June Medical Services L. L. C. v. Russo
The Supreme Court struck down Louisiana's law requiring abortion doctors to hold admitting privileges at hospitals within 30 miles of their clinics, ruling it unconstitutional for the same reasons the Court had rejected a virtually identical Texas law in 2016.
The 5-4 decision was delivered by four liberal justices joined by Chief Justice Roberts — who wrote separately to narrow the reasoning — deepening divisions over how courts should evaluate state abortion regulations going forward.
“This case is similar to, nearly identical with, Whole Woman's Health. And the law must consequently reach a similar conclusion. Act 620 is unconstitutional.”
The plurality's summary conclusion that Louisiana's admitting-privileges law must fall for the same reasons the Texas version did.
How it got here: Abortion clinics and doctors sued in federal court before Act 620 took effect; the district court permanently enjoined it after a six-day bench trial; the Fifth Circuit reversed; the Supreme Court granted certiorari on both the merits and a standing cross-petition.
The Case in Depth
What happened
Louisiana passed Act 620 in 2014, requiring any doctor who performs abortions to hold active admitting privileges at a hospital within 30 miles of the clinic — almost word-for-word the same as a Texas law the Court struck down in 2016. Abortion clinics and doctors sued before the law took effect, presenting evidence it would reduce Louisiana's providers from five doctors at three clinics to at most one doctor at one clinic, making it impossible for most of the approximately 10,000 women who seek abortions in Louisiana each year to obtain one.
The question before the Court
Can Louisiana require abortion doctors to hold hospital admitting privileges nearby — a rule nearly identical to one the Court struck down in Texas four years earlier?
The Court's answer
Yes — Louisiana's admitting-privileges law is unconstitutional. The Court ruled that Act 620 imposed a burden on women's access to abortion just as severe as the nearly identical Texas law struck down four years earlier. District court findings — that the law would drive most abortion doctors out of practice for reasons having nothing to do with their competence and would leave demand vastly exceeding supply — were supported by the record and not clearly wrong. The law also served no meaningful health benefit: hospitals routinely deny privileges based on criteria unrelated to a doctor's ability to perform abortions safely.
Chief Justice Roberts provided the decisive fifth vote, agreeing stare decisis required the same outcome as Whole Woman's Health. He wrote separately to reject the plurality's approach of formally balancing a law's health benefits against its burden on abortion access, arguing Casey's "substantial obstacle" test alone is the governing standard.
Curious how the Court got there? See the step-by-step legal reasoning →
Why it matters
Louisiana's law — which would have reduced the state's three abortion clinics to at most two and its five abortion doctors to at most two, leaving one provider unable to absorb even 30% of annual demand — remains permanently blocked. Women in Louisiana keep access to abortion services as they existed before the law. States cannot simply copy Texas-style admitting-privileges requirements after Whole Woman's Health.
What changes now
The Fifth Circuit's judgment reversing the district court's permanent injunction is itself reversed, reinstating the injunction blocking Act 620. Louisiana cannot enforce the admitting-privileges requirement. No remand is ordered. However, the decision's fractured rationale — with Roberts rejecting the plurality's balancing approach — leaves the precise test for evaluating health-and-safety abortion regulations unsettled, inviting future challenges in other states.
What this does not decide
The ruling does not decide whether Roe v. Wade or Planned Parenthood v. Casey were correctly decided — neither party asked the Court to revisit them, and Roberts explicitly declined to do so. It also leaves open how courts should evaluate abortion health regulations that do not create a substantial obstacle, and does not resolve the disagreement between the plurality and Roberts over whether benefits must be weighed against burdens.
Concurrences and dissents
Concurrence — Justice Roberts
Chief Justice Roberts agreed the abortion providers have standing and that Louisiana's law must fall, but for narrower reasons than the plurality. He would not revisit Whole Woman's Health's outcome — stare decisis requires the same result because Louisiana's law is nearly identical to Texas's and imposes the same burden per unchallenged district court findings. But he rejected the plurality's balancing test, arguing Casey's sole inquiry is whether a law places a 'substantial obstacle' in a woman's path, without separately weighing the law's health benefits against its burdens.
Dissent — Justice Thomas
“Our abortion precedents are grievously wrong and should be overruled. Because we have neither jurisdiction nor constitutional authority to declare Louisiana's duly enacted law unconstitutional, I respectfully dissent.”Justice Thomas's core objection, arguing the Court lacks both standing jurisdiction and constitutional authority to strike the law.
Justice Thomas argued the abortion providers lack Article III standing — not merely prudential standing — because they assert only their patients' constitutional rights, not their own. Without standing, the Court has no jurisdiction at all. More fundamentally, he argued Roe v. Wade and its progeny are 'grievously wrong,' having invented a right to abortion from constitutional penumbras with no textual support in the Fourteenth Amendment. He would have dismissed for lack of jurisdiction, or alternatively affirmed Louisiana's law.
Dissent — Justice Alito
Justice Alito argued Louisiana did not waive its standing objection and that abortion providers fail both prongs of the third-party standing test — they lack a close relationship with patients (brief transactional encounters lasting minutes) and there is no meaningful hindrance to women suing on their own. He also argued this pre-enforcement case differs materially from post-enforcement Whole Woman's Health, the district court applied a legally flawed 'good faith' test that ignored the doctors' incentives to minimize privilege-seeking efforts, and Whole Woman's Health's balancing approach misread Casey. He would remand for a new trial.
Dissent — Justice Gorsuch
Justice Gorsuch argued today's decision violates multiple foundational constraints on judicial power simultaneously: third-party standing rules are not satisfied; the facial-challenge standard is inverted (the law is invalidated statewide despite constitutional applications); the deferential standard for prospective injunctions is ignored; and the plurality imports Whole Woman's Health's fact-specific Texas findings as universal legal rules applying to Louisiana. He also rejected the Roberts concurrence as resting on a holding Whole Woman's Health never actually made.
Dissent — Justice Kavanaugh
Justice Kavanaugh joined the Alito dissent and agreed five justices reject Whole Woman's Health's cost-benefit balancing standard. He parted from the other dissenters, however, in concluding the case should be remanded because the factual record is too incomplete at the pre-enforcement stage — the record does not adequately show the three relevant doctors genuinely cannot obtain admitting privileges, and thus does not establish that any Louisiana clinic would actually close.
How the Court got there
The legal reasoning, step by step
- The plurality addressed standing first. The State had argued only women — not abortion providers — could sue to challenge the law. But the Court found the State waived that objection in the district court by declaring there was 'no question that the physicians had standing to contest the law' and urging a quick ruling on the merits. Beyond waiver, a long line of cases has allowed abortion providers to assert their patients' rights, making them the 'least awkward' challengers of laws that regulate their own conduct.
- On the merits, the plurality applied the constitutional standard from Planned Parenthood v. Casey (1992) and Whole Woman's Health (2016): an abortion regulation is unconstitutional if it has 'the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion' — called an 'undue burden.' The plurality also weighed the law's claimed health benefits against the burdens it imposed on abortion access.
- The district court supervised the abortion doctors' efforts to obtain qualifying privileges for over 18 months and heard extensive trial testimony. It found the doctors largely failed for reasons unrelated to competence — hospitals deny privileges based on minimum-admission quotas, covering-physician requirements, and outright opposition to abortion, none of which reflect a doctor's ability to perform abortions safely. The Fifth Circuit improperly replaced those factual findings with its own, violating the 'clear error' standard that governs appellate review of trial court facts.
- On access, the district court found that enforcing Act 620 would eliminate three of the five doctors, and a fourth would stop if left as the only northern Louisiana provider. That would leave one doctor in New Orleans serving all 10,000 annual patients — well under 30% of capacity — with women from Shreveport facing a nearly 10-hour round trip and a required overnight stay due to Louisiana's 24-hour waiting period. The record also showed new doctors were unlikely to replace those who left, for the same privilege-access reasons.
- On claimed benefits, the record showed no evidence that patients had better outcomes when their doctors held admitting privileges. Complications from abortion are rare; existing transfer agreements provide adequate emergency continuity of care; and when complications arise at home, patients are sent to the nearest available hospital regardless. The State's own expert conceded hospitals primarily assess in-hospital performance — not outpatient abortion competence — when granting privileges.
- Chief Justice Roberts concurred in the judgment on narrower grounds. He agreed stare decisis required the same result as Whole Woman's Health because Louisiana's law is functionally identical and would impose the same burden according to the district court's unchallenged factual findings. But he rejected the plurality's benefits-weighing as inconsistent with Casey, which asks only whether a law imposes a 'substantial obstacle' — not whether its benefits justify its costs.
Doctrinal impact
Cases affected by this decision
Reaffirms Whole Woman's Health v. Hellerstedt (579 U.S. ___)
The plurality upholds its outcome and applies its framework; Roberts uses it to control this case through stare decisis.
Reaffirms Planned Parenthood of Southeastern Pa. v. Casey (505 U.S. 833)
Both the plurality and Roberts reaffirm Casey's 'substantial obstacle' / undue burden standard as the governing framework for abortion regulations.