by Alexi Koseff for CalMatters
CalMatters is an independent public journalism venture covering California state politics and government. For more info, visit calmatters.org.
California abortion clinics are building new facilities closer to transit hubs and training more staff. A package of a dozen abortion rights bills moving through the Legislature could expand the number of providers, provide financial assistance to women traveling to California to terminate their pregnancies, and legally protect the doctors who treat them.
As new restrictions rapidly sweep the country in anticipation of a U.S. Supreme Court ruling this summer that may dramatically scale back or even end the constitutional right to abortion, California is preparing to step into the void — and welcome a possible surge of patients losing access in dozens of other states. That scenario seems more likely after Politico published a draft majority opinion by the court that would overturn Roe v. Wade.
“People from across the country are already looking to California as a haven state, as a beacon to provide them the care they need,” Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California, said during a recent online program. “It is our moral imperative that we continue to provide the leadership that people are looking for.”
Planned Parenthood, which operates about half of the 165 abortion clinics in California, reports that it has treated at least 80 out-of-state patients per month on average since September, when Texas adopted a law allowing residents to seek civil damages against anyone who aids an abortion after six weeks of pregnancy
That move turbocharged a political and cultural battle that has all but cut off abortion access in the most conservative parts of the country in recent years and sent advocates in liberal states scrambling to build a bulwark for reproductive rights.
Unable to secure an injunction against the Texas law while courts consider the legality of the novel attempt to circumvent Roe v. Wade — the landmark 1973 Supreme Court decision that protected the right to an abortion without excessive government restriction — clinics in the state shut down to avoid a deluge of lawsuits. Thousands of patients are now seeking abortions elsewhere, overwhelming neighboring Oklahoma and New Mexico and pushing some women further afield to more friendly states including California.
“The need right now of expanding access is pretty clear to all of us,” state Senate President Pro Tem Toni Atkins told reporters last month. The San Diego Democrat is carrying Senate Bill 1375, which would allow some nurse practitioners to independently perform first-trimester abortions without a doctor’s supervision.
Getting ready for more patients
Sue Dunlap, president and CEO of Planned Parenthood Los Angeles, said she has been preparing for years for the moment when the organization would have to become a haven for patients from all over the country who have nowhere else to turn for an abortion.
That has included expanding and reorganizing its network of facilities to be near airports, bus and train stations, and supportive emergency rooms and medical providers. Dunlap said she worked with UCLA’s law school to establish a new center for the study of reproductive health law and policy. Planned Parenthood Los Angeles also collaborates with medical schools across the country on abortion training, particularly in states where those opportunities might not otherwise exist.
Dunlap declined to provide data on how many out-of-state patients the organization serves, arguing that the numbers would not fully reflect the situation because of the secrecy and fear surrounding abortion. But she noted that Los Angeles, as a center of tourism and commerce, has long been a destination for women seeking abortions — even before it was legal, when patients often then crossed the border to Mexico for the procedure.
“Los Angeles is a place that people identify with ideas of freedoms,” Dunlap said. “Los Angeles is also a place that, when you don’t know where to go, you come here.”
The people who do come “are almost always in incredibly desperate situations,” she added, and many have more challenging circumstances and complications than in the past.
Dunlap mentioned a pregnant woman from Texas who was diagnosed with breast cancer, necessitating a double mastectomy. Though the woman did not want to terminate her pregnancy, Dunlap said, she had to travel to one of Planned Parenthood Los Angeles’ clinics in recent months because she could not get an abortion in her own state.
Planned Parenthood Mar Monte, which covers Northern and Central California and Northern Nevada, said it treated 66 out-of-state patients at its California clinics between September and March, including 22 patients from Texas. One of them was a college student who was prepared to use her scholarship money to fly to California until it provided her with a voucher, according to an anonymous patient testimony shared by the organization.
With Oklahoma and other states on the verge of shutting down abortion access as well, president and CEO Stacy Cross said the organization is preparing to take on between 250 and 500 more patients per week in its network of facilities.
Medication abortion is now available at all of its sites. Clinics are hiring more staff and making sure any medical provider who is licensed to perform abortions has the necessary training, even if they specialize in one of the other services that Planned Parenthood offers, so that they can schedule more appointments.
Next month, Planned Parenthood Mar Monte plans to break ground on a new, larger facility in Reno that is closer to the airport. Cross wants to add a second site in northern Nevada for what she anticipates will soon be more patients coming from Utah.
The work is personal for Cross: Both of her grandmothers died from a lack of access to reproductive care — one from an illegal abortion and the other in childbirth, delivering her ninth child at age 47, she said. She worries that Californians don’t fully understand how quickly and fully abortion access could shut down across the country if the Supreme Court reverses the Roe decision.
“Every time I even say those words out loud, it sends a chill down my back. It’s horrific to think about,” Cross said. But California has done an amazing job preparing: “We fill the gaps.”
Divide deepens between red and blue states
Those gaps are almost certain to widen in the months to come. Spurred on by the success of the Texas law, anti-abortion legislators across America are racing to advance new restrictions.
In just a one-week stretch this month, Republican Florida Gov. Ron DeSantis signed into law a ban on most abortions after 15 weeks of pregnancy; GOP Gov. Kevin Stitt of Oklahoma signed a bill making it a felony to perform an abortion in the state, punishable by up to 10 years in prison; and Republican legislators in Kentucky overrode a governor’s veto on a measure to impose broad new requirements on abortion providers that they say make it impossible for them to continue operating. A federal judge temporarily blocked the Kentucky law.
Though many of the policies are currently unconstitutional, conservative states are laying the groundwork in anticipation that the Supreme Court will soon uphold a Mississippi law that bans abortion after 15 weeks of pregnancy. A decision on that case is expected by June, and some experts believe the justices will take the opportunity to overturn the Roe ruling altogether, which would trigger near or complete bans on abortion in about half of states, including Arizona.
Liberal states are responding with their own measures to protect the right to abortion in law, and to increase access to accommodate a potential influx of patients from beyond their borders.
In November, Vermont voters will decide whether to amend the state constitution to enshrine reproductive autonomy, while Democratic Michigan Gov. Gretchen Whitmer is trying to circumvent her state’s Republican-controlled Legislature by asking the state Supreme Court to overturn a pre-Roe abortion ban that is still on the books.
Oregon recently approved a $15 million fund that could provide financial assistance to patients, including those from outside the state, who need help paying for abortion fees and other costs. Washington adopted legal protections against prosecuting people who aid an abortion or women who experience pregnancy losses. Democratic legislators in Maryland overrode a veto by the Republican governor to pass a bill that would require health insurance plans to cover abortions and put $3.5 million toward training providers.
Several states have adopted or are pursuing measures to expand who is authorized to perform an abortion to include other advanced medical professionals beyond doctors, such as nurse practitioners and physician assistants, following a move that California made more than a decade ago.
“California has been on the forefront for a long time,” said Elizabeth Nash, a state policy analyst for the Guttmacher Institute, which researches and promotes reproductive rights. “It has helped other states see what’s possible.”
Making California an abortion ‘sanctuary’
California is pushing further still. In September, after the Texas law took effect, Gov. Gavin Newsom convened the Future of Abortion Council, a coalition of reproductive rights, health and justice groups, to explore how to make the state a “sanctuary” for abortion. More than 40 policy recommendations, released in December, formed the basis for the sweeping legislative package now advancing at the Capitol.
If approved by the end of session in August and signed by Newsom, the measures would become law next year, though supporters hope some pieces might be incorporated into the state budget that must be approved by June 15. Those could kick in immediately this summer, when the Supreme Court decision on abortion is expected.
“There is definitely an urgency to get some of these things in place and get prepared, because this is happening regardless of whatever timeline our Legislature is on,” said Lisa Matsubara, general counsel and vice president of policy for Planned Parenthood Affiliates of California, which is sponsoring or co-sponsoring most of the bills in the package. “We are doing everything we can to make sure we are as ready as we can be.”
The centerpiece is SB 1142, by Democratic Sens. Anna Caballero of Salinas and Nancy Skinner of Berkeley, which would create a state-administered fund to assist patients who face financial barriers to obtaining an abortion and support public research into improving access. Advocates are seeking $20 million from the state to launch the fund.
There is also Assembly Bill 2134 by Assemblymember Akilah Weber, a San Diego Democrat, which would set aside money for clinics that provide uncompensated care to low-income patients whose insurance does not cover abortion and contraceptive services. Supporters argue the funding is crucial to ensure that not only wealthy women are able to travel to California for abortions.
Jessica Pinckney, executive director of Access Reproductive Justice, the only statewide abortion fund in California, says the bill could expand its grants to women who need help paying for their abortion, travel and lodging, lost wages, a doula or other expenses.
Last year, the Oakland-based fund supported 551 patients with an average of about $300, Pinckney said, not enough to meet anybody’s full need. She would also like to do more outreach to let women know the fund exists.
About 80 people the fund served were from 18 different states Pinckney added, but most are low-income or patients from one of the dozens of mostly rural counties without an abortion provider, who may need to travel hours and stay overnight for a multi-day abortion procedure in their second trimester.
“Even in the state of California, there are quite a few barriers,” Pinckney said. “This is an unmet need for Californians already.”
In recognition that conservative states may continue to ramp up legal and financial penalties for abortions, another collection of bills aims to protect doctors who travel to other states to perform the procedure or who treat out-of-state patients: AB 1666 by Assemblymember Rebecca Bauer-Kahan, an Orinda Democrat, would nullify civil judgments from other states related to reproductive care. AB 2091 by Assemblymember Mia Bonta, an Alameda Democrat, would prohibit medical providers and health insurers from sharing information in cases that seek to penalize abortion. AB 2626 by Assemblymember Lisa Calderon, a Whittier Democrat, would prevent the state medical board from suspending or revoking the license of a physician who is punished in another state for performing an abortion in accordance with California law.
Other major legislative efforts include Atkins’ bill to allow abortions by independent nurse practitioners and AB 1918 by Assemblymember Cottie Petrie-Norris, which would create a “reproductive health service corps” for underserved parts of the state.
“It’s about strengthening our foundation, our health care foundation, to expand the pool of health care professionals who can provide abortions,” Atkins said.
The measures are moving through the legislative process so far with widespread support from the overwhelmingly Democratic lawmakers, and seem likely to be approved if they reach the governor’s desk. Newsom already signed a law last month that prohibits health insurers from charging a co-pay or deductible for abortions, thus eliminating out-of-pocket costs for covered patients. He pledged that California would continue to “protect and advance reproductive freedom for all.”
Yet the bills have not been entirely without controversy. Hundreds of protesters gathered at the Capitol last week to oppose AB 2223 by Assemblymember Buffy Wicks, an Oakland Democrat, which would end a requirement that coroners investigate the cause of fetal deaths resulting from suspected self-induced abortions, clarify that women cannot be held criminally or civilly liable for pregnancy loss or abortion, and create an ability to sue prosecutors and others who violate that protection.
Protesters holding crosses and “Babies’ Lives Matter” signs packed onto the steps of the building to hear from Pastor Jack Hibbs of the Calvary Chapel Chino Hills megachurch. Nearby, a Christian band and twirling dancers led a crowd in a worship service.
Supporters say the measure is necessary to protect Californians from overzealous law enforcement and district attorneys who may be hostile to abortion rights. They point to two Kings County women who were charged with murder and imprisoned in the past five years after delivering stillbirths and testing positive for methamphetamine, in what Attorney General Rob Bonta has called a misapplication of the state criminal code. Advocates argue that fear of prosecution may deter some women from seeking necessary care.
But critics of the Wicks bill highlight a provision that states women cannot be penalized for “perinatal death due to a pregnancy-related cause,” referring to a baby who dies in an undefined period immediately after birth, which they contend is so vague as to legalize infanticide.
“It is trying to really tear down one of the few restrictions that California does have when it comes to terminating pregnancies, and that is the actual point of delivery,” Jonathan Keller, president of the religious advocacy group California Family Council, said following the Capitol rally.
While Wicks has vehemently denied that’s what the measure would or is intended to do, Keller said, “Intentions don’t matter. It’s actual legislative text that matters.” He added that the outrage has helped his group organize broader and more fervent opposition to the abortion legislation than it has managed in the past.
“We do think that many of the bills in this package are actually out of step with the state of California,” Keller said, including the fund to help out-of-state women travel to California for abortion care. He calls it “abortion tourism.”
His claims have been picked up by the Republican National Committee, which issued a statement denouncing Wicks’ bill and calling abortion “murder,” but seem unlikely to gain much traction in the Democrat-dominated Legislature.
At the first committee hearing for the bill, following the rally, only one legislator questioned Wicks, who slammed her opponents’ tactics: “These same groups that are trying to ban abortion across this country and imprison people for stillbirths have manufactured a disinformation campaign using disturbing and violent imagery that is not grounded in medical science or the text of the bill,” she said.
Despite nearly an hour of testimony from opponents, the bill sailed through on an 11-3 vote.