we'll hear argument this morning in case number sixteen eleven forty the national institute of family and life advocates vs be sarah was the first mr chief justice and may it please the court california took aim at pro life pr d centers by compelling license centers to point the way to an abortion and imposing onerous advertising rules on unlicensed senators who do not provide ultrasounds or any other medical services the state then provide exemptions for all other medical other side if the state where they had all women could have provided that perform abortions would have to tell the patients if you would like to carry the pregnancy to term you have access to clinics that will assist them provide  similar case in the casey decision from pennsylvania pennsylvania or impose that recorder meant in the context of an informed consent discussion informed consent is triggered by a doctor proposing to perform a particular medical intervention medical interventions or surgeries abortion is a medical intervention and in that case the medical interventions require the discussion of the benefits of the procedure the risk of the procedure  parenthood center in pennsylvania did pregnancy tests and ultrasounds but did not perform abortions requiring that planned panic parents that are they talked about abortion encouraged abortion that would be unconstitutional to compel them to give this disclaimer because it's not a procedure that makes justice ginsburg to protect her own question but i was interested her in her question the hypothetical case yes the hypothetical case is doctors who were offering abortion services have to say that if the pregnancy is carried to a full full term there's a certain your honor that it would be the hypothetical case i understand your honor if the state anchors that in the informed consent framework then it would be patients that if they want to carry the pregnancy to term they can have assistants call this number yes that is in the context of proposing a medical intervention describing the alternatives in this court in harris mrs mccreight and in casey indicated that the state has an additional interest beyond the health of the woman in the interests of advancing the life of the unborn child to a degree can't go too far if you are saying that it is a non medical facility i mean i don't want to put words in your mouth this is a question if there is a non medical facility that the state has reason to think is i telling women about only one set of options and not another set of options but here the case would be their only telling women about abortion providers and they're not telling women about other way is that they may be able to complete their pregnancy that the state could not impose a requirement that that facility post a notice saying in fact there are many kinds of facilities in the world and some are abortion providers and some are crisis pregnancy centers and some are something else that that that would not be permissible your honor that would be decided since it's an unlicensed facility the requirement is being framed up everything turns on whether a medical procedure was going to be performed and my hypothetical was designed to take out the medical procedure in other words this is a facility that just prefers women but it's refers women only to abortion providers and the state decides we don't want facilities that refer women only to abortion providers we want facilities that will tell women about the full range of their options and so the question is would a requirement that such a facility post a notice saying there actually are a lot of options and here is how you can access them would that be unconstitutional yes you are because under your hypothetical it's a targeted law it's aimed at particular people and not given to all doctors who diagnose it confirmed pregnancies and what if it wasn't targeted what if there were a state law that required every doctor or facility that provides medical treatment for pregnant women to post a notice setting out the full range of options available to those women and where they might obtain services at no cost if those if if those are available would there be anything wrong with a law like that where your honor if it's done in a manner similar to what's being done here in california to require pro life doctors whether in the clinic or otherwise to point the way to no borson facility and to facilitate abortion would be constitutionally problem probably one if it did that what if this notice provided for set out all of the options and it applied to everybody so it would apply to pro life facilities but it would also apply to clinics that perform abortions i understand provided no other form of assistance for pregnant women your honor the i think the i can would still be the same perhaps it would arise in our family are the outcome would still be the same as my prior answer i'm sorry  and that was what and that is it would be unconstitutional to require that statement to a doctor who is pro life principally because of the free exercise issues that would arise in that case but this case is different because not only is the  requirements of which doctors have to give the notice gerrymandered the notice itself is gerrymandered it is not giving women all their options the notification required says that the state will pay for abortion services but it does not tell california women it will pay for pregnancy there are a lot of different things i mean the simple basic thing if you can just say it as simply as possible in law as you well know what is sauce for the goose is sauce for the ga and so i think what's bothering from these questions people is it bothers me there are pro choice states and there are pro life states all right so if a pro life state condell a doctor you have to tell people about adoption why can't a pro choice state tell a doctor facility of whatever it is you have to tell people about abortion say that simple one we've said you can make a doctor who is very pro life teller about abortion ok get it and why don't we have to say to keep sauces the same well you're a pro choice state then  you can make these people tell them about abortions your honor if it is simply a line of demarcation about your position on abortion that would be unconstitutional in any state but the laws that have been upheld are doctors who are going to perform abortions not if you want to draw laws as to whether it's actually the doctor medical treatment about to do it as not yes ok i got my other question and so on the other one i have is you have a totally different line in which you are attacking this and that is you say which is certainly a point that this death picks out sixty to seventy really pro life facilities and says you have to post these signs but nobody else does right isn't that if you had your own ok now what are that sounds like a you have a point there if that's correct but there no have to be a trial on that what do you argue to this is just a preliminary injunction don't you have to have a trial or present some evidence i don't know what your evidence is i don't know what the evidence is on the other side and can we decide that without knowing the evidence or your honor the the gerrymandering of the statute is evidence from the face of the statute the way the statute works is that it begins by only regulating clinics that are licensed under section two a will for the california code that is limited principally to nonprofit community clinics so all doctors in private practice are out of the statute to begin with in the state admits this in its brief additionally among those nonprofit clinics the clinics that are  in general practice are exempted out even though they serve pregnant women then you take the class the last gerrymandering in the chain is among those that are principally giving pregnancy services if you're willing to sign up for the state's family pact program which requires you to dispense abortifacient drugs then you're out of the program as well so through its clever series of legislative gerrymandering the state has ended up with the result that only nonprofit pro life pregnancy centers are required to post a notice and the notice itself is bias along those lines one of the question occurs to me that similar to justice briar's with respect to the adequacy that record we have for on licensed clinics  we don't have a lot of evidence with respect to the nature of the burden that would be imposed by the forty eight font requirement on all ads there's some evidence in the amicus briefs that it might be like a nine thousand dollars a month tax for advertisements but when what do we do about the lack of a record here and whether we should wait for an as applied challenge you wanted as a government suggests your honor this court faced a similar situation that i've been as case where there was a detail disclosure required a certain financial profession and this court didn't have a financial record it didn't have a financial record in the miami herald case either it would simply read the statute made common sense inferences in the advertising context the rule is the font must be larger than the main body of the ad or the same size as the main body of the ad with special fonts and colors if that's the case think of a chevrolet ad where the warnings about are there disclaimers about financing had to be as big or bigger than the word chevrolet that is not an effort to inform people that's an effort to clutter the ad and drown out the message of the ad we do and we know that right we don't know what kind treat pregnant women are required to the same requirements but when there is special imposition upon a targeted group of people because they don't like their position on abortion that is a form of targeting that this court outlawed in sorow and that's what's going on here can can you please explain to me what the differences between the license and on license in terms of the services certainly and then i have a question based on that but you seem to be basing your argument on the point that at least the unlicensed people are not providing procedures correct they're not providing any medical services is earl there they are advertising themselves i looked at one of the few of them and exemplary of this is the fallbrook pregnancy resource center website and it's i'm fairly sophisticated there's a woman on the home page with a uniform that looks like a nurse's uniform in ultrasound machine it shows an exam room the text of the page titled abortion says fallbrook will educate clients about different abortion methods available and describe in medical terms different abortion procedures the website also says clients will be evaluated by nurses and that they follow all hipaa regulations which if they're not a medical provider they don't have to follow hipaa if a reasonable person could look at this website and think that you're giving medical advice with the unlicenced know this be wrong your honor to answer the first part of your question are unlicensed facilities do not provide any medical services being defined as but they do provide medical ridiculous well they provide advice on the topic of pregnancy which would be so let me ask you how's that different from what a doctor does when you're going for a pregnancy you see the doctor and the doctor will describe hopefully the benefits of a pregnancy and perhaps it's risky because depending not all pregnancies are without complications so this is consulting about a medical condition how is that any different than casey you come in to talk to a doctor about abortion the state says you have to tell but her son the alternatives your honor so if you're going to choose to talk to people about if you're an unlicensed facility about pregnancy why shouldn't you tell people that you're the doctor or your honor in in k c again the doctors that were being regulated were the ones that were performing abortion in the court made note in k c that it up held that requirement because it was parallel to the general practice of informed consent unlicensed people who talk to women say you can choose parenthood you can talk about adoption they talk about the issue of pregnancy to be sure though is it ok for is it wrong for  agencies to give advice on immigration rights scope with states like this who say if you're going to give advice on immigration matters you better tell people you're not a lawyer those are unconstitutional no your honor  that new york statute that does that gives those immigration people who are required to give the notice the ability to intervene in cases in matters that would otherwise be the practice of law and so what that it mounts to assume or to a statute referred to by the state in  brief where natural pads and other alternative providers who are clearly otherwise engaged in the practice of medicine are allowed to do so if they were describing medicine medicine as defined by the state you need a license to practice medicine true in normal circumstances where you're giving people advice about pregnancy when you're not a licensed facility please explain to me what is both misleading incorrect or suggestive in any way that a person has to do something like go to this stuff to a doctor how's that doing anything other than telling people that despite how the picture looks on the is not a medical facility your honor it is illegal in california to practice medicine without a license is illegal to pretend to protect practice medicine without a license if that's what's going on here surely california would have found a way to do that very well in this case i didn't go beyond the record to look on the internet because i don't think we should do that but i do have a hypothetical what would happen if an unlicensed and a t unlicensed center just had a billboard that said choose life would they have to make the disclosure yes you're right so they had to make a twenty one or twenty word i mean words and for right it would be twenty nine words twenty twenty twenty nine words in the same size fought in the same size of his life and a number of languages whatever is now are but that county if we can ask we can ask the state of california with the state of california disagree with that do you think i mean you know no i don't think they'll disagree because it seems to me that that means that this is an undue burden in that instance and that should suffice to invalidate the statute yes your honor that's our position mr farris can i ask you've been pending a lot when you've tried to distinguish casey on the idea of informed consent and certainly some of the requirements in casey are informed consent in the way we would understand that talking about the risks of various procedures all the things that we want doctors to talk about when we go to them and seek medical care but there were definitely requirements in k c that don't have much to do with informed consent as i've ever understood it you know that that the doctor having to inform patients about that medical assistance benefits may be available for childbirth and neonatal care inform women that the father would be liable to pay child support so those kinds of requirements that they just don't seem to have much to do about informed consent and they are and this goes back to justice briar's sauce for the goose point that they're really the exact flip side of the requirements in this case so how am i supposed to think about that your honor they are triggered by a medical intervention rather than in this case is triggered by a disclosure was that that's a factual difference that there's a doctor in the room and in one case there's not but these are not informed consent requirements your honor this court held they were in casey because they were components of informing women about the alternatives to the abortion process i see that my time is it got to the point i'd like to reserve the balance for rebuttal thank you thank you  mr chief justice and may please the court the first amendment allows states to require truthful factual disclosures about one's own goods or services what the first amendment does not allow and what california has done is to require pregnancy centers to make disclosures about services they do not provide and that would violate their most deeply held beliefs without any showing by the state that it truly needs to compose speech rather than speak its own message what that is is that when about if they  if you are providing women's health services you have to list all the services that you provide now let them apply to everybody it would apply to that provide abortion in time deceptive the all providers across the board in the state you've got to put a notice on the wall that lists the services you provide that looks to the united states like truthful factual information about what you are doing that seems like you know pretty close to the core of souter i think the concern here is that the license notice in california and similar statutes in two states are why you know annoy or really different from the vast bulk of disclosure requirements like that one i didn't understand the question to be along the lines that you've answered it's not simply a requirement of whether or state decides we want you to tell the public what you provide what you provide and that's all i may have misunderstood the question to the extent the notice is about your own services and we think that is permissible it's a disco the truthful disclosure about your own services as you move away from that in the way that three states have done then i think you're triggering heightened scrutiny of the first amendment which in your view clad family planning clinics do not have to tell any woman about a bore adoption i think it depends on whether it's time they don't provide adoption is not their service as as physicians are saying if it is just a center that counsels people on abortion in a general sense no it doesn't center that helps women plan their families that's what it is now that it's not they don't have doctors who are performing abortions there i'm just saying it's a family planning center ok it's an information center my pumps point is the same there are millions of people in this country who have views on this subject that are absolutely opposed one to the other so that to me suggests the law should keep it as simple as possible and that's why sauce for the goose sauce for the gander i mean we have the law is permissible which says doctor you must tell the woman about adoption then why shouldn't the law say family planning center you must tell the woman about abortion sounds even handed sounds as if everybody in the same business is out of the same rooms you the government and and the and if you are trying to make a distinction there and i need to know if you're right the only distinction i hear so far is one has a doctor about to perform and the other has just a counsellor or is there any other distinction possible just for that is the crucial distinction i agree with you on the sauces for the goose and the candor but when you are performing a medical procedure and you're making disclosures about your own services what the plurality opinion in case he says this is a page eighty  what i think for most people you'd think family planning you know family planning that the category and the woman will make a decision and then the state can tell them some things they have to say and we know they can tell them about adoption they can make make them tell them about adoption so why can't they make them tell them about abortion because justice breyer that when you are going in to have a procedure and you've got to make certain disclosures that's a disclosure of the related to it we just let him finish the answer please that's a disclosure related to the service that you're providing and then it's just a question of how much you have to disclose and casey drew that should say go ahead you've got to make an informed choice and all the government is saying we're not saying not comes for the gander we agree what we're saying is the more you get away from that kind of a disclosure that's about what you're doing with or customer client the more scrutiny it ought to get under the first and think the question is why shouldn't there is a state says you know what this is the regime we want we want to say to family planning clinics that they should put up a poster saying we do family planning we do not do adoption and we want to say crisis pregnancy centers along the lines of petitioners here we do adoption we do not do family planning or abortion and and and and the state thinks that would be a good system because when a woman goes into either one of these kinds of places don't know what's there and the know what's not there and why would that be problematic well i think because once it's no longer tied to the specific goods or services that the clinic or center or whomever is is providing then the more we ought to be worried that they're making you just advertise what other people are doing and this case is even one step beyond your hypothetical because it's not even saying to the clinic say what you do and don't do it saying look we want people to know about services that the state is trying to hide and that different than casey in case we required doctors to hand them a state created materials selling the women about what services the state and others provided adoptions cen fathers had to pay things now i think your distinction and you keep repeating it is these sensors i'm assuming both the license and unlicensed ones are not doing procedures but i don't know what an ult sound is it's not a procedure i don't know what a pregnancy test is it's not a procedure i don't know how counseling on the pregnancy state is not part of medical advice in the same way a doctor gives it when he's considering an abortion procedure i don't understand the difference so both of them are doing medical related procedures and both are being asked that she said there's a distinction in not advertising someone else's services but in case we permitted it so please explain to me again why there's a difference here so just sudden where i agree with everything you said in the back half there and if california were coming in and saying before you license clinic perform an ultrasound you've got to provide certain information to make sure that's an informed choice but that woman to get the ultrasound in the face of risks and alternatives then it's like casey and the question is just how much disclosure do you have to provide and casey i think gives us important guidance on that california's notice isn't doing that at least on the license side on the license side it's not helping the women who come into the clinic make an informed choice to opt into one of the medical procedures and i'm not disputing that ultrasound and the rest are procedures that could trigger those kinds of disclosure requirements it's saying we have a generalized interest in having them know that we provide some low in free cost services and if that's their generalized interest that's tailor made to an obvious alternative which is a let the state do what pregnancy centers do and i'm somehow both are going to provide for your time expired cannot can i ask you something about your brief that that troubles me and that is th government's request that we recognize a new category of speech called professional speech which is subject to a lesser standard of review and this case is very important in itself but adopting this new category of speech would have far reaching consequences and i would like you to explain why that is consistent with stevens and other cases where the court has recently said we are not going to recognize any new categories of unprotected speech and how you would define the boundaries of professional speech and there's been a lot of cases on there been some cases on this in lower courts but just to take a couple of examples journalists are professionals so would they be subject to this standard how about economists how about climate scientists how about a fortune teller the fourth circuit said that a fortune teller is a is a  professional how about somebody who writes an advice column for parents wouldn't be we be getting into very dangerous territory if we do this so justice alito there's a lot there and i swear i make a few points and i think the third circuit's opinion king does a pretty nice job of this the court's already talked about professional speech now it's often talked about it in the context of commercial speech and it's lump them together in cases legs out or in a rollup but what we tried to do in our brief was to say look there are similar doctrines they overlap but they have somewhat different origins and historically there are certain professions that are regulated that wouldn't include fortune tellers that wouldn't include economists or journalists but it would include doctors and lawyers and maybe accountants and so we do think that there is some room for the states historically in that area and what we've tried to say is whether it's souter or some equivalent for professional speech if it's a disclosure about what you're doing we should think that's a fairly low level of scrutiny and the more that we shift away from that even in the commercial and professional speech box we may not get to strict scrutiny but it is heightened scrutiny and the state's license notice can't satisfy i would say if the court goes all the way to strict scrutiny every corrective disclosure that a manufacturer has to make about some product that it's put out in the public that has a risk i think would get strict scrutiny and our concern is that's going to dilute strict scrutiny and we're concerned that's going to undermine the first amendment thank you mr walsh thank you to climb mr chief justice and may it please the court the interest served by the license disclosure is very much like that of the disclosure in casey promoting informed choice by a patient more specifically it allows  empowers the woman by explaining that her financial circumstance does not make her unable to access alternative and supplemental care including full prenatal and delivery care that petitioners do not themselves supply and it gives her that knowledge in time to be useful because pregnancy and medical care is extraordinarily time critical there is a sense when you read this statute mr klein there's at least a question that arises as to whether this statute has been gerrymandered so would you speak to that because if it has been gerrymandered that's a serious issue and other words if you know it's like we have these general disclosure requirements but we don't really want to apply them generally we just want to apply them to some speakers who speech we don't much like your honor the disclosure is targeted at women who seek free care for pregnancy not that any particular viewpoint and clinics that by their very licensing status provide free or sliding scale low cost pregnancy care are the ones where those women are going to be found and where this information is immediately useful to them or if you have a that's neutral on its face but then it has a lot of crazy exemptions and when you apply all the exemptions what you're left with is a very strange pattern a gee it turns out that just about the only clinics that are covered by this are pro life clinics you think it's possible to infer intentional discrimination in that situation yes that kind of hypothetical can support ok so let me ask you about some of these exemptions which i think are hard to understand why does this apply only to clinics whose primary function is providing service to pregnant women you could have a small clinic let's say it's it has thirty pregnant women come in a month but that's the primary thing it does then you could have a big clinic that has one hundred pregnant women come in a month but it does so many other things that the pregnancy is not the primary concern why would why was the applied to one and not the other what you wanted that serves the purpose of having the disclosure mostly made in the context in which it's useful as opposed to being made in a lot of context where it's not and this court has said that legislature should be encouraged to apply speech requirements more narrowly when they can read it i mean i don't understand that what how why does it apply almost only to for it to mom profits and not for profits if the purpose is to get this information out to poor women don't you think there are examples of poor women who stumble into a for profit facility wouldn't it be beneficial to for them to know that they could get treatment at no cost through the state why are most for profits exempted you honor as a category for profit clinics do not seem to treat primarily women who need free and sliding costs citing cost care in the same way now i will say it's always possible to imagine a new boundary for the law but under intermediate scrutiny a law does not need to be perfect and a legislature  concentrate its efforts that where the need for the law is about individual doctors why are they your honor individual doctors specialize as a category in treating people who have a way to pay for care whether they're already in gold in medicaid or health insurance or whether they just have the finances free clinics are not on the same see when you put all of this together you get a very suspicious pattern and i don't know that we need to go into statistics about what the percentage of covered clinics are are pro life and whether or not but we do we have an amicus brief from a party in the state court case where the state court held that this law is unconstitutional and according to their statistics ninety eight point five percent of the covered clinics are pro life clinics you know yes and i understand we're speaking outside of the record here but that that keys evidence in the state court did not was off by i think a factor of ten in terms of how many covered and on i mean it it differed by a factor of ten when it told the state court how many covered non anti abortion what is your position  what's the percentage your honor the state does not have firm numbers on this we have done a preliminary assessment which found a significant number of non anti abortion covered facilities however i will also say that deriving this from purely state databases is very tricky because they rely on self reporting that's hard to interpret as to who really does primarily pregnancy care it's exactly the kind of thing you could  say a few words about how these boundaries came about in other words you have these various lines that the statute draws and then it has these exemptions and what was the state thinking i mean you know and i realize that the state you know there are problem is but tell me how you knew where the problem was tell me how what you thought the problem actually was what were you doing what were you trying to do well let me start with the question of what the problem is and the problem is that the has overseen the state legislature has overseen an expansion of public medical care in california but as experienced that publicity campaigns invariably leave a gap that was highly concerning to them in the pregnancy context because of the medical issues and because of the severe timing constraints to get care that makes a difference and so the the goal of the statute is to identify women who are seeking pregnancy care and appear unable to pay for it themselves or through insurance or public coverage they already have that's why it's targeted at free clinics now there was a reference to exemptions and the exemption leaving aside the exemption for federal clinics which i think  is obvious the exemption for medicare providers reflects that a notice would serve little purpose at a provider which already provides care under those programs and which has the incentive to mean women in goal in one way to think about how late this gets an act it is to say where we're really concerned that there are low income women don't have a lot of access to information don't realize what all their options are want to make sure in general and across the board that they get the best information that's available to them another way to think about what the problem is and how a statute like this comes about is more targeted it's to say there are these crisis pregnancy centers all over california and we know that women into them and they don't realize what they are and they're being subject to being misled and we think that this is a terrible problem and it might be that you know that the state could legitimately view that as a problem as a much more targeted problem whether it's a problem or not it's much more targeted than the first and i guess what i'm asking is is this the second kind of statute or is it the first kind of statute it's the first kind of statute in the author's verbatim statement first kind of statute then why shouldn't this court pick cognizance of the state's other available means to provide messages if it's about just ensuring that everyone has full information about their options why should the state free ride on a limited number of clinics to provide that information well you wanted the state the legislature is aware of the shortcomings of other methods as evidenced by the gap that has remained despite their efforts to publicize now what you describe is as freewriting i respectfully submit is a permissible speech requirement in the professional context well but if you're trying to educate a class of persons about their rights it's pretty unusual to force a private speaker to do that for you under the first amendment if you don't i don't think it's unusual to require a professional to explain alternatives as  or additional options that are available as in casey and also as in the laws that have been cited in our brief the new york maybe i'm sorry maybe you could finish your answer justice kagan's question let me ask first what is the party out a i don't know i don't even remember which was the first kind of statute anymore in which was the second kind of statute but i was saying a state could really be responding to a sort of generalized of a feeling that in general poor women don't have access to information or a state could be responding to a feeling that there are a particular kind of center that is misleading women as to what they do and don't provide and i can see this statute arising in either of those two ways and wanted you to tell me why you thought it arose in the first way and not in the second right well let me say i don't think there are exclusive the primary issue is women not knowing where they can get the free care they need for all of their options including carrying a healthy pregnancy to term and having a healthy baby but obviously the informational problem is going to be especially concerning where there are cases of think i got the impression that there are about six years so senators maybe seventy that are really pro life for religious reasons of different kinds right and they don't want to talk about abortions and then it seemed to me maybe there are a thousand senators all together in california or several hundred and i really did end up wondering well you know all those centers of the poor women really get the information about free abortions i have no idea i mean the fact that they may have helped medical thing doesn't mean they tell everybody about it i don't know what they're like so this is my question don't we need a trial on this and i don't see you i mean i'm just telling you right now i have no idea and your answers don't tell me they're not imperial you haven't told me whether women who don't go to these sixty seven centers but do go to say seven hundred are all informed  center is a is a is a member of the cal medical program or not i don't know whether they're all in for and i suspect that you don't either and therefore i i think trial that's what they're for what's the answer to that your honor we agree you're going into the record at the preliminary injunction stage which is all this concerns was not sufficient to support an injunction at a marriage stage there would presumably be a great deal of evidence on both sides just said pro life and put their name it appears as if the law would require them to have the statement this is not a medical facility in forty eight point five but like offering obstetric ultrasound sonograms right what if it weren't dealing with the more general principle what if you had an organization that simply provided adoption services and advertised there is an alternative to abortion try adoption could the state make them include the disclosure requirement that you have with respect to license facilities because that's an alternative to pregnancy i would say you'd want to make all the abortion alternatives also fully available  and make the low income women aware of those who do and those that requirement on that facility i don't think so your honor and it wouldn't end such a requirement wouldn't be serving the same interest and let me explain why these to set the licensed facilities provide medical care page ninety one of the petitioners appendix their complaint describes medical care they provide to pregnant women and so women go there so what additional and what ultrasounds or discussion of family planning what more would it take to require the adoption center to be covered any one of the ones that you have listed for licensed centers in other words what would make it subjected to the same kind of requirements a license center yeah and what point you know you say let's say that ultrasounds are out of it is that disclosure still required for that facility and i don't think the ultrasounds per se make the difference what would make the difference as a constitutional matter is is that licensed as a medical facility and does it provide medical care to people who didn't see testing if the an option center also provided pregnancy testing could you cover them if it provided it as a as a licensed medical service through licensed medical providers then the state would have to justify the sufficiently important state interest with the and what taught your answer that it provides to services adoption and pregnancy testing could you impose the disclosure requirement on that facility and your honor i think it would be much more difficult to justify oh that's why i'm asking the question right trying to figure out i'm trying to figure out the limits of your argument i mean the the centers here have a variety of services they provide and you say because of that we can impose this requirement on them now before we can a say yes or no to your argument i would like to know the limits of it a silty that provides adoption services and pregnancy testing can they be covered by your law through a licensed provider yes they could not just said they do i don't know what you mean by through a license for and that is all they do they counsel adoption and they provide pregnancy testing could you require them to say look there are other options you may want to consider and therefore here's a disclosure saying you hear the facilities where you can get other options under fluxion i think probably not  here's the difference because they're providing ace so much more limited set of medical services that it may be less misapplying best to go back to my question i have read the law with respect to facility and it requires a facility to do one of two of four things before it qualifies under the law so unfortunately your appear right that  they have to one off for ultrasounds obstruct that's sonograms or prenatal care pregnancy or pregnancy testing or diagnosis or  three prenatal monogrammed test or pregnancy and for collect health data but they have to do two more more of those things but let's go back to the question justice kennedy asked one of these medical care facilities s pro life and their name is that are they required to post a notice and you started answering that question and i don't think you finished it in the answer is no they're not required to be as they are now offering in the advertising one of these services because they're not right they're not doing too bad it's not it's not only where that is in the statute if it's a covered facility then any ad that they put out including one that just says choose life has to it has to include this disclaimer we're not licensed but in order to be a covered unlicensed facility it has to do two or more yes it has to do those things so you have this facility offers pregnancy testing and they advertise that they offer pregnancy tests and that's all they do and they put up with an ad that says choose life they have to put in the disclaimer if if yes in that circumstance they may be required to do that and do you agree that mandating speech that the speaker would not otherwise give indeed does not agree with alters the content of the message yes it does right so then you're saying that on this billboard you the st require that the message be the content of the message be altered even though they're not providing medical services yes your honor because the criteria are designed not to see who's providing medical services that's taken care of by our unlicensed practice law it's designed to address instances where the services that are offered and provided could make a woman believe that she's going to have be accessing medical services and is spending her time and resources to to do targeting the religion is not part of this calculus and in the case that you have well your honor your hypothetical statute did target at evangelical groups that is on its face unconstitutional so i'm assuming we want to take it out  languages it can be very weird if your honor if the statute if in application to a kind of ad that centers otherwise have been running and would run if it makes it too burdensome to place those ads the statute would be unconstitutional as applied to that what is that situation for los angeles county this is california law you should know the answer somebody is going to put up an ad a covered and licensed facility to post an ad in los that they used to run that it would be impossible to run it that way would be unconstitutional but that requires actual standing and what kind of any other reason if it's what kind of an end would as to what type of and with that not be unconstitutional well your honor there is nothing in the record about what ads these plaintiffs do in fact run so we don't know we do know this doesn't apply to t v and radio ads for instance but i want to make sure if i may to address one so you want me to have francisco has for instance but in any case that doesn't address the such a procedure would not be superior first that kind of policing that kind of issue would not necessarily be more speech familiar i mean any fraud provisions in commercial speech are well known and and don't pose any of the problems we've been discussing today so why wouldn't that be a superior mechanism for addressing these concerns if if we're talking about a narrower set of concerns you know fraud concerns so the narrower concerns which are not the only ones here it could be significantly more or at least it's an open question about whether it would be as or more speech intrusive to be really getting into everything that the petitioners are saying to assess it as opposed to requiring a two sentence notice that mostly obviates the need for that because it gives women the information to protect themselves and make informed decisions in the very limited time that they have available simply by seeing the notice to call the government and the one to one is prophylactic and requires you to compel speech from someone else that implicates first amendment concerns the second is puts the burden on the government to prove the someone has abused their free speech rights and this court's normally pretty jealously protective of speech so why isn't again that the latter approach preferable for the same reason that it wasn't a necessary step in casey because in the regulation of professional speech the government given the close and reliant really ation ship that the patient has on her physician can require a certain amount of speech to ensure that the patient makes informed decisions about very important matters the main difference from casey is how much less burdensome this disclosure is because there's more flexibility in how it can be delivered and because it's only giving a phone number for the patient to call and get information from the government rather than requiring the physician to herself and over a complete state written pamphlet which is what the disclosure in casey required would it be fair to say and i still don't have a full lancer to my question right pro life nothing else unlicensed facility it meets all of the criteria has an ad that says just pro life and puts its name does it have to give the notice yes or no yes if it meets the other criteria and it's possible is by job and seems to me more burdensome and wrong because it's not tie to an advertisement that is promoting medical five of our reply brief indo to we point out the state's website for where the state tells low income women how they can go to private doctors and get information or get services for pregnancy yet those doctors are all exempt from the can this a ct as are all nonprofit clinics that have the general kind of practice the justice alito is question described as to the aberdeen burden but the amicus heartbeat international on page twenty four of their brief gave mock up of what an ad would look like when you have simply a pregnancy of questions and a phone number and all that the language is required in los angeles county that's what it would look like and it's clearly burdensome and the aired on your honor that that's not correct it was raised below is our reply brief sets out it's in the complaint it's in the briefing of the district court is the oral argument the district court is the briefing an oral argument in the court of appeals all those details  on footnote five of our reply brief the good for the goose good for the gander concerned here's what's going to happen if california's laws upheld a pro life state is going to find out that there isn't no difference anymore between people who perform abortions and those who counsel about it who talk about it if merely talking about abortion is sufficient to require you to give pro life and ration we have taken a big step in the wrong direction of politicize in the practice of medicine if everyone who recommends abortion can have to give these kind of i mean that's since it was my it's it's you have to be a professional group giving advice in a professional way it's not i don't think who some gander has to do with everybody in the world it has to do and there are things called plan family planning clinics etc certainly your honor and so taking it on narrow in a broader construction the narrow construction the is i understood your hypothetical as a family planning center the didn't actually perform abortions but did all the other services i believe it would be unconstitutional in a pro life state to require that center because to give a pro life kind of disclaimer this was required in pennsylvania because they're not doing anything that relates to the practice of medicine in that context but taking the broader construction if we're not going to gerrymander this and say all doctors who treat pregnant women have to give all the options if if that's the case doctors who advise to deliver and doctors who advise to get abortions are going to be swept into this requirement and the political ramifications of that are enormous we should not politicize the practice of medicine in that way and the line that casey drew between performing abortions versus advising about abortions is a constitutionally appropriate line and if you want to rest thank you counsel the case is submitted