Abortion debate: Here are 13 ways California is preparing for influx of out-of-state patients

As the country braces for a Supreme Court decision that could overturn Roe v. Wade, California lawmakers are speeding ahead to expand abortion care and protect providers in the Golden State to meet an expected surge in demand for help from out-of-state women.

Until recently, the rate of abortion procedures has been declining in California. But the state could be the nearest provider for up to 1.4 million women of reproductive age who could no longer have access to abortion in their home states, particularly for those who live in Arizona.

“California’s role will be very important,” said Dr. Ushma Upadhyay of UC San Francisco’s Department of Obstetrics, Gynecology & Reproductive Science. “We will signal to people across the country that California supports their reproductive rights, and we’ll help them obtain this basic health care service.”

Without more abortion providers and funding, women here could face longer wait times — and clinics could experience greater costs and stress, say providers.

State legislators are now considering a package of 13 bills to help California meet the demand. And Gov. Gavin Newsom has promised more money, pledging $125 million in the state’s upcoming budget.

These efforts focus, in general, on meeting the two greatest needs: increasing providers and decreasing costs. But they also aim to protect pregnant people and abortion providers from legal persecution, bolster security of clinics and create a web page with centralized information for anyone seeking care.

“Millions of more people are going to continue to need access to abortion. That is why it’s crucial that California continue to take steps to not just protect abortion access, but expand access,” said Brandon Richards of Planned Parenthood Affiliates of California.

It is not yet known exactly what the Supreme Court’s ruling on a new Mississippi abortion law, expected this month or in early July, will say. An early draft opinion, obtained by Politico, indicated that it would overturn Roe v. Wade, the landmark ruling nearly 50 years ago that guaranteed the constitutional right to abortion,  pushing the issue of whether abortion is legal to individual states.

This would be a seismic shift in the nation’s legal landscape, because 26 U.S. states are on track to ban abortions, including 13 that will go into effect immediately. In two states adjacent to California – Nevada and Oregon — abortion rights are protected, so the decision will not force people there to leave home.

But in Arizona, on California’s southern border, the ruling could have an immediate effect, restricting most abortions after 15 weeks of pregnancy. Planned Parenthood and other providers are expanding services near the Arizona border.

UC San Francisco and other specialty care providers in the Bay Area are expected to treat out-of-state women who are suffering from complicated pregnancies in the second trimester and are suffering from a medical crisis.

Residents of places much farther from California may also choose to travel to the Golden State if they have family or friends here, or prefer the anonymity of a big state, experts say. If wait times lengthen in other states, they may be desperate for more prompt treatment.

California is already the nation’s leader in abortion access, according to a nationwide analysis by the Guttmacher Institute, a reproductive health research group. The state covers the cost for lower-income Californians on Medi-Cal, and also requires private insurance to cover the procedures. There’s no waiting period or parental consent requirement.

Anyone can seek an abortion in California for any reason if the fetus cannot survive outside the womb. Typically, that’s until the 24th week of the pregnancy. Abortion is available after 24 weeks in California if continuing the pregnancy threatens the life or health of the pregnant person.

Among likely voters in the state, 76% said they did not want Roe vs. Wade overturned, according to a poll earlier this year by the nonpartisan Public Policy Institute of California.

On Wednesday, Democratic legislative leaders introduced a bill that would amend the California Constitution to permanently enshrine abortion rights. While the Constitution has a right to privacy that has been interpreted to cover the right to an abortion, this amendment would explicitly protect the procedure. It is likely to be approved by a supermajority of Democrats in both legislative houses by the end of June, then would be placed on the Nov. 8 statewide ballot — a move that could motivate Golden State voters during this fall’s high-stakes mid-term elections.

The proposal is one of a flurry of abortion-related bills in Sacramento. Several would help boost the number of providers. One would focus on training nurse practitioners, certified nurse-midwives, and physicians’ assistants. Another would create a Reproductive Health Service Corps to recruit providers in underserved areas. And others would strive to shield clinicians from civil and criminal liability if they provide abortions to out-of-state patients, and help providers get professional liability coverage.

Other bills are focused on protecting patients, enhancing the privacy of medical records related to abortion and pregnancy and not complying with subpoenas from other states.

Also under consideration are bills that would boost funding. One helps subsidize abortion expenses; another pays for the “practical support” work, such as airfare, gas money or lodging, of community-based organizations.

Anti-abortion groups are gearing up to oppose the legislative push and are criticizing state leaders for turning California into what they call “a hub for abortion tourism” for women from out of state.

“The only thing that’s missing are tickets to Disneyland,” said Susan Arnall, vice president of Legal Affairs for the Right to Life League.

Among Californians, the demand for abortion has declined, with a 16% decrease in the rate between 2014 and 2017 at the state’s 419 facilities, the last time data was collected. But even before the leak of the draft Supreme Court opinion, Planned Parenthood was seeing an influx of 500 out-of-state patients per month seeking reproductive health care, according to Richards.