Reality Check on Abortion Access in Pro-Access States

A collection of good reads, events from the week, and policy insights.

Welcome back to This Week in Abortion - Your roundup of good reads, news updates, and policy insights on abortion. First up we’ve got the Supreme Court, then I’ve gone deep on the feature this week, but I peppered in some humor. (If nothing else, I got myself chuckling.) Finally, a collection of the top news items from the last two weeks.

Good Reads about the Supreme Court

As you know by now, the Supreme Court released an opinion in FDA v. Alliance for Hippocratic Medicine that elicited a sigh of relief from those supporting access to abortion medication. But, it didn't settle any of the key questions. Some links:

• Great Analysis by Dahlia Lithwick And Mark Joseph Stern.

• Responses from the anti-abortion groups: “FDA's recklessness continues for now,” “Standing for Babies,”  “Some Observations on Today’s Ruling in FDA Abortion-Drug Case.”

• Since the links above make clear that the anti movement is coming for your mail, here is a primer on the Comstock Act.

Next up is EMTALA, the hearing left me hopeful.

Feature: Access in Pro-Access States

When we are talking about abortion access a ton of focus is placed, rightfully so, on the massive numbers of people who live in states with bans. But, what about those of us in states that are reliably pro-access? This is on my mind after I attended a panel discussion on access in Illinois, featuring some incredible speakers. You can see the video below.

As lucky as we are, it’s easy to forget that bans in anti-access states affect us too.  Illinois, California, and other states have absorbed the healthcare burden of anti-access communities. From lags in our own care, to our taxes, to our donations, residents in pro-access states are subsidizing basic care denied to others, at the same time we are fighting to preserve access in our own communities. 

If that pisses you off, good. This feature takes a look at the status of access for residents in pro-access states, future threats, and what you can do.

Status of Access: Today, at this moment, access for residents in pro-access states is OK.

In the year post-Dobbs pro-access states experienced an influx of patients - Illinois border clinics saw a 750% increase in patients from out of state. The deluge increased wait times for everyone, including in-state patients. But things seem to have gotten better. 

I checked in with Dr. Caitlin Myer, who - along with an army of research assistants - tracks wait times and other key access characteristics. She says, “At a high level, what we’ve observed is that appointment availability [has] generally improved. Now, with Florida enforcing a 6-week ban and redirecting thousands of patients north to North Carolina and Virginia, appointment availability has declined in those destinations. But it isn’t nearly as bad as we saw initially after Dobbs.”

So, the situation has improved, but it ain’t magic. Four things have helped:

1. Access to medicated abortions became easier, solidifying a decades-long trend. This trend relieves some of the demand for inpatient care, making it easier for patients in states with bans to get appointments.

2. Changes in state laws gave providers relief and flexibility. 14 states and DC now allow nurses to perform certain abortion procedures, increasing capacity for providers. Some states also increased access to contraceptives and set new requirements for insurance providers. (NCLS)

3. Money, money, money. Last June Sarah McCammon reported, “At least 15 municipal and six state governments allocated nearly $208 million to pay for contraception, abortion and support services…far more than the roughly $55 million spent on similar services in the three years before.”  In my home state of Illinois, at least $23 million was allocated for abortion support services in the past year. While I’m glad they are spending it, that’s nearly $2 a person that could have been spent on other things like roads, government debt, or - I don’t know - sending everyone a card on Pulaski Day. 

In the year after Dobbs, rage donations were also a major factor, helping to make the process for out-of-state patients more affordable and smoother, which has benefits across the system. Unfortunately, over time a lot of that giving has disappeared.

4. The community pulled together. I have seen this firsthand in Illinois, and it’s the same across the country. Advocates, practitioners, and governments got creative and pulled together. This coordination is especially beneficial to independent clinics who, although they “represent about 24 percent of all facilities offering abortion care,…provide 55 percent of all abortion procedures nationwide.” It’s also evident in programs like Illinois’ Complex Abortion Regional Line for Access, which provides patient navigation for complex abortion care. 

Future Threats: It was a fight to get to this point and it will be a fight to stay here

In fortified pro-access states, it’s possible to feel as safe and secure as in the pre-Dobbs days. And yes, things are pretty damn good. But, you should know, there are cracks in the walls.

• Access to medicated abortion is not guaranteed. There are more legal challenges ahead for mifepristone and misoprostol and the Comstock Act is looming large as one of the ways the anti-access movement will try to cut off access to everyone, regardless of where you live.

• Anti-access advocates have moved their money and attention from anti-access states to pro-access states and towns. They are pushing local ordinances that prevent clinics from opening, funding a rash of deceptive, crisis pregnancy centers, or just generally making it impossible for practitioners to do their work.

• The structural improvements and services that have allowed practitioners to keep up with demand post-Dobbs requires money. The reality is that donations to abortion funds and clinics will not return to the frenzied levels they reached post-Dobbs. It’s not clear how much of a hole this creates or if taxpayers will step in to fill it.

What you can do

As Sarah Garza Resnick, CEO of Personal PAC, said this week, “No one is coming to save us,” So, give and get creative. 

Two other speakers from the event - Chicago Abortion Fund and Hope Clinic - are on the front lines in Illinois. To find groups based in your state visit the National Network of Abortion Funds and Abortion Care Network.

Most importantly stay engaged. 

Even if you don’t have a uterus or know anyone who does (because…you’re a medieval monk?) that’s your tax dollars being spent.

Just think, if we treated abortion like any other health care, that money could be used during the dark days of a midwestern winter to wish every person in America a Happy Pulaski Day!

More News 

• 👍 In Texas, Amarillo City Council became the first border town in the state to shut down anti-access policies getting pushed on in their community.

• 👍👎 A federal judge in Arkansas rejected, for lack of standing, a bid by anti-access states to shut down new federal rules that require employers to provide reasonable accommodations for abortions. Meanwhile, a judge in Louisiana awarded an injunction in a separate challenge, blocking the enforcement of the rule in Louisiana and Missouri. 

• 👎 Remember those Republican women who fought for compromises (all be it very very very very modest ones) to South Carolina’s abortion ban? Well, two out of the three of them lost their primaries. Cara Mund, a pro-access Republican in North Dakota also lost her primary.

• 👎 A Missouri judge rejected a lawsuit brought by diverse religious leaders against Missouri’s abortion ban. 

• 🤷The Texas Medical Board issued rules regarding exceptions to the state’s abortion ban.

• 😯“We’re about to find out how pro-life the pro-life movement is,” That’s a quote from Albert Mohler after the Southern Baptists voted to denounce current standards of practice for in vitro fertilization practices like genetic health screening.

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