PARTNER PERSPECTIVE

Patchwork: Abortion Policies in the States

JENNIFER DRIVER
Senior Director of Reproductive Rights, State Innovation Exchange

In 2022, the United States hit the high water mark of abortion restrictions passed in state legislatures, with over 540 restrictions introduced in 42 states and 42 abortion restrictions enacted in 11 states. Anti-abortion legislators were relentless in their attacks on abortion access, testing the limits of the U.S. Supreme Court majority and laying the groundwork for when Roe v. Wade would be weakened or eliminated entirely. That time came with the Dobbs v. Jackson Women’s Health Organization decision that upheld Mississippi’s 15-week abortion ban and explicitly overturned Roe. 

While the debate around this issue was hyper-focused on the Supreme Court, many overlooked the most important battleground of the abortion rights fight: state legislatures. Texas’ blatantly unconstitutional abortion ban, SB 8, made it clear that anti-abortion lawmakers will introduce egregious bills—and the Supreme Court made it clear that it will do nothing to stop them. This is despite recent polling showing that 80% of Americans support the legal right to abortion. This was reaffirmed by the overwhelming showing of voters in Kanas rejecting a measure that would remove protections for abortion from the state constitution. Despite this popular support, anti-abortion lawmakers continue to attempt to ban access to abortion. States such as Idaho and Oklahoma embraced this extreme Texas law by passing similar statutes.

In the aftermath of the Dobbs decision, most abortions are now banned in at least 14 states. The most recent law, signed by West Virginia Governor Jim Justice, bans nearly all abortions in the state. This came mere days after Indiana’s ban on nearly all abortions, the first state to draft and pass a full ban on abortion after Roe was overturned, took effect and after Senator Lindsey Graham proposed a national ban on abortion after 15 weeks.

While more state legislatures are considering restrictions, others are strengthening abortion rights. Some states have already acted to protect the legal right to abortion. In 2019, New York enacted the Reproductive Health Act to codify the Roe ruling into state law, and Illinois enacted a similar law to protect all individual decision-making around reproductive health, including abortion, contraception, and pregnancy care. In 2021, New Mexico repealed a pre-Roe law on the books that criminalized abortion, ensuring that legal abortion continued to be protected in the state after Roe was overturned. In Maryland legislators passed MD HB 937, the Abortion Care Access Act, Delegate Ariana Kelly's bill that expands who can perform abortions in the state and provides $3.5 million in financial support to clinically train health care professionals to offer reproductive services. The bill would also make the state’s existing abortion care coverage under Medicaid permanent and require most private health insurance plans to cover abortion care without cost-sharing or deductibles.

But protecting the legality is only step one. State legislators now have a duty to unapologetically protect the abortion access people everywhere will need in the face of a confusing and patchwork landscape. Some states, like Washington state, are removing any public or private insurance coverage restrictions on abortion. And in New York, Attorney General Letitia James called for the creation of a state fund to support the cost of transportation, accommodations, and abortion care for patients seeking treatment in New York if their own state has banned abortion. 

Additionally, some states, like California and Maine, have expanded their provider pool to meet the needs of thousands of patients crossing state lines to access abortion care. States like Virginia and Illinois are repealing existing abortion restrictions, while others such as New Jersey have taken steps to protect abortion clinic employees from possible harm. And just this past session, Connecticut passed a law to mitigate the harm caused by deceptive crisis pregnancy centers. Good policies being proposed include a Massachusetts bill to make medication abortion available on college campuses and a plan in Georgia to ensure that communities of color are centered in any new legislation to protect abortion rights.

Abortion restrictions create additional financial and logistical barriers to accessing basic, necessary reproductive health care services. These laws often force people seeking abortion to travel long distances to get care, which can require taking time off from work, arranging transportation, and paying for child care. Beyond the financial burdens of abortion restrictions, the threat of criminalization exists.More than 1,700 women have been arrested for pregnancy outcomes since the 1973 Roe ruling through 2020. And the impact of these restrictions falls most heavily on those who already disproportionately lack access to health care, including people struggling to make ends meet, Black and brown people, and LGBTQ+ individuals. At their core, policies that restrict abortion are racist, xenophobic, and designed to exert power over and control people’s bodies.