‘All hands on deck': Some states brace for influx of patients if Roe is struck down

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Clinics say they have been preparing for months, but they will need more help to scale up to accommodate potentially thousands more people.

In southern Illinois, a few miles from the Missouri border, a clinic that provides abortion procedures is preparing for a deluge.

The Planned Parenthood clinic in Fairview Heights is surrounded by “trigger law” states that would immediately ban abortions if Roe v. Wade is struck down. If that happens, the clinic could see upward of 15,000 more patients a year, about half of the additional patients expected to flow to Illinois.

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It’s trying to get ahead of the inundation. The clinic has posted five new positions, and it’s considering operating seven days a week, up from six, with 12-hour day and nighttime shifts. 

But it’s already clear it will need more help.

Reproductive rights
Anti-abortion activists wave at passing cars outside the Planned Parenthood clinic in Fairview Heights, Ill., on March 8, 2022. Neeta Satam / The Washington Post via Getty Images
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“In all of the ecosystem of abortion care, there is not now, nor will there be, enough resources to take care of the catastrophe that is impending,” said Dr. Colleen McNicholas, a physician who works at the clinic, which is jointly operated with Hope Clinic in nearby Granite City, Illinois. “But we are going to continue to work with the folks who are committed and providing those resources.”In the days that followed the leak of a Supreme Court draft opinion that would overturn long-standing constitutional protections for abortion rights, Illinois and several other states committed to protect abortion rights if Roe were overruled. Clinics in those states say they have been preparing for months by adding staff members, forming coalitions and raising money. But as pressure mounts to service potentially thousands more people, many say they will need more help to scale up.

“There needs to be an all-hands-on-deck approach to this,” McNicholas said, adding that in addition to assistance from the private sector, clinics need lawmakers to follow through on promises to fund infrastructure and security. 

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Illinois Gov. J.B. Pritzker, who in 2019 signed a law establishing a fundamental right to reproductive health care, vowed that “abortion will always be safe and legal here in Illinois.” 

In Montana, the Blue Mountain Clinic, which has provided abortion care in Missoula for the last 45 years, is bracing for an influx of women from the surrounding states of Idaho, Wyoming and North and South Dakota, and even farther out, if the landmark ruling is flipped.

The clinic has already seen women from Texas traveling up to 1,600 miles for care since Texas passed a law banning abortions at around six weeks of pregnancy, before most women know they are pregnant, without any exceptions for rape and incest.

“We care for people who have really difficult circumstances and are already faced with a lot of barriers in Montana being a rural state. Many folks have to travel 200 to 300 miles one way for care, so we’re already helping people that are facing a lot of burdens, and we imagine that those burdens are just going to continue to increase,” said Nicole Smith, the executive director of the nonprofit clinic.  

Staff members at the blue mountain clinic in missoula, mont.
Staff members at the Blue Mountain Clinic in in Missoula, Mont.Courtesy Blue Mountain Clinic

The clinic is buying more equipment, training additional abortion counselors and upgrading security systems to accommodate an increase in demand, Smith said, adding that it will do whatever it takes to keep its doors open despite financial hardships. 

“My staff have been chronically underpaid for two decades, and financial resources are definitely something that we’re working on. It’s a constant struggle, but we are definitely working to build up our capacity to do more fundraising, more outreach efforts and more grant writing,” she said. 

Smith said her clinic, like most others, relies on abortion funds, grants and private donations to keep going, but it also works with the state’s four other abortion clinics to share patient loads. 

Abortion funds are organizations that largely operate on local levels and work with clinics to provide money for the procedure itself, transportation, lodging, and childcare to those who can’t afford it. 

Dr. Warren Hern runs a private practice in Boulder, Colorado, where he sees patients in need of later-term abortions, many of whom are high-risk. 

Hern’s practice can accommodate no more than a dozen patients a week because of the level of care and the number of visits needed for each one, he said. He is seeing twice as many patients as he saw eight months ago, and his schedule is already booked three weeks out. That is likely to increase if Roe is overturned, he said.  

Colorado has said it will continue to provide abortion access regardless of Roe, as Gov. Jared Polis signed a law last month that guarantees the right to an abortion in the state. 

While Illinois, Montana and 14 other states use their own Medicaid funds to cover the procedure for low-income women, Colorado doesn’t provide public funding for the procedure because of a constitutional provision from the 1980s that prohibits it. 

Hern’s office has received calls from women all over the country, particularly Texas, Oklahoma, Louisiana, North Dakota and others that have banned or severely limited abortion care in recent months, he said.

“I’m preparing to expand my services. But it takes a long time. I think that this is a continuing problem,” he said. “We’ve improvised, and we’ve been doing it successfully, but I’m at the limit, and it’s very difficult to respond to this in a short time. The purpose is not to do as many abortions as we can but to help all the women that we can comfortably take care of and give them the best-quality care. That’s the purpose. And that takes a lot of time and energy for each patient.” 

Care goes beyond just the procedure at many clinics in safe haven states, he said. Hern’s clinic has a pantry of food for women who can’t afford it; the office also helps facilitate travel and accommodations with abortion care organizations. 

California has also thrust open its doors to welcome any woman in need of abortion care. In March, Gov. Gavin Newsom signed a law that eliminates out-of-pocket insurance fees for abortion services. Newsroom has promised other measures to protect access, including proposing a state constitutional amendment enshrining the right for a vote in November. 

The state could end up being home to nearly 30 percent of all abortion clinics in the U.S., even though it has just 12 percent of its population, the San Francisco Chronicle reported. 

Planned Parenthood of Orange & San Bernardino Counties operates nine health centers across two counties in California. 

After the opinion was leaked, the organization said it would expedite opening a 10th clinic in San Bernardino County specifically to service out-of-state patients from neighboring Arizona. Arizona has a trigger law that would immediately criminalize abortions. 

The center estimates an influx of up to 40 patients a week just from Arizona, said Nicole Ramirez, the senior vice president of communication and donor relations at Planned Parenthood of Orange & San Bernardino Counties. 

“In preparation, we’ve created an abortion aid program, we’ve added and trained additional staff members, we’ve increased the number of appointments for abortion that we have, and we hired a patient navigator whose job is to assist patients with all travel. Abortion aid covers travel, lodging and the cost of care for people who don’t have the resources to get to us.” Ramirez said. 

The organization spent $2.6 million last year to provide services for those unable to pay. 

While the clinic is well-positioned, continued support is still crucial, especially if Roe is overturned, she said. 

“Are we ready? 100 percent. Our doors are staying open, and we are ensuring care for everybody,” Ramirez said. “Can we use support? Absolutely. We can use all the help we can get.” 

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