such as the Pennsylvania section of the American Congress of Obstetricians and Gynecologists (ACOG) and the Pennsylvania Medical Society strongly oppose this bill.
Under well-established constitutional standards, HB 1948 is quite clearly unconstitutional.
The Strange Debate About HB 1948
For a while, HB 1948 seemed to have stalled—like much business in the legislature. It took more than 270 days to finalize the 2015 budget—an impasse that forced dozens of nonprofit organizations serving rape survivors, domestic violence victims, hungry children, and the elderly to lay off workers and turn away clients.
But in April, Pennsylvania lawmakers whisked HB 1948 to the floor within 24 hours.Then, on June 21, the bill suddenly sailed through the appropriations committee and was rushed to the house floor for third consideration.
HB 1948 passed the house after the kind of bizarre, cringe-worthy debate that makes “Pennsylvania House of Representatives” feel like an insult to the good people of the state. Surely, Pennsylvanians can represent themselves better than elected officials who want to punish abortion providers, liken abortions to leeches, ignore science, and compare abortion regulations to laws restricting pigeon shooting. Surely, they can do better than the legislators who hosted the June 21 farce of a debate about a bill designed to force women to carry unviable pregnancies to term.
At that debate, primary sponsor Rep. Rapp stood for questions about HB 1948. But when Rep. Leanne Krueger-Braneky (D-Delaware County) began the debate by asking Rapp about what doctors, if any, were consulted during the drafting of the bill, Speaker of the House Mike Turzai (R-Allegheny) halted proceedings to consider if such a question is permissible. Also a co-sponsor of the bill, he concluded it was not, offering the explanation that legislators can inquire about the content of the bill, but not its source or development.
Rapp eventually stated she had many meetings while drafting the bill, but refused to answer with whom. She invoked “legislator’s privilege” and insisted the meetings were “private.” Legislator’s privilege is an esoteric provision in the state constitution intended to protect the process from undue influence of lobbyists, not shield lobbyists from public inquiry.
The bill’s language—referring to D and E by the nonmedical term “dismemberment abortion”—echoes legislation promoted by the National Right to Life Committee (NRLC). The NRLC has also drafted boilerplate 20-week bans, along with Americans United for Life, an anti-choice organization and a leading architect of the incremental strategy for building barriers to access safe and legal reproductive health care.
Next, Rep. Madeleine Dean (D-Montgomery) asked Rapp if similar bills have been deemed unconstitutional in other states.
Indeed, they have. According to Elizabeth Nash, senior state issues advocate at the Guttmacher Institute, similar D and E bans have been blocked in Oklahoma and Kansas, and 20-week bans have been struck down in Arizona and Idaho. HB 1948 is one of the first pieces of legislation to combine both provisions into one bill; at the Women’s Law Project, we call it a “double abortion ban.”
But no one in the chambers would know that these anti-abortion restrictions have been obstructed because, once again, Speaker Turzai halted the proceedings over these questions. This time, he stopped the debate citing the house rule that lawmakers cannot ask a question if they already know, or the speaker suspects they know, the answer.
In any case, so it went. Pro-choice lawmakers of the Women’s Health Caucus of the Pennsylvania Legislature spoke out against the bill, reading letters from physicians and sharing tragic stories of family members who died after being denied abortion care during severe pregnancy complications.
When Rep. Rapp was asked if she knew that many severe fetal abnormalities were not diagnosed until or after the 20th week of pregnancy, she responded that many were not diagnosed until birth, which misses the point: HB 1948 is designed to deprive women who receive a diagnosis of a severe fetal anomaly, even unviable pregnancy, at 20 weeks or later of safe and legal abortion.
That’s alright with Rapp and others pushing HB 1948; the bill contains no exemptions for fetal anomalies or pregnancies that were a result of rape.
The bill’s supporters didn’t refute allegations that if passed into law, it would negatively affect health care. They argued their case by invoking metaphors instead. They compared abortion regulations to laws about pigeon shoots. They compared fetuses to bald eagles and abortion to leeches. A white male legislator, a description unfortunately almost synonymous with “Pennsylvania legislator,” compared abortion to slavery, drawing the ire of Rep. Jordan Harris (D-Philadelphia).
“We use slavery references when it benefits, but won’t do anything about the systems that negatively affect their descendants,” tweeted Rep. Harris.
The house voted 132-65 in favor of the bill, mostly among party lines, though 25 Democrats voted for it and nine Republicans voted against it. Gov. Wolf has promised he will veto it if passes, while HB 1948 proponents are working to gather enough votes for an override if necessary.
"To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall," said Jessica Mason Pieklo, vice president for law and the courts at Rewire. "The good news is that the Supreme Court's decision in Whole Woman's Health provides advocates with a solid foundation to begin those next fights."
The U.S. Supreme Court struck down Monday two provisions in Texas’ anti-abortion omnibus law known as HB 2, and with that ruling the dominos began to fall. Similar anti-abortion laws in Wisconsin and Mississippi were blocked Tuesday by the Supreme Court, and Alabama’s attorney general announced he would drop an appeal to a legal challenge of a similar law.
However, significant obstacles remain to ensure access to reproductive health care throughout the country. A number of states have in place slightly different variations of the requirements struck down by the Court, which means it remains to be seen how lower courts may apply Monday’s ruling to restrictions that aren’t exactly like those included in Whole Woman’s Health v. Hellerstedt.
Monday’s decision is a significant victory for patients and providers, but it doesn’t guarantee that targeted regulation of abortion providers (TRAP laws) across the country will start to fall immediately, explained Jessica Mason Pieklo, vice president for law and the courts at Rewire.
“To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall,” Pieklo said. “The good news is that the Supreme Court’s decision in Whole Woman’s Health provides advocates with a solid foundation to begin those next fights.”
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Dozens of states in recent years have passed TRAP laws, which single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to clinics and physicians in other medical fields.
As Rewirepreviously reported, key players in the development of HB 2 were deeply connected to AUL and other conservative lobby groups.
The Supreme Court ruled in Whole Woman’s Health v. Hellerstedtthat two TRAP provisions under HB 2 placed “a substantial obstacle in the path of women seeking an abortion,” and constituted “an undue burden on abortion access.”
Specifically, the Court struck down the requirement that physicians who provide abortion care must have admitting privileges at a hospital within 30 miles of the facility where the physician will provide abortion services. The Court also struck down the requirement that facilities providing abortions meet ambulatory surgical center (ASC) requirements, which involve prohibitively expensive medically unnecessary building renovations.
There are 16 states that have passed laws mandating that physicians who provide abortion care have admitting privileges or similar requirements. In addition to laws that have been struck down in Alabama, Mississippi, Texas, and Wisconsin, courts have also blocked similar laws in Louisiana, North Dakota, and Oklahoma.
These laws typically require physicians have admitting privileges at a hospital near the facility where they provide abortion care. Some of these laws require that the hospitalsprovide OB-GYN services, and some require the physician to be board certified in OB-GYN medicine.
Other laws require that the hospital be no more than 30 miles from the facility where the abortion is performed, or have varied in defining the geographic boundary.
The law that was struck down in Mississippi required the admitting privileges be obtained at a “local hospital.” And Utah’s current law requires the hospital be within a “travel time of 15 minutes or less,” while Florida’s recently passed law requires the hospital be within a “reasonable proximity.”
There are 24 states that have passed laws requiring facilities in which surgical abortion services are performed to meet ambulatory surgical center standards that go beyond what is needed to ensure patient safety, and another 17 states require clinics that may only provide medication abortion to meet these same standards, according to the Guttmacher Institute.
As Nick Bagley, an assistant professor at the University of Michigan School of Law, told Vox, similar laws that have been passed in other states may face legal challenges in the wake of Whole Woman’s Health, but the details of those challenges may vary. “The Supreme Court only applies to Texas,” Bagley said. “Other states will have slightly different laws with slightly different facts to argue over.”
Florida and Indiana TRAP Laws Set to Take Effect
This year Florida passed its own Texas-style anti-choice omnibus law, which takes effect Friday. However, there are some differences between the two laws, including differences in the types of regulations of physicians who provide abortion care.
Clinics that offer abortion services in Florida will be required to have a written patient transfer agreement, which includes the transfer of the patient’s medical records, with a hospital within “reasonable proximity” to the facility. Physicians also will be required to have admitting privileges at a hospital within “reasonable proximity” to their clinic.
The law also mandates annual inspections of all licensed abortion clinics, requires any medical facility in which abortions are performed to submit a monthly report, and prohibits state or local governments from entering into contracts with organizations that provide abortion services.
State Sen. Kelli Stargel (R-Lakeland), who voted for the bill, expressed concern after the senate vote that the bill’s language could become an issue in the courts. “Those clauses gave me concern that it would make it as though our intent was to close down all abortion clinics in the state,” Stargel told the Tampa Bay Times. “That was not the intent of this bill.”
After the Supreme Court’s ruling on Monday, Stargel reiterated that despite the bill’s similarities to the Texas law, it was not lawmakers intent to restrict access to abortion. “In Florida, we passed [the law] to safeguard women’s health, not to close abortion clinics,” Stargel said in a statement, reported the Florida Sun Sentinel.
Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, told the Miami Herald that the language of the bill may be different, but that Florida lawmakers had the same intent as Texas lawmakers: to shutter abortion clinics.
“It’s definitely different language,” said Goodhue. “But the intent is the same.”
Planned Parenthood has filed a lawsuit challenging the law, however, the organization is not challenging the admitting privileges requirement.
Goodhue told the Florida Sun Sentinel that the organization will determine if there are grounds for other lawsuits in the future. “Right now, we’re seeking emergency relief on the other three provisions, but we’ll make sure that access to care is protected,” Goodhue said.
Gov Rick Scott (R), who signed the bill into law in March, said during a press conference Monday that his administration is reviewing the Supreme Court’s decision, reported the Miami Herald.
Lawmakers in Indiana have in recent years passed multiple laws to restrict access to abortion, including laws that have provisions mandating that physicians have admitting privileges and other reporting requirements.
Mike Fichter, president and CEO of Indiana Right to Life, said in a statement that the Supreme Court showed “utter disregard for women’s health and safety,” and defended a similar law passed state lawmakers this year.
“We will be reviewing the Supreme Court’s decision thoroughly to see how this legal precedent could affect Indiana’s laws on admitting privileges and abortion facility building standards,” Fichter said.
An omnibus abortion bill passed in 2011 contained multiple abortion restrictions, including a provision that a physician performing an abortion must have admitting privileges at a hospital located in the county where abortions are provided or a contiguous county.
The law also allowed for a physician to meet the requirement by entering into an agreement with a physician who has admitting privileges at a hospital in the county or contiguous county.
The law created a requirement that a written agreement between a physician performing an abortion and a physician who has written admitting privileges at a hospital in the county or contiguous county be renewed annually.
The law also requires the state department of health to submit copies of admitting privileges and written agreements between physicians to other hospitals in the county and contiguous counties where abortions are performed.
Ali Slocum, spokesperson for Planned Parenthood of Indiana and Kentucky, told the Indianapolis Star that the organization does not have any immediate plans to challenge the law in court. “We are focused on what is currently in the pipeline. It is possible that the standard that the court set [Monday] could be used to challenge restrictions in other states,” Slocum said.
Efforts in State Legislatures to Repeal Laws
In some states lawmakers and advocacy groups may push to repeal similar laws following the Whole Woman’s Health decision.
Arizona lawmakers have passed several anti-choice laws in recent years and, like Texas and Florida lawmakers, justified those regulations as necessary to ensure the health and safety of women in the state.
Jodi Liggett, vice president of public affairs for Planned Parenthood Arizona, said in a statementthat the Supreme Court made a “clear statement” that laws that restrict access to abortion care are unconstitutional.
“Arizona is a large state, with population spread across many rural areas. Laws that delay care, require travel over great distances and overnight stays certainly place real-life burdens on women seeking our care,” Liggett said.
Arizona Senate Minority Leader Katie Hobbs told the Arizona Republic that she will lead the effort in the legislature to repeal similar laws. “No woman or doctor should be punished for receiving or providing essential medical care,” Hobbs said. “These restrictions have never truly been about women’s health.”
However, repealing anti-choice laws in the GOP-dominated Arizona state legislature may prove difficult.
Republicans hold an 18-12 majority in the state senate and a 36-24 majority in the state house, and they have introduced dozens of anti-choice bills in the past several years. There have been seven laws to restrict access to abortion passed by Arizona lawmakers, including a law similar to Texas’ HB 2which requires abortion providers to have admitting privileges.
Those efforts have been spearhead by the Center for Arizona Policy, a conservative think tank that promotes anti-choice, anti-LGBTQ, and so-called religious freedom legislation.
Cathi Herrod, president of the Center for Arizona Policy, said in a statement that the Supreme Court’s decision eliminated “common-sense safety precautions” for women seeking abortion care. “To give the abortion industry a blanket exemption from laws applicable to every other medical facility is unconscionable,” Herrod said.
Josh Kredit, general counsel for the Center for Arizona Policy, told the Arizona Republic that the Supreme Court’s decision suggest that abortion providers should be treated differently that other health-care providers.
“They are arguing they should be exempt from garden-variety health and safety regulations,” Kredit said. “It was clear that Texas, when it passed these, was focusing on protecting women, just like many of our laws that we pass in Arizona.”
Dr. Thomas M. Gellhaus, president of the American College of Obstetricians and Gynecologists, said in a statement that the Court’s decision made it clear these laws do not improve the health and safety of patients seeking abortion. Said Gellhaus: “As the court found, it was clear that the ambulatory surgical center and admitting privileges requirements at the heart of Texas law HB 2 did not improve the safety of women, and served only as a barrier to women’s ability to access safe, legal abortion when needed.”
“Of course, this is not the end of the battle when it comes to abortion access,” Gellhaus added. “In dozens of states, women are living under laws that impede access in a variety of ways, for example banning certain abortion procedures, setting gestational limits, mandating that medically inaccurate information be provided to patients, and more. None of these have a basis in medicine, and all of them represent political interference in the patient/physician relationship. We will continue to oppose these laws and to promote safe access to legal abortion for our patients.”