Planned Parenthood of Heartland, Inc. v. Reynolds, No. 20-0804

CourtUnited States State Supreme Court of Iowa
Writing for the CourtOXLEY, Justice.
PartiesPLANNED PARENTHOOD OF THE HEARTLAND, INC., on behalf of itself and its patients, Appellee, v. KIM REYNOLDS, IOWA DEPARTMENT OF HUMAN SERVICES, IOWA DEPARTMENT OF PUBLIC HEALTH, and KELLY GARCIA in her Official Capacity as Director of the Iowa Department of Human Services and Interim Director of the Iowa Department of Public Health, Appellants.
Decision Date30 June 2021
Docket NumberNo. 20-0804

on behalf of itself and its patients, Appellee,
and KELLY GARCIA in her Official Capacity as Director of the Iowa Department of Human Services
and Interim Director of the Iowa Department of Public Health, Appellants.

No. 20-0804


Submitted March 23, 2021
June 30, 2021

Appeal from the Iowa District Court for Polk County, Paul Scott, Judge.

State and state agencies appeal district court order declaring Act placing conditions on participation in federally funded grant programs unconstitutional. REVERSED AND REMANDED.

Oxley, J., delivered the opinion of the court, in which Christensen, C.J., and Waterman, Mansfield, McDonald, and McDermott, JJ., joined. Appel, J., filed a dissenting opinion.

Thomas J. Miller, Attorney General, Jeffrey S. Thompson, Solicitor General, Thomas J. Ogden (argued), Assistant Attorney General, for appellants.

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Julie A. Murray (argued) and Carrie Y. Flaxman of Planned Parenthood Federation of America, Washington, D.C., and Rita Bettis Austen of America Civil Liberties Union of Iowa Foundation, Des Moines, for appellee.

Alan R. Ostergren, Des Moines, and Charles D. Hurley, Urbandale, for amicus curiae the Family Leader Foundation.

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OXLEY, Justice.

The Iowa General Assembly enacted sections 99 and 100 of House File 766, which added funding conditions prohibiting abortion providers from participating in two federally funded educational grant programs directed at reducing teenage pregnancy and promoting abstinence. A former grantee of both grants, now ineligible to receive funding, immediately sought declaratory and injunctive relief on the basis that the conditions violated its constitutional rights. The district court agreed and enjoined enforcement of the legislative enactments. Upon careful analysis of the challenged constitutional rights and the State's interest in selecting the messenger for its programs, we conclude the conditions are rationally related to the classification selected by the general assembly. Because an abortion provider lacks a freestanding constitutional right to provide abortions, any conditions premised on providing abortions cannot be considered unconstitutional. We reverse the district court's order striking down sections 99 and 100 of House File 766.

I. Background Facts and Proceedings.

Planned Parenthood of the Heartland (PPH) challenges an amendment to Iowa law that prevents it from receiving federal grant funding under two state-administered programs in which it has historically participated: the Community Adolescent Pregnancy Prevention Program (CAPP), administered by the Iowa Department of Human Services, and the Personal Responsibility Education Program (PREP), administered by the Iowa Department of Public Health. The state agencies award federal grants to third parties through a competitive bidding process. Both programs focus on educating Iowa's youth about sexual education, including pregnancy prevention. PREP is particularly focused on providing programming to select counties in an effort to reduce teen

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pregnancies and sexually transmitted infections (STIs) in high-risk areas of the state.

As a condition of the grants, recipients must use state-selected curricula in both programs. Neither curriculum allows discussion about abortion, and the funds for the programs are strictly prohibited from being used to support abortion-related services. The parties stipulate that PPH has neither used grant funding for abortion-related services nor discussed abortion as part of CAPP or PREP programming in the past.

PPH has been a grantee of CAPP and PREP funding since 2005 and 2012, respectively. In some cases, PPH has partnered with schools that do not otherwise have similar programming or trained personnel to provide CAPP and PREP programs. During the 2018-2019 contract period, PPH received awards of $182,797 for CAPP and $85,000 for PREP programming. PPH used that funding to provide CAPP or PREP services in ten different counties. In five of those counties (Des Moines, Lee, Linn, Pottawattamie, and Woodbury Counties), PPH was the only fiscal year 2020 CAPP or PREP applicant. If PPH does not receive funding for these grants, those five counties will likely not receive any CAPP or PREP programming.

On June 11, 2019, PPH signed four two-year CAPP contracts with the Iowa Department of Human Services and was approved for $463,374 in grant funding for CAPP programming during the first two-year period. On July 31, PPH signed a one-year PREP contract with the Iowa Department of Public Health containing three one-year renewal options and was awarded $85,076 in grant funding for the first year of PREP programming. PPH estimates the loss of CAPP and PREP funding will result in a 28% reduction in its education budget.

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On April 27, 2019, the Iowa General Assembly passed sections 99 and 100 of House File 766 (the Act), which provide that any contract for CAPP or PREP funding entered into on or after July 1, 2019, 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.

2019 Iowa Acts ch. 85, §§ 99(1) (CAPP funding), 100(1) (PREP funding). Although the Act is written in general terms, an exception exempts from the 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.

Id. at §§ 99(1), 100(2). PPH asserts the exception is intended to benefit at least two existing CAPP and PREP grantees within the UnityPoint hospital system. On May 3, Governor Kim Reynolds signed the Act into law.

By its terms, the Act clearly precludes PPH from participating in the CAPP and PREP programs. In 2017, PPH performed approximately 95% of all abortions in Iowa. Aside from PPH, only one other provider in Iowa performs abortions that are generally available to the public. Upon patient request, all PPH health centers refer patients for abortion care. PPH also engages in advocacy that supports access to abortion services for patients who decide to have an abortion. PPH is an ancillary organization of Planned Parenthood North Central States, a Planned Parenthood affiliate.

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Shortly after the Governor signed the bill, 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. On May 29, the District Court for Polk County issued a temporary injunction enjoining enforcement of the Act, finding that PPH was likely to prevail on its equal protection claim. Two days later, on May 31, the Iowa Department of Human Services and the Iowa Department of Public Health, respectively, sent notices of intent to award PPH a three-year contract for CAPP programming and a four-year contract for PREP programming.

After cross motions for summary judgment, the district court granted PPH's motion for summary judgment. The district court concluded 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 State appealed, and we retained the appeal.

II. Standard of Review.

"We review constitutional claims de novo." AFSCME Iowa Council 61 v. State, 928 N.W.2d 21, 31 (Iowa 2019). In reviewing constitutional challenges to statutes, "we must remember that statutes are cloaked with a presumption of constitutionality. The challenger bears a heavy burden, because it must prove the unconstitutionality beyond a reasonable doubt." Id. (quoting State v. Seering, 701 N.W.2d 655, 661 (Iowa 2005), superseded by statute on other grounds, 2009 Iowa Acts ch. 119, § 3 (codified at Iowa Code § 692A.103 (Supp. 2009)), as recognized in In re T.H., 913 N.W.2d 578, 587-88 (Iowa 2018)).

III. Analysis.

PPH raises two primary challenges to the Act. PPH alleges the Act violates its equal protection rights under the Iowa Constitution by

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unconstitutionally distinguishing between those who provide and advocate for abortion and those who do not. It also challenges the Act under the unconstitutional conditions doctrine, arguing the Act conditions the receipt of government funds on PPH giving up its rights to free speech, free association, and a due process right to provide abortions.

A. Equal Protection Challenge. PPH claims that the Act violates its right to equal protection under article I, sections 11 and 62 of the Iowa Constitution. In support of that contention, PPH argues that the Act is underinclusive, overinclusive, and not rationally related to a state interest. Alternatively, PPH argues the Act burdens its fundamental rights such that we should subject the Act to strict scrutiny review. We conclude rational basis is the appropriate level of scrutiny, and the Act passes rational basis review.

While federal precedent is instructive when interpreting Iowa's similar equal protection provisions, we are not bound to follow federal analysis in construing Iowa's constitutional provisions. See Varnum v. Brien, 763 N.W.2d 862, 878 & n.6 (Iowa 2009). We zealously protect our constitution's equal protection mandate, but we must also respect the legislative process, which means we start with a presumption that legislative enactments are constitutional. AFSCME Iowa Council 61, 928 N.W.2d at 31-32.

Iowa's tripartite system of government requires

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