News Law and Policy

Legal Fight Over Contraception Benefit Hits Next Phase

Jessica Mason Pieklo

A series of appellate court decisions in the coming months could determine how and when the Supreme Court reviews the birth control benefit in the Affordable Care Act.

Federal courts of appeals will hear arguments this week in three cases that could frame the coming Supreme Court battle over the birth control benefit in the Affordable Care Act.

On Wednesday, the U.S Court of Appeals for the Seventh Circuit will hear two of the three cases. Last December a split panel of the federal appeals court granted an emergency injunction for Cyril and Jane Korte and their company Korte & Luitjohan Contractors (K&L), a full-service construction contractor based in Illinois. The same court also granted an emergency injunction in the case of Grote Industries v. Sebelius, which involved a privately held Indiana-based business that manufactures vehicle safety systems. Given the similarities between the cases, the court consolidated them, agreeing to hear them together. In both cases the for-profit businesses were granted injunctions from having to comply with the mandate. But that’s not what is noteworthy about these two cases. What’s noteworthy is that those injunctions were granted over the searing dissent of Judge Ilana Diamond Rovner, whose methodical deconstructing of the claim that for-profit businesses have religious liberty interests sufficient to deny their employees access to contraception via their insurance coverage illuminates what’s really going on in the battle over the birth control benefit.

In the legal battle over the contraception benefit, conservatives see a chance to radically re-define the nature of religious liberty in the United States and to provide broad protections from obeying the law for businesses. It’s a dangerous combination of religious extremism and corporate extremism, which Circuit Judge Rovner laid bare last February. Now the appeals court is going to have another look.

The other high-profile appellate argument happening this week is in Hobby Lobby v. Sebelius. Hobby Lobby, a for-profit arts-and-crafts store has become something of a celebrity cause for conservatives challenging the contraception benefit. Last year a panel of three Tenth Circuit Court of Appeals judges refused to grant Hobby Lobby’s request for an injunction. Hobby Lobby sought emergency intervention from the Supreme Court, but that request was denied. Then, in an unusual move, the full Tenth Circuit agreed to hear the case en banc, which can mean that a majority of the judges on the panel disagree with the earlier decision. If that is the case, and the full panel reverses the earlier decision, Hobby Lobby would be granted an injunction while the lawsuit challenging the constitutionality of the mandate proceeds. Those arguments take place on Thursday, May 23.

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At the rate the legal challenges to the mandate are piling up—at last count there were 63 lawsuits pending in federal courts—the Supreme Court could decide the issue by 2014. Of those 63 cases, 32 cases have been brought by non-profit organizations. Three cases were withdrawn by the plaintiffs, while eight cases were dismissed and those decisions were not appealed, leaving 21 of the non-profit cases pending. Where decisions have been reached in the non-profit cases, courts are largely dismissing the cases because they are not ripe or because plaintiffs lack standing. This is because non-profits with religious objections to providing contraceptive coverage currently have a one-year delay in implementing the benefit while the administration finalizes the rule defining the scope of religious exemption under the birth control benefit.

Almost as many cases have been filed by for-profit companies, with 31 challenges filed by businesses ranging from a mining company to an HVAC company to a furniture manufacturer and a property management company. These cases are moving quickly because these companies are not eligible for the delay in complying and for the most part are already required to provide the contraceptive coverage benefit.

The courts addressing these challenges are reaching different outcomes, all but guaranteeing Supreme Court review. In these challenges, so far one court has reached the merits, granting the government’s motion to dismiss in O’Brien v. HHS, which is now on appeal to the Eighth Circuit Court of Appeals. There, the district court recognized that the Religious Freedom Restoration Act, the federal law the companies are relying upon to challenge the benefit, “is not a means to force one’s religious practices upon others.” The Eighth Circuit Court of Appeals has issued a stay pending appeal.

So far no court of appeals has reached the merits of the challenges yet. Three courts of appeals (the Third, Sixth, and Tenth) have refused to delay the enforcement of the contraceptive coverage benefit while three courts of appeals (D.C., Seventh and Eighth) have given temporary relief. This means there’s a patchwork of contradictory results blanketing the country, with some of the federal courts nearly evenly split on whether for-profit companies can avoid providing contraceptive coverage for their employees. It also means there’s an increasingly likely chance the Roberts court will end up taking up challenges to Roe v. Wade’s viability standard nearly the same time it considers the religious rights of employers to deny health insurance benefits to employees. If that happens, 2014 could be the year the Roberts court does to reproductive rights law what it did to campaign finance law in 2010 with Citizens United.

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

News Law and Policy

Virginia School Board Wants Supreme Court in Fight Over Transgender Student Bathroom Access

Jessica Mason Pieklo

The Gloucester County School Board wants the Supreme Court to decide whether federal law requires schools to let transgender students access facilities such as bathrooms that conform to their gender identity.

A Virginia school board will ask the U.S. Supreme Court to step into the fight over bathroom access for transgender students in the first real legal test of the Obama administration’s agency actions on the issue.

The case involves Gavin Grimm, a Gloucester County student who, in 2015, challenged his school’s policy of separating transgender students from their peers in restrooms and mandating that students use bathrooms consistent with their “biological sex” rather than their gender identity.

As previously reported by Rewire:

Grimm’s attorneys at the American Civil Liberties Union argued that the restroom policy, which effectively expels transgender students from communal restrooms and requires them to use “alternative … private” restroom facilities, is unconstitutional under the 14th Amendment and violates Title IX of the U.S. Education Amendments of 1972, a federal law prohibiting sex discrimination at schools that receive federal funding.

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The school board defended its policy, arguing that it was consistent with federal law and that it protected the privacy rights of other students at Grimm’s school.

Grimm’s attorneys had asked a federal court for an injunction blocking the policy. A lower court initially sided with the school board; Grimm’s attorneys appealed to the U.S. Court of Appeals for the Fourth Circuit, which reversed the lower court and ruled that Grimm’s lawsuit against his school could proceed.

On Tuesday the Fourth Circuit agreed to put its decision on hold while the school board filed a petition asking the Supreme Court to step in. The board is arguing that the Obama administration has gone too far on transgender rights, beginning in 2012, when it issued an initial agency opinion that refusing transgender students access to the bathrooms consistent with their gender identity violated Title IX.

In October 2015 the administration took that opinion one step further and filed a friend of the court brief on Grimm’s behalf with the Fourth Circuit, arguing it was the administration’s position that the school board’s policy specifically violated federal law. Then, in May this year, the administration expanded that opinion into a directive. Though it still didn’t have the force of law, the directive put all schools receiving federal funding on notice: Should they deny transgender students access to facilities that conform to students’ gender identity, they would be in violation of federal law and subject to lawsuits. The Fourth Circuit relied heavily on this guidance in siding with Grimm earlier this year.

It is not clear whether the Roberts Court will step into the issue of transgender students’ rights at this time. So far, no other federal appeals court has weighed in on the issue.

Meanwhile, 22 states have filed a lawsuit challenging the Obama administration’s 2016 directive, arguing that the administration overstepped its authority. That lawsuit is also in its early stages.

Both Grimm’s lawsuit and the states’ lawsuit in response suggest the issue of transgender rights and sex discrimination will end up before the Roberts Court at some point.