Texas House Bill 2 (2013) required that a “physician performing or inducing an abortion . . . must, on the date [of service], have active admitting privileges at a hospital . . . not further than 30 miles from the” abortion facility, and that the facility meet the state’s “minimum standards . . . for ambulatory surgical centers.” As a basis for enjoining enforcement, the district court found: as enforcement of the admitting-privileges requirement began, the number of abortion facilities dropped from about 40 to about 20, so that the number reproductive-age women living more than 50 miles from a clinic doubled and the number living more than 200 miles away increased about 2,800%; the number of facilities would drop to seven or eight if the surgical-center provision took effect; before H.B. 2’s passage, abortion was extremely safe with very low rates of complications and virtually no deaths; abortion was safer than many more common procedures not subject to the same level of regulation; and the cost of compliance with the surgical-center requirement would likely exceed $1.5 million-$3 million per clinic. The Fifth Circuit reversed, citing res judicata. The Supreme Court reversed: the constitutional claims are not barred by res judicata. This as-applied, post-enforcement challenge rests upon factual developments that occurred after an earlier facial challenge, once enforcement started and several clinics closed. Both of the challenged requirements place a substantial obstacle in the path of women seeking a previability abortion and constitute an undue burden on abortion access. Courts must consider the burdens a law imposes on abortion access together with the benefits those laws confer. The state’s evidence did not show how the law advanced its legitimate interest in protecting women’s health when compared to prior law, which required providers to have a “working arrangement” with doctors who had admitting privileges and required abortion facilities to meet extensive health and safety requirements that were policed by inspections.

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