After the bombshell leak of a supreme court draft opinion last week revealed that the majority of justices plan to overturn Roe v Wade, a handful of states have been reaffirming and expanding their abortion care.
In recent days, a flurry of bills and statements have been emerging in largely Democratic-run states as lawmakers and organizations scramble to prepare for the possibility of a post-Roe America.
As some states seek to become “safe havens” for out-of-state abortion seekers, other states have been increasing abortion funding, expanding provider access and offering legal protections from lawsuits launched by citizen “bounty-hunters” against those involved in abortions.
Only 38% of women of reproductive age live in states that have shown support for abortion rights, according to the research organization Guttmacher Institute. In contrast, 58% live in states that have demonstrated hostility towards abortion rights. Only 4% of women live in middle-ground states.
Last month, the New York state senator Liz Krueger introduced a bill that would shield New York doctors who offer abortion services to out-of-state patients by prohibiting law enforcement from cooperating with out-of-state investigations on abortion provisions.
“At this critical moment New York must ensure abortion access both to New Yorkers and refugees from other states who are being denied their basic rights,” Krueger told the Guardian.
“We must provide iron-clad protection for New York healthcare providers against abhorrent and regressive laws in other states,” she added.
Similarly, Alessandra Biaggi, another New York state senator, introduced a bill that would create an abortion access fund and allow taxpayers to contribute to it.
“We created this bill to make sure that we were not just saying that people have a right to an abortion, but also that they have access to it because we know that simply by just saying the right does not mean that people have the means to do it,” Biaggi told the Guardian.
In addition to transportation costs, the fund would cover childcare services, lodging, various medical expenses and other logistical support.
Biaggi also introduced another bill that would offer out-of-state women who seek abortion or gender-affirming services the claim of “unlawful interference” with their rights if they end up facing criminal or civil complaints.
In Connecticut, Governor Ned Lamont signed a bill into law that will protect people who provide or receive abortion services in Connecticut and are then sued in another state.
The first-in-the-nation law, which is set to take effect on 1 July, will also improve abortion access in Connecticut by expanding the type of practitioners eligible to perform certain abortion-related care.
“We want to make sure that we have the healthcare infrastructure to provide for not only our own residents, but also the folks who are going to be coming here for care,” state representative Matt Blumenthal, who co-sponsored the bill, said.
As Connecticut is poised to become one of the country’s few safe havens, lawmakers like Blumenthal are well aware of the challenges that will come with an uptick in out-of-state abortion seekers.
“A possible influx in out-of-state patients … is definitely a concern. We’ve already seen individuals coming from Texas to get abortion care here in Connecticut and that was one of the reasons we wanted to expand the providers eligible to give the care,” he said.
Blumenthal added, “We got important sources of funding in our budget this year to protect reproductive healthcare in the state and that’s very important because you know the people who are going to be affected by these bans in other states are going to be disproportionately people of low income, people of color who can’t afford to travel freely.”
Another state that has been weaving additional abortion care funds into its laws is Oregon. In February, the state legislature established the Reproductive Health Equity Fund which will allocate $15m to the non-profit Seeding Justice for expanded abortion access.
Seeding Justice has described the fund, which will help Oregon brace for the abortion ban in neighboring Idaho, as a “once-in-a-lifetime opportunity to invest in abortion access as a central part of Oregon’s healthcare infrastructure”.
“These funds are meant to be holistic …Those funds are really focused on patients get[ting] care and extending provider capacity,” An Do, executive director of Planned Parenthood Advocates of Oregon, said.
Do continued, “Within Oregon, we know that we need to be ramping up our healthcare infrastructure … and shrinking the access desert … so I think that is a big place to be able to make investments.”
California has similarly positioned itself as “a refuge state” of abortion rights. In January, the state legislature introduced a package of 13 bills to designate California as a sanctuary for abortion care.
In addition to offering more legal protection to out-of-state patients and providers’ privacy, the bills seek to expand the number of providers that are able to perform abortion services.
One bill seeks to remove co-pays, deductibles and other cost-sharing requirements for abortions for all state-licensed health care service plans that are issued after 2022. Another bill would deny out-of-state subpoenas for patient information on reproductive health services that are granted in California.
Other bills seek to protect California abortion providers by prohibiting the removal or suspension of medical licenses for a California licensee providing abortion care who is complying with state law.
In Colorado, lawmakers are also rushing to codify abortion access protections. Colorado is one of the few states that does not require a 72-hour waiting period after abortion counseling. It also does not have any restrictions surrounding when in a pregnancy an abortion can take place.
In April, Colorado’s governor, Jared Polis, signed the Reproductive Health Equity Act, officially encoding the right to abortion into state law.
According to the Colorado health department, 13% of the 10,400 abortion seekers who had the procedure in Colorado in 2020 were from out of state. As at least three of Colorado’s immediate neighbors are certain or likely to ban abortion if Roe v Wade gets overturned, the state is preparing for an uptick in out-of-state abortion seekers, which may push Colorado residents further way to seek care.
Greer Donley, a law professor at the University of Pittsburgh who specializes in reproductive healthcare, told the Guardian, “People will feel the effects of Roe being overturned, even if their state continues to allow abortion provision.”
“The primary way they will see these effects is through the wait times … If half the states ban all or most abortions within the next few months, then the clinics in blue states will be inundated with patients traveling from out of state,” she said.
As a result, Colorado clinics have vowed to do everything they can in order to expand access to abortion providers as they struggle with worker shortages, lengthy wait times and post-abortion complications.
“Capacity is critical. We know that clinics in access states are scheduling patients in weeks rather than days and they have added more exam rooms by consolidating offices and waiting areas. And opening new facilities is difficult, as is finding staff, since we are in a healthcare worker shortage,” said Elizabeth Nash, Guttmacher Institute’s state policy expert.
“For patients, helping them pay for the abortion and abortion-related travel is key,” she added.
In Maryland, lawmakers passed a bill last month that allows medical professionals other than physicians to perform abortions. The law will allow nurse practitioners, nurse midwives and trained physician assistants to carry out the procedure.
In addition, the law will require the state to invest $3.5m annually in abortion-care training and will require the majority of insurance providers in the state to cover abortion costs.
Last month, Governor Gretchen Whitmer of Michigan filed a lawsuit in a state court that seeks to strike down the state’s 1931 law that criminalizes abortions unless they are performed to protect a woman’s life.
The lawsuit also seeks to establish the right to an abortion in the state’s constitution.
Despite the various steps that progressive states have taken to expand abortion access, some still have certain restrictions in place that need to be removed to ensure abortion care is fully accessible.
In addition to capacity problems, another significant restriction is costs. “States need to look at how they help people pay for abortions, as we know that most patients pay out-of-pocket for their abortion,” Nash said.
With at least 26 states poised to, likely or certain to ban abortions if Roe v Wade is overturned, the fight for abortion rights is more urgent than ever.
“I can’t underscore how seismic a change this is,” said An Do. “We never lost a constitutional right. This is just the beginning … They [the justices] have written us all out of the constitution. What’s next is marriage equality, what’s next is so many people’s access to birth control.
“We cannot be apathetic and we cannot lose ourselves into despair. We need to fight tooth and nail.”