The Decisions We Forget: The Supreme Court Can Change Everything When Nobody's Looking

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Crisis pregnancy centers, or CPCs, are designed to dissuade pregnant people from terminating their pregnancies. But their tactics often go far beyond persuasion and veer into trickery. They are typically designed to look like abortion clinics, and many set up shop near a real clinic to confuse and intercept patients who are trying to access abortion care. Most do not have a medical professional, like a doctor or nurse, on staff. Still, they position themselves to look like real medical centers: Staff may dress in scrubs to convey the appearance of medical professionalism, and some offer no-cost tests and ultrasounds that are presented as professional services.

The issues with CPCs go beyond not providing genuine medical care—they pitch and frame their services as medical care even though it is not. Despite this deception, red, purple, and even some blue states don’t regulate or rein in these entities—in fact, many give them public money. Many states, such as Florida and Texas, have simultaneously refused to expand Medicaid under the Affordable Care Act, starving hospitals of the resources needed to maintain legitimate maternity wards. The upshot is that people seeking pregnancy-related health care, including maternal care for wanted pregnancies, frequently wind up at CPCs—which are unable to meet the most basic needs of patients.

How did all of this come to be? How could it even be legal to pose as a medical service when you are not giving medical advice? The backstory of these organizations—and the role they have come to occupy in today’s America—is one of the starkest examples of how Supreme Court decisions layer atop one another to change our society. Too often, we look at these rulings in isolation, missing their full impact. But Supreme Court decisions on religion, speech, states’ rights, and abortion all intersect. The path to how so many Americans live now—with dramatically restricted access to reproductive health care that often turns dangerous and even deadly—began well before the Supreme Court overturned Roe in 2022’s Dobbs v. Jackson Women’s Health Organization. It began when the increasingly conservative court facilitated an explosion in crisis pregnancy centers across the country.

By the late 1990s, however, the court’s conservative majority had substantially weakened the First Amendment’s bar against state subsidization of religious exercise and coercion. CPC supporters saw an opportunity, and devised what was essentially a test case: In 1999, Florida passed a law allowing drivers to pay extra for a “choose life” license plate; the state then funneled that money into CPCs, often through an intermediary like Catholic Charities. The scheme survived legal challenges. A majority of states have since adopted similar programs.

This precedent paved the way for a massive infusion of taxpayer dollars into the CPC network. In 2001, President George W. Bush went a step further, redirecting federal funds to CPCs, sending $30 million to the centers in his first term. Most of that money came from Bush’s abstinence-only education program. The funding paused during President Barack Obama’s tenure. But it roared back under President Donald Trump, who redirected money from Title X, the federal family-planning program, to CPCs. At the same time, Trump cracked down on funding for health care providers who offered or even mentioned abortion, starving them of federal funds.

Cases cited in excerpts:

Bowen v. Kendrick - https://www.oyez.org/cases/1987/87-253

Rosenberger v. Rector and Visitors of the University of Virginia - https://www.oyez.org/cases/1994/94-329

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