--:-- Sean Rameswaram: Support for Today Explained comes from Adio. Adio is an AI-native customer relationship management platform that Adio says is built for the next era of companies.
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--:-- Sean Rameswaram: Support for this show comes from strawberry.me. Be honest. Are you happy with your job or are you stuck in one you've outgrown or never wanted in the first place?
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--:-- Sean Rameswaram: Earlier this year, the anti-abortion group Americans United for Life went through all of the states in America and ranked them by how pro-life, in their words, they are. And at the top of that ranking was the state of Louisiana.
--:-- Sean Rameswaram: Louisiana has three abortion clinics. And on Wednesday, the Supreme Court heard oral arguments in a case that could bring that number down to one.
--:-- Sean Rameswaram: So I've been covering this case for a long time. And in late December, I went to one of the three remaining clinics in Louisiana, Hope Medical Group for Women.
--:-- Sean Rameswaram: Hope is in Shreveport. It's in northern Louisiana. And depending on what happens with the Supreme Court case this year, Hope could face being closed.
--:-- Sean Rameswaram: The clinic itself, it felt like it had really taken a lot of steps to be homey and be welcoming. You know, it was the holiday season. Some of the staff were wearing reindeer antlers.
--:-- Sean Rameswaram: There's coffee and posters on the walls of things to do in Shreveport and sort of touches to make it a little bit more welcoming. But it also is a reminder that people are coming to this clinic from really far away.
--:-- Sean Rameswaram: Staff at Hope told me folks are coming from Texas. They're coming from Oklahoma. They're coming from Arkansas. Sometimes they're coming from Mississippi.
--:-- Sean Rameswaram: So it can be routinely a 200-mile drive for people to get an abortion there. I got there early in the morning. The staff was there, but the patients weren't there yet.
--:-- Sean Rameswaram: They started to come in mid-morning. There's a brief time where the clinic is really bustling, and there's lots and lots of people, and the waiting rooms are full.
--:-- Sean Rameswaram: I believe a majority of their patients are Black, and a majority of them live below the poverty line. It's a lot of people in their 20s.
--:-- Sean Rameswaram: And that tracks with abortion around the country. Also in a lot of cases, folks are there not yet to get their procedure because in Louisiana, in order to get an abortion, you first have to make an appointment, get counseling from a doctor, and get an ultrasound.
--:-- Sean Rameswaram: The doctor has to give you certain state-mandated materials. And then you have to wait 24 hours. That's a law that exists in a lot of states. Louisiana is one of them.
--:-- Sean Rameswaram: So a lot of the folks that were coming through the clinic on the day I was there, they weren't actually getting their abortion yet. They were just coming to talk to a doctor, get an ultrasound, get some materials, then they have to go home and wait.
--:-- Sean Rameswaram: So here's what you're doing. You're going to this clinic. It might be hundreds of miles away. You have an initial appointment where you get an ultrasound. You discuss it with the doctor.
--:-- Sean Rameswaram: The doctor has to give you also certain state-mandated information. And some of it includes information that a lot of reproductive health advocates say isn't correct, including an abortion will raise your risk of breast cancer.
--:-- Sean Rameswaram: There's no evidence of that. In any case, you get the materials, you get the ultrasound, then you have to go home and wait for 24 hours.
--:-- Sean Rameswaram: If you can go home, but if you are 200, 300 miles away from home, then maybe you're staying the night in Shreveport, maybe you're paying for a hotel.
--:-- Sean Rameswaram: And the procedure itself is $550. So to get an abortion at Hope, you need $50 for the initial consultation.
--:-- Sean Rameswaram: And then it starts at $550 for an abortion procedure, whether that's a medication abortion where you take pills or a surgical abortion.
--:-- Sean Rameswaram: And then it goes up from there depending on how far along you are in your pregnancy. I heard a lot of stories from staff members of people maybe having to barter, saying maybe I'll take care of your kid for a week if you'll drive me or I'll pick up a shift at work or things like that, trying to figure out something that will work.
--:-- Sean Rameswaram: Then you have to take the time off work, which might be a couple of days if you're staying overnight. You have to find someone to take care of your kids.
--:-- Sean Rameswaram: The majority of people who get abortions in America already have at least one kid. So there just a lot that drives the cost up.
--:-- Sean Rameswaram: So on top of all of these difficulties to secure an abortion in a place like Louisiana this case at the Supreme Court might make it even harder.
--:-- Sean Rameswaram: What's going on? Right. So Louisiana for years has been passing a number of restrictions on abortion. And in 2014, they passed a law requiring abortion providers to have admitting privileges at a local hospital.
--:-- Sean Rameswaram: What does that mean? So if you got admitted to the hospital, that doctor could come into the hospital and treat you there.
--:-- Sean Rameswaram: Now, these are very difficult to get for abortion doctors. And one of the main reasons is that abortion patients don't go to the hospital very often.
--:-- Sean Rameswaram: They don't usually need to because the rate of complications for abortion is really low. The other reason that admitting privileges are hard to get, one of the other reasons that they're hard to get, is that hospitals don't necessarily want to give abortion doctors admitting privileges.
--:-- Sean Rameswaram: The hospital itself may be opposed to abortion. But usually in the past, in other states, admitting privileges laws have had the effect of shutting clinics down.
--:-- Sean Rameswaram: What's the defense of these laws? Why do they even need to exist? So I talked to the state legislator who wrote the Louisiana law, and she really frames it as a women's health issue.
--:-- Sean Rameswaram: It's a she. Yeah. She's a Democrat. Louisiana is the number one pro-life state in the nation. And mainly because in Louisiana, it doesn't matter if you're Democrat, Republican, black or white, we fight for life.
--:-- Sean Rameswaram: I tell people in my state when they ask me, why are you a black female Democrat fighting for life? I say, because I'm a Christian first.
--:-- Sean Rameswaram: Louisiana is a rare state where being anti-abortion is kind of bipartisan. There are a lot of anti-abortion Democrats.
--:-- Sean Rameswaram: Her argument is this is a women's health issue. Patients need continuity of care. They should be able to have their doctor go over to the hospital to take care of them.
--:-- Sean Rameswaram: What abortion rights folks would say is that the continuity of care argument doesn't necessarily make sense, in part because so few people are going to the hospital, but also because if you're 100 miles away, 200 miles away from the clinic where you got your abortion and you have a complication later, you're probably going to the hospital in your town.
--:-- Sean Rameswaram: You're not going to the hospital near the clinic where this doctor might have admitting privileges. And that's why Hope Medical Group for Women, the clinic that I visited in December, decided a few years back to challenge Louisiana's admitting privileges law.
--:-- Sean Rameswaram: And that challenge has been working its way through the courts ever since. And on Wednesday it was the subject of oral arguments before the Supreme Court.
--:-- Sean Rameswaram: Depending on what the Supreme Court decides, it's not just clinics in Louisiana that could close. Other states could decide that they could pass admitting privileges laws or they could pass other similar laws to restrict clinics and those clinics could close.
--:-- Sean Rameswaram: A lot of people, even on both sides of the issue, are calling this the beginning of the end of Roe v. Wade. Somebody said that to me outside the court on Wednesday and I've been hearing it a lot.
--:-- Sean Rameswaram: There's a lot of feeling, really, on both sides, that Roe v. Wade's hanging by a thread, and it's getting thinner and thinner, and it's a totally different court. It's the Trump era.
--:-- Sean Rameswaram: I think everyone agrees the stakes couldn't be higher. Anna North is a senior reporter for Vox. Hope Medical's corporate name is June Medical Services LLC.
--:-- Sean Rameswaram: The health secretary of Louisiana's name is Stephen R. Russo. In a moment, oral arguments in June Medical Services LLC v. Russo. I'm Sean Rameswaram from This is Today Explained.
--:-- Sean Rameswaram: Support for today's show comes from Adio. What is Adio? Adio Adio is an AI-native customer relationship management system built specifically for the next era of companies.
--:-- Sean Rameswaram: They say it's extremely powerful, adapts to your unique data structures and scales with any business model. According to Adio, Adio takes less than a minute to set up, and within seconds you will have your email and calendars synced.
--:-- Sean Rameswaram: You'll see all your relationships in a fully-fledged platform, they say, all enriched with that actionable data. And they say you can build AI-powered automations and use its research agent to tackle some of your most complex processes to seize so that you can focus on what matters, building your company.
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--:-- Sean Rameswaram: Stay explained. We all have moments where we could have done better, like cutting your own hair. Oh yikes Or forgetting sunscreen so now you look like a tomato Ouch Could have done better Same goes for where you invest Level up and invest smarter with Schwab.
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--:-- Sean Rameswaram: Ian Millhiser, you covered the Supreme Court for Vox, And you were at the court yesterday for oral arguments in this case, June Medical Services v. Rousseau.
--:-- Ian Millhiser: It was a little surprising. So when I woke up Wednesday morning, I thought there was a 0% chance that the Supreme Court would vote to strike down this anti-abortion law.
--:-- Ian Millhiser: OK. And when I left, I was a little surprised by Chief Justice Roberts, who is very conservative and very conservative in particular on abortion.
--:-- Ian Millhiser: I left think there's maybe a 30 percent chance that he will flip over and vote to strike down the anti-abortion law. Which means the clinic would win and the state of Louisiana would lose.
--:-- Ian Millhiser: That's right. I think there is at least some chance that there's going to be five votes in favor of the clinic here.
--:-- Ian Millhiser: The reason why is that the state claims that it passed this law in order to protect patients' health. And Robert seemed unpersuaded at times by that argument.
--:-- Ian Millhiser: It's not a convincing argument. There's very little empirical evidence for it. Hope Medical Center, the abortion clinic at the heart of this, has performed about 70,000 abortions.
--:-- Ian Millhiser: And only four of those have led to complications that required hospitalization. So if your fear is that there's this epidemic of people who are having complications after they have an abortion require hospitalization and they can't get into the hospital because there isn't – fear not.
--:-- Ian Millhiser: That problem has already been solved by the fact that abortion is very safe and the chances that an abortion patient is going to require hospitalization is vanishingly small.
--:-- Ian Millhiser: Is this the argument that the clinic made in front of the court yesterday? That's right. Yeah.
--:-- Ian Millhiser: So the clinic – and I should point out like some of our listeners might be having deja vu here. The reason why they might be having deja vu is because in 2016, there was a case called Whole Women's Health v. Hellerstedt.
--:-- Ian Millhiser: Mr. Chief Justice, and may it please the court, the Texas requirements undermine the careful balance struck in Casey between states' legitimate interests in regulating abortion and women's fundamental liberty to make personal decisions about their pregnancies.
--:-- Ian Millhiser: They are unnecessary health regulations that create substantial obstacles to abortion access. And what the Supreme Court said in that case is that admitting privileges laws do not benefit patients.
--:-- Ian Millhiser: And basically all that the clinic was arguing in this case was, hey, that thing that you said less than four years ago, still true.
--:-- Ian Millhiser: The federal district court, after a trial, found the two provisions were unconstitutional. They constituted an undue burden on a woman's right to choose.
--:-- Ian Millhiser: The Court of Appeals for the Fifth Circuit reversed. We, in turn, agree with the district court and we reverse the Court of Appeals.
--:-- Ian Millhiser: So why hear the case then if they've already decided something so close in Texas? The biggest difference between Whole Woman's Health, the case from four years ago, and June Medical, the case that was heard this week, has nothing to do with the facts of the case.
--:-- Ian Millhiser: It has nothing to do with the law. It has everything to do with the personnel. on the Supreme Court.
--:-- Ian Millhiser: Four years ago, Justice Kennedy was still on the court. And Justice Kennedy, you know, I wouldn't call him a huge defender of abortion rights.
--:-- Ian Millhiser: You know, he voted to strike down the overwhelming majority of the abortion restrictions that came before him. But every now and then he would see a restriction.
--:-- Ian Millhiser: He says, no, that goes too far. You're cutting too far into this core constitutional right that my court has recognized. And that's what he said in Whole Woman's Health.
--:-- Ian Millhiser: Kennedy's gone. Kennedy was the fifth vote in Whole Woman's Health, and his replacement, Brett Kavanaugh, has a very consistently anti-abortion record.
--:-- Ian Millhiser: In making your argument, you ignored and, I believe, mischaracterized a Supreme Court precedent. You reasoned that Jane Doe should not be unable to exercise her right to choose because she did not have family and friends to make her decision.
--:-- Ian Millhiser: The argument rewrites Supreme Court precedent. And Gorsuch is also fresh to the court from that 2016 decision.
--:-- Ian Millhiser: That's right, yeah. Neil Gorsuch was appointed to replace Justice Scalia, who actually died while the whole women's health case was pending.
--:-- Ian Millhiser: So did Gorsuch and Kavanaugh weigh in on Wednesday in any way that might suggest how they're going to vote? So Gorsuch was quiet at the oral argument, but based on his record, you know, when he was a lower court judge, he took some very aggressive steps against Planned Parenthood.
--:-- Ian Millhiser: Like, I'm pretty darn confident that Gorsuch is going to cast anti-abortion votes. Kavanaugh also signaled that he intends to vote with the state here
--:-- Ian Millhiser: And Kavanaugh argument So remember that Whole Woman Health the Texas case said that admitting privileges laws do not benefit patients.
--:-- Ian Millhiser: And it also said that it's also really hard for doctors to get these things, or at least for abortion doctors to get admitting privileges. And so this is a huge burden for no benefit. It struck down.
--:-- Ian Millhiser: Kavanaugh said, well, how do we know that's true in Louisiana? Sure, it might be true that in Texas, it's really hard for abortion doctors to get these credentials. But maybe it's different in Louisiana. Is it? No, it's not.
--:-- Ian Millhiser: The American Medical Association and the Medical Association representing obstetricians and gynecologists filed an ambicus brief where they said, nope, it's the same.
--:-- Ian Millhiser: The evidence in the case suggests that it's the same. There are several doctors in this case who tried to get admitted in villages and weren't able to do so.
--:-- Ian Millhiser: And often it was for the exact reason that I said, like one of the doctors, for example, only provides medication abortions and doesn't really have much of a medical practice beyond like every now and then prescribing medication abortions.
--:-- Ian Millhiser: And so this person admits pretty much no one to a hospital because there's no need that for any of this doctor's patients to go into a hospital. And so that person would have a really tough time getting admitting foolish.
--:-- Ian Millhiser: In fact, the state's own expert witness admitted that, yeah, that doctor would have a tough time getting admitting privileges.
--:-- Ian Millhiser: So what's the bigger picture here? We know from what you said about giving the state a 30 percent chance of winning this case here that Louisiana would go from three abortion clinics to maybe just one.
--:-- Ian Millhiser: Right. Which would make the procedure even more restrictive in the state. But what's going on here with the Supreme Court, Roe v. Wade and this new cast of characters?
--:-- Ian Millhiser: So this case is likely to come down to Roberts. He was the only person I saw up there who seemed in any way uncertain about how he would vote.
--:-- Ian Millhiser: And Roberts really doesn't like Roe v. Wade. You know, if the lawyer for the state had come in and had said, we think that Roe v. Wade was wrongly decided and we think that this court should overrule it and here's our argument for why this should be overruled.
--:-- Ian Millhiser: And they've just been opened about what they were trying to accomplish. I think there's a really good chance Roberts would have said, yes, like that's what I want to.
--:-- Ian Millhiser: What the state did instead is it passed this law, which is really an abortion restriction, but it's kind of disguised as a health regulation.
--:-- Ian Millhiser: And then they asked the justices to say, like, we want you to pretend that this law is going to protect people's health, even though we can't provide you much evidence that it will.
--:-- Ian Millhiser: And even though you said four years ago that it won't. And even though our lawyer is now in an oral argument and the liberal justices are peppering her with questions, asking her to find demonstrate evidence this will protect women's health and she's unable to do it.
--:-- Ian Millhiser: The state was asking the justices to participate in a pretty deceptive act here. There's a chance that Roberts isn't going to go there.
--:-- Ian Millhiser: But what does it mean for the next case that comes that isn't handled this way, that doesn't have this precedent? What does it mean when someone comes to the Supreme Court, to this new cast of characters, Gorsuch and Kavanaugh, and says Roe v. Wade is bad law?
--:-- Ian Millhiser: Yeah, I mean, and that's, I think, the bad news for people who care about abortion rights is I think that there's a chance that Roberts gives Roe v. Wade a stay of execution here.
--:-- Ian Millhiser: But eventually someone is going to show up and they're going to be more open about what they want. I mean, they're the heartbeat bills. You know, there are various laws being passed by states right now where the states are being pretty honest about their motive.
--:-- Ian Millhiser: They're saying, look, like we think abortion is bad and we want to protect fetal life. And so we are passing this law for the purpose of protecting fetal life and making it harder for people to get abortions.
--:-- Ian Millhiser: And I think that if a state comes in and they say that openly and honestly, I think it's very likely that there's going to be five votes who say, yes, we agree with you.
--:-- Sean Rameswaram: Support for this show comes from Macy's. Fall is right around the corner, and that means layering season is too. Macy's Fall Fashion Guide can help you get a pulse on all the latest trends and must-haves.
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--:-- Sean Rameswaram: No matter your vibe, you can explore the Macy's Fall Fashion Guide and find the perfect look for you. Shop in-store or online at nacy's.com.
