The Wyoming Supreme Court ruled this week that the state’s abortion ban violates each Wyoming citizen’s right to “make his or her own health care decisions,” protected by the state constitution. The ruling could have important implications for challenges to abortion bans across the country based on a universal right to health care.
Medical Freedom Amendment
In that case, State v. Johnsona group of health care providers, patients, and organizations challenged the constitutionality of two 2023 laws: the Wyoming Life Act and the Abortion Pill Ban, which would criminalize virtually all abortions. The plaintiffs argued that both abortion bans violate their right to make medical decisions, which is protected by a 2012 amendment passed to limit the scope of the Affordable Care Act. In a November 2024 ruling, the court of first instance blocked enforcement of the law, concluding that it violates the proposed amendments.
Wyoming is one of six states — Alabama, Arizona, Florida, Ohio, and Oklahoma — to pass health care freedom amendments in response to the Affordable Care Act. Following the law’s passage, conservatives argued that the new federal health care law limited patients’ choices about their own health care. This debate influenced amendments like Wyoming’s, but those amendments were often framed simply as protecting the right to “make health care decisions.” These modifications were primarily symbolic. To the extent that patient choice is limited, federal law trumps state law.
But a decade and a half later, abortion and transgender rights advocates are turning to those provisions to challenge laws they say violate basic health care. Last year, an Ohio appellate court struck down a law banning gender-affirming care for trans minors, finding it violated the state’s anti-Affordable Care Act amendments. The Ohio Supreme Court later stayed the ruling. An appeal is pending in the High Court.
Abortion is medical
Until the Wyoming Supreme Court’s 4-1 decision, no state supreme court had ruled on whether bans on abortion and trans health care violated the Affordable Care Act-era Health Care Freedom Amendment. johnson Upheld the trial court’s ruling that the state’s abortion ban was unconstitutional.
The court first discussed whether abortion qualifies as medical treatment. The state had asked the court to postpone Congress’ conclusion that abortion is not a medical procedure but the “intentional termination of the life of an unborn child.” Moreover, the state reasoned, there could be no right to access services that the state already criminalizes. The court rejected this argument, emphasizing that the Wyoming Supreme Court, not the state Legislature, is the final arbiter of the meaning of the state constitution.
The court then turned to the meaning of “health care” at the time the 2012 amendments were ratified. The state said only limited services necessary to “maintain a person’s health or recover from physical illness or pain” are eligible, and this limited definition does not include abortion. The court disagreed, holding that medical care includes services necessary to maintain a person’s “healthy body, mind, and spirit.” The court concluded that “pregnancy involves physical and psychological challenges and risks,” and defined abortion as medical care.
The state had argued that even though abortion is a medical procedure, it ends the life of a fetus that the state has an interest in protecting, so the decision to undergo an abortion is not solely a pregnant woman’s. In the court’s view, this argument confuses two issues: whether the decision to terminate an abortion belongs to the individual pregnant woman, and whether the state’s interest in protecting the life of the fetus can justify the restriction in question. Regarding the first question, the court held that the Wyoming Constitution protects the fundamental, individual right to make health care decisions, including abortion. The law further stated that the encumbrances on that right must be examined based on strict standards of review. This strict standard of review required states to prove that the law was narrowly tailored to serve a compelling government interest, which they were unable to meet.
The ban is not aimed at protecting the life of the unborn child.
Regardless of the answer to that question, the court declined to determine whether the state’s purported interest in preserving prenatal life from pregnancy was persuasive because it determined that the state had not shown that the abortion ban met the “strictly calibrated” scope of the strict scrutiny analysis.
Looking to whether the prohibition was more restrictive than necessary to achieve the state’s interests, and assuming it was unavoidable, the court focused on the exceptions to the law. The Life Act allows for abortion in several scenarios. First, “if a physician’s reasonable medical judgment is necessary to prevent the death of a pregnant woman.” Second, if the pregnancy is the result of incest or sexual assault, the survivor “shall report the act of incest or sexual assault to law enforcement and a copy of the report shall be provided to the physician.” Third, the “fetus” is “substantially likely to suffer from a fatal fetal abnormality or the pregnancy will prove to be a molar pregnancy.” There were well-worded exceptions to the ban on medical abortion, allowing abortion “if necessary to protect the woman from imminent danger that substantially endangers her life or health,” or in cases of rape or incest. This exception defines “imminent danger” to include “physical conditions only.”
The court highlighted the fatal fetal anomaly exception, which applies when there is a substantial possibility that the child will die within hours of birth. The report argued that the range of fatal fetal abnormalities is broader than defined by law, and includes children who are certain to die within days or weeks after birth, rather than hours. So how, the court asked, did forcing these women to carry term pregnancies serve “the compelling interest of protecting the life of the fetus without unduly interfering with the pregnant women’s right to make medical decisions?” The court reasoned that this exception did not meaningfully advance the state’s interest in protecting fetal life and forced patients to face risks to their health.
Additionally, the court expressed skepticism about language that limits “imminent danger” to physical conditions. The report pointed to irrefutable evidence that mental illnesses during pregnancy, such as perinatal depression and psychosis, pose a serious threat to the health of some patients. These conditions can lead patients to self-harm and otherwise increase the likelihood of adverse pregnancy outcomes. The court reasoned that excluding mental health harm from scenarios that might justify abortion failed to strike an appropriate balance between the state’s interest in preserving life and a woman’s right to make health care decisions.
The state’s rape and incest exceptions also proved problematic for courts. The majority saw no connection between the state’s rape and incest exception and the state’s purported interest in protecting the life of an unborn child. After all, if states believe that life begins at conception, why didn’t the state’s obligation to prevent abortion apply with equal force to cases of sexual abuse? Even if the state had other valid reasons for granting the exception, the court found that the Life Act’s reporting process, which requires survivors to report assaults to law enforcement and provide a copy of the report before health care providers can proceed, creates an unreasonable and often insurmountable hurdle for patients seeking abortions.
lonely opponent
Judge Kari Jo Gray dissented. She agreed that the state constitution recognizes the fundamental right to make health care decisions, including abortion, but believed the majority was incorrectly applying strict scrutiny. Mr Gray would have applied the “reasonable and necessary” standard. In his view, such a standard is required by the amendment’s language, which provides that “the Legislature may determine reasonable and necessary limitations on the rights granted under this article in order to protect the public health and general welfare or to accomplish any other purpose set forth in the Wyoming Constitution.”
Mr. Gray left some ambiguity about what such a standard would require, but it would be far more respectful of the state than the majority’s application of strict oversight. Under her standards, she said, the ban and its exclusions are permissible efforts to “save babies’ lives” and respect “pregnant women’s health care choices.” Mr Gray said they achieved this task by prioritizing “regulation of non-essential procedures”. (Judge John G. Fenn, in a similar opinion, said he used the same standard, but opined that the state had failed to prove the ban was a “reasonable and necessary” restriction.)
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The ruling is unlikely to end Wyoming’s abortion fight. The majority signaled that the Legislature could bring the issue before Wyoming voters, which would require a two-thirds majority in the state’s overwhelmingly Republican Legislature. It’s unclear how such an amendment would come to fruition, but recent polls show that 59 percent of Wyoming residents support broader access to abortion as allowed in the Life Act.
However johnson This is the country’s first major high court decision based on the right to medical freedom, but it is likely not the last. Advocates in states that have enacted similar amendments may look to the case as a model for challenging their own abortion regulations. While the Wyoming decision does not guarantee anything in state supreme courts, jurisdictions with different histories and geographic backgrounds, it may be a harbinger of future battles over the relationship between abortion and health care.
Mary Ziegler is the Martin Luther King Jr. Professor of Law at the University of California, Davis School of Law.
Recommended Citation: Mary Ziegler, Wyoming Supreme Court strikes down law banning abortionSᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (January 8, 2026), https://statecourtreport.org/our-work/analysis-opinion/wyoming-supreme-court-strikes-down-laws-banning-abortion
