The retrofitting of clinics has been variously estimated to cost $1.5 million to $3 million, well out of reach of most abortion facilities. As for admitting privileges, there are all kinds of complications. Few doctors are willing to perform abortions and those that are willing often have to travel a long way to the clinics they serve. Often they choose not to live near a clinic out of fear for their lives, since there are still extremists out there who regularly threaten to murder abortion providers—not something to be taken lightly given the history of such assassinations. Doctors are also denied privileges at hospitals with religious affiliations, which often are the only ones available in some less-populated areas.

Under Casey’s mixed ruling, five justices (including Kennedy) agreed that states could impose restrictions as long as they did not constitute an “undue burden” on women seeking to terminate their pregnancies. The justices will be deciding whether the appeals court erred on two interlaced grounds: Failing to consider if laws supposedly passed to protect women’s health actually serve the government’s interests in promoting health, and permitting Texas to enforce laws that reduce access to abortion even if they don’t promote health.

It should be noted that the Fifth Circuit overruled a 2014 district court decision that had found the Texas restrictions did not, in fact, promote women’s health. On the contrary, the district court ruled, the law cut access to an extremely safe procedure, forcing women to drive long distances with expensive overnight stays and to take extra time off work, and, worst of all, spurring some of them to choose self-induced abortions.

U.S. District Judge Earl Leroy Yeakel ruled that the law created “a brutally effective system” specifically designed to close abortion facilities, not to improve women’s health as the state’s attorneys argued. “The act’s two requirements erect a particularly high barrier for poor, rural or disadvantaged women throughout Texas, regardless of the absolute distance they may have to travel to obtain an abortion,” Yeakel wrote.

At SCOTUSblog early last month, professor of law Dawn Johnsen wrote:

… the Fifth Circuit decision reversing the district court was plainly wrong for its refusal to consider the actual, extremely harmful health effects of the Texas clinic regulations. On a straightforward application of the Court’s controlling precedent, both contested provisions are unconstitutional. On undisputed facts, the question is not close. More must be going on here. What is truly at issue? The insightful concluding sentence of Michael Dorf’s post provides an excellent starting point: “The only real question in this case is the one that Charles Black saw at issue in Brown v. Board of Education: whether ‘the Court, as a Court, can permissibly learn what is obvious to everybody else and to the Justices as individuals.’” The answer here, of course, is yes, and that is made easy by the Court’s reaffirmation in Casey of the judiciary’s obligation to closely scrutinize abortion regulations to protect against attempts to shut clinics. The Fifth Circuit was able to shut its eyes to reality only by ignoring this obligation and, under the extreme deference of rational basis review, blindly accepting Texas’s demonstrably false claim that it is promoting women’s health.

The impact of the Supreme Court’s ruling in Whole Woman’s Health can hardly be overstated.