Wyoming Supreme Court Strikes Down Laws Banning Abortion

The Wyoming Supreme Court held this week that the state’s abortion ban violated the right of each Wyomingite “to make his or her own health care decisions,” protected under the state constitution. The holding could have important ramifications for challenges to abortion bans across the country that are based on a general right to health care.

Health Care Freedom Amendments

In the case, State v. Johnson, a group of medical providers, patients, and organizations challenged the constitutionality of two 2023 laws — Wyoming’s Life Act, which criminalizes virtually all abortions, and a ban on abortion medication. The plaintiffs argued that both abortion bans violated the right to make health care decisions, as protected by a 2012 amendment passed to limit the reach of the Affordable Care Act. A trial court blocked enforcement of the laws in a November 2024 ruling, concluding that they violated the amendment.

Wyoming was one of six states — with Alabama, Arizona, Florida, Ohio, and Oklahoma — that passed health care freedom amendments in response to the Affordable Care Act. In the aftermath of the act’s passage, conservatives argued that the new federal health care law restricted patients’ choices over their own health care. This argument inspired amendments like Wyoming’s, which were often framed broadly, simply protecting the right to “make health care decisions.” These amendments were largely symbolic: Federal law would have trumped state law to the extent any limits on patient choice arose.

But now, a decade and a half later, abortion and transgender rights advocates have turned to these provisions to challenge laws that infringe on what they say is basic health care. Last year, an Ohio appellate court struck down a law banning gender-affirming care for trans minors, finding it violated that state’s anti-Affordable Care Act amendment. The Ohio Supreme Court later stayed the ruling; an appeal is pending before the high court.

Abortion Is Health Care

No state supreme court had issued a decision about whether bans on abortion or trans health care violated an Affordable Care Act-era health care freedom amendment until the Wyoming Supreme Court’s 4–1 ruling in Johnson affirming the trial court’s holding that the state’s abortion bans were unconstitutional.

The court first addressed whether abortion qualified as health care. The state had urged the court to defer to the legislature’s conclusion that abortion was not health care but the “intentional termination of the life of an unborn baby.” By extension, the state reasoned, there could be no right to access a service that the state already criminalized. The court rejected this argument, stressing that the Wyoming Supreme Court, not the state legislature, was the final arbiter of the state constitution’s meaning.

The court then turned to the meaning of “health care” at the time the 2012 amendment was ratified. The state said that only a narrow set of services qualified — those needed to “maintain the physical condition of the individual or to restore her condition from physical disease or pain” — and that this restricted definition did not cover abortion. The court disagreed: Health care included services needed to make an individual “sound in body, mind, or spirit.” Concluding that “pregnancy comes with physical and emotional challenges and risks,” the court defined abortion as health care.

The state had argued that even if abortion were health care, the decision to undergo the procedure was not a pregnant person’s alone because it terminated a fetal life, which the state had an interest in protecting. In the court’s view, this assertion conflated two issues: whether abortion decisions belonged individually to pregnant people and whether the state’s interest in protecting fetal life could justify otherwise problematic restrictions. As to the first question, the court held that the Wyoming Constitution protected a fundamental, individual right to make health care decisions that encompassed abortion. It then said that any burden on that right must be reviewed under a strict scrutiny standard, a demanding test that required the state to show that a law was narrowly tailored to serve a compelling government interest — one the state could not meet.

The Bans are Not Narrowly Tailored to Protect Fetal Life

The court declined to decide if the state’s asserted interest in preserving prenatal life from conception was compelling because the court found that, regardless of the answer to that question, the state had not demonstrated the abortion bans satisfy the “narrowly tailored” prong of the strict scrutiny analysis.

Turning to whether the bans were more restrictive than necessary to achieve the state’s interest, assuming it was compelling, the court zeroed in on the laws’ exceptions. The Life Act allowed for abortions in several scenarios: first, if “necessary in the physician’s reasonable medical judgment to prevent the death of the pregnant woman;” second, when a pregnancy was the result of incest or sexual assault, provided that the survivor “report the act of incest or sexual assault to a law enforcement agency and a copy of the report shall be provided to the physician;” and third, when there was “a substantial likelihood that the unborn baby” had “a lethal fetal anomaly or the pregnancy is determined to be a molar pregnancy.” The medication abortion ban had exceptions that were worded differently, allowing abortion when “necessary to preserve the woman from an imminent peril that substantially endangers her life or health,” as well as in cases of rape or incest. This exception defined “imminent peril” to include “only a physical condition.”

The court highlighted the exception for fatal fetal abnormalities, which applied when there was a “substantial likelihood of death of the child within hours” of a live birth. It opined that the universe of fatal fetal abnormalities was broader than defined in the law, including children who were certain to die within days or weeks, rather than hours, of birth. How then, the court asked, did it serve “the compelling interest of protecting unborn life without unduly interfering with a pregnant woman’s right to make the health care decision” to force these women to carry pregnancies to term? The court reasoned that the exception forced patients to face risks to their health without meaningfully advancing the state’s interest in protecting fetal life.

The court then expressed skepticism about the language limiting “imminent peril” to physical conditions. It pointed to unrebutted evidence that mental illness during pregnancy, such as perinatal depression or psychosis, posed a serious threat to the health of some patients. These conditions could lead patients to self-harm or otherwise increase the odds of adverse pregnancy outcomes. Excluding harm to mental health from scenarios that could warrant an abortion, the court reasoned, failed to properly balance the state’s interest in protecting life and women’s right to make health care decisions.

The state’s rape and incest exceptions also proved problematic for the court. The majority saw no connection between the state’s rape and incest exception and the state’s claimed interest in protecting fetal life. After all, if the state believed that life began at conception, why didn’t the state’s obligation to stop abortion apply with equal force in cases of sexual abuse? Even if the state had some other justification for its exception, the court found that the Life Act’s reporting procedure — which required survivors to report their assault to law enforcement and produce a copy of that report before a provider could proceed — created an unjustified and often insurmountable obstacle for patients seeking an abortion.

The Lone Dissent

Justice Kari Jo Gray dissented. Although she agreed that the state constitution recognized a fundamental right to make health care decisions that encompassed abortion, she believed that the majority incorrectly applied strict scrutiny. Gray would have applied a “reasonable and necessary” standard. In her view, such a standard was required by language in the amendment providing that “the legislature may determine reasonable and necessary restrictions on the rights granted under this section to protect the health and general welfare of the people or to accomplish the other purposes set forth in the Wyoming Constitution.”

While Gray left some ambiguity as to what such a standard would require, it was far more deferential to the state than the majority’s application of strict scrutiny. Under her standard, she said, the bans and their exclusions were a permissible effort to both “save the baby’s life” and respect “a pregnant woman’s health care choices.” They accomplished this task, Gray stated, by prioritizing “the regulation of non-essential procedures.” (In a concurrence, Justice John G. Fenn said he would have used the same standard, but opined the state had failed to prove the bans “reasonable and necessary” restrictions.)

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The ruling is unlikely to end abortion battles in Wyoming: The majority signaled that the legislature could put the issue before Wyoming voters, a move that would require a two-thirds majority vote in the state’s overwhelmingly Republican legislature. It is unclear how such an amendment would fare, although recent polling suggests that 59 percent of Wyoming residents backed broader abortion access than that authorized under the Life Act.

Though Johnson is the country’s first major high court decision based on a right to health care freedom, it likely won’t be the last. Advocates in states with similar amendments may look to the case as a model for challenging their own abortion restrictions. While the Wyoming decision does not guarantee anything in jurisdictions with different state supreme courts, histories, and regional contexts, it may offer a preview of coming fights 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.

Suggested Citation: Mary Ziegler, Wyoming Supreme Court Strikes Down Laws Banning Abortion, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (Jan. 8, 2026), https://statecourtreport.org/our-work/analysis-opinion/wyoming-supreme-court-strikes-down-laws-banning-abortion