In 2019, the Iowa General Assembly passed a law adding funding conditions that barred abortion providers from participating in two federally funded educational grant programs. These programs focus on educating Iowa’s youth on sexual education, including pregnancy prevention. Planned Parenthood of the Heartland (PPH) has historically been a recipient of this grant.
As a condition of this grant, PPH has not been allowed to discuss abortion-related services as part of its federally funded educational programming. The 2019 amendment to Iowa law (the “Act”) provides that any contract for this funding must exclude from eligibility any applicant entity
that performs abortions, promotes abortions, maintains or operates a facility where abortions are performed or promoted, contracts or subcontracts with an entity that performs or promotes abortions, becomes or continues to be an affiliate of any entity that performs or promotes abortions, or regularly makes referrals to an entity that provides or promotes abortions or maintains or operates a facility where abortions are performed.
The Act also includes an exception which exempts from exclusionary language “any nonpublic entity that is a distinct location of a nonprofit health care delivery system, if the distinct location provides [CAPP or PREP] services but does not perform abortions or maintain or operate as a facility where abortions are performed.” Because PPH performs abortions in Iowa, the Act serves to bar PPH from accessing grant funding for educational programming.
Shortly after Governor Reynolds signed the Act into law, PPH brought a declaratory judgment action arguing the Act violated PPH’s rights to equal protection, due process, free speech, and free association under the Iowa Constitution. The district court granted PPH’s motion for summary judgment, ruling that the Act’s “nonprofit health care delivery system” exception made the Act so overinclusive and underinclusive that it failed a rational basis review. The Court reversed the district court in an opinion authored by Justice Oxley, joined by Chief Justice Christensen and Justices Waterman, Mansfield, McDonald, and McDermott.
The Court analyzed two challenges to the Act on appeal: whether the Act violates PPH’s equal protection rights under the Iowa Constitution and whether the Act violates the “unconstitutional conditions doctrine” because it would require PPH to give up its rights to free speech, free association, and due process right to provide abortions in order to be eligible for grant funds.
With respect to PPH’s equal protection claim, the Court found that rational basis, not strict scrutiny, was the appropriate standard of review. The Court noted that PPH argued that the Act did not have a rational basis because its abortion services are “wholly separate from,” and unrelated to, the educational programming it provided under the grant funds at issue in the Act. The Court credited this argument in holding that the Act, therefore, did not implicate Iowa women’s fundamental right to obtain an abortion, meaning that the Act did not trigger strict scrutiny.
The district court found that the Act failed rational basis review, but the Court disagreed. PPH argued that the Act is underinclusive, overinclusive, and not rationally related to a state interest. The State argued that the Act serves three legitimate interests: to express its preference for childbirth over abortion, to ensure that its state-sponsored sexual education message is not delivered by entities that derive significant revenue from abortion-related activities, and to avoid indirectly subsidizing abortion providers. The Court found these purposes to be legitimate, citing federal authority finding that the State is entitled to disapprove of and attempt to discourage abortion, and to refuse to fund abortion efforts—even indirectly.
PPH argued that if the Act’s purpose is to prohibit organization who provide abortion services to give sexual education, then the Act is underinclusive and does not rationally advance that interest, because the “nonprofit health care delivery system” exception allows some organizations that engage in abortion services to participate in the programs. PPH also argues that it is overinclusive it bars “entities that do not provide abortion in Iowa at all, but instead provide referrals for abortion, engage in advocacy to protect and expand abortion access, or associate with abortion providers or advocates.”
The Court disagreed. Because PPH performs 95 percent of the abortions in Iowa, it reasoned, barring PPH from participating in educational programming would further the interest in preventing entities who provide abortions from delivering the State’s sexual education message. Additionally, the Court found that the statute is not overinclusive because it does not deny funding to any entities that do not provide abortions.
PPH also argued the Act is unconstitutional because it violates the unconstitutional conditions doctrine, which prevents that government from requiring a recipient of government funds to forego certain constitutional rights as a condition to receiving the funds. The Court observed, however, that the State is not required to remain neutral on their viewpoint to controversial topics. The Court held that the legislature may impose limits of the use of funds to ensure they are used in the manner that the legislature intends, as long as it is constitutional. While PPH may, in certain circumstances, bring a lawsuit derivatively asserting its patients’ rights to obtain abortions, PPH itself lacks a due process right to provide abortions. Because the Act does not require PPH to forego any constitutional rights, the Court held the Act does not impose an unconstitutional condition.
Justice Appel dissented. He would have held that the Act imposed an unconstitutional condition on PPH because the Act amounted to an indirect attack on abortion rights. Justice Appel disagreed that PPH’s standing to vindicate the constitutional rights of its patients is not limited to “direct” challenges to abortion regulations rather than statutes such as the Act which may indirectly result in limiting the availability of abortion services.
Allison Adams is a student at the University of Iowa College of Law.
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