With abortion rights threatened by an imminent Supreme Court ruling, Massachusetts advocates on Friday unveiled a broad agenda to protect and expand reproductive services to accommodate patients from the Bay State and beyond.
The slate of legislative, budget, and regulatory proposals includes efforts to protect Massachusetts abortion providers from being sued or extradited for treating patients from states that outlaw the procedure, if the high court allows. A leaked draft opinion of a Supreme Court ruling last week indicated a majority of the high court is poised to overturn Roe v. Wade, the 1973 ruling that made abortion legal.
The plans were advanced by the Planned Parenthood Advocacy Fund of Massachusetts, Reproductive Equity Now, and the ACLU of Massachusetts — the groups that worked to codify abortion rights in Massachusetts state law in 2020 in anticipation of Roe being overturned.
Known as the “Beyond Roe Coalition,” the advocacy groups want to position Massachusetts as a leader in providing affordable reproductive care of all kinds and recognizing abortion as health care. One recommendation calls for passage of legislation requiring “full-spectrum pregnancy care” — insurance coverage for abortion but also for prenatal and postpartum care with no out-of-pocket costs, recognizing that steep deductibles and copayments make reproductive care inaccessible for many people, particularly people of color.
“Massachusetts must continue to be a leader in ensuring that abortion is accessible, affordable, and available to all,” said Carol Rose, executive director of the ACLU of Massachusetts. “Our right to abortion shouldn’t depend on where we live or how much money we make. All people should be able to control their own bodies, lives, and futures.”
Massachusetts is among 16 states where abortion rights will remain intact, even if Roe is overturned, and among those considering ways to accommodate more people. On Tuesday, Connecticut Governor Ned Lamont signed a bill that protects providers and patients who seek abortion care in that state from prosecution in states that outlaw it. California Governor Gavin Newsom beefed up to $125 million a reproductive health package in preparation for an influx of people from other states, and New York Governor Kathy Hochul announced a $35 million investment in abortion providers. Oregon lawmakers created a $15 million fund to provide grants to nonprofits that would help people who can’t afford abortions pay for them.
Thirteen states have trigger laws that would ban abortion automatically if Roe v. Wade is overturned, according to the Guttmacher Institute, a research organization that supports abortion rights. Another 13 states are viewed as certain or likely to ban all or most abortions in the future.
Since most of those states lie far south or west of Massachusetts, it’s not clear how much demand they would generate in the Bay State. But patients from Texas have been coming to Massachusetts since the fall, when a state law there began barring abortions after about six weeks. Obstetrician-gynecologist Dr. Luu Ireland, who works at both UMass Memorial Medical Center and at Planned Parenthood League of Massachusetts in Worcester, estimated she has cared for as many as 10 Texans in that time.
“Folks are coming where they already have connections, where they have family, where they have support,” Ireland said. “People are coming where it’s a direct flight. They’re coming here because Massachusetts is known as being a safe place to access abortion.”
As demand from out-of-state patients increases, even Massachusetts residents will have a harder time finding appointments for abortion here, she predicted. Massachusetts allows abortions up until 24 weeks of pregnancy. After that, they are permitted only to end pregnancies with fatal fetal anomalies or, if it is necessary, in the doctor’s judgment, to preserve the patient’s physical or mental health.
To help clinics accommodate new demand, the coalition is calling on the state to subsidize their security and staffing and finance technology upgrades for telehealth visits that are increasingly used with medication abortions.
The thought of Massachusetts becoming a destination for women seeking abortions is abhorrent to abortion opponents, who said they intend to fight the coalition’s proposals. Abortion rates have been on a steady decline for years. In 2020, the most recent year available, 16,452 abortions were provided in Massachusetts, according to the Registry of Vital Records and Statistics.
“To want to increase that is barbaric,” said Andrew Beckwith, president of the antiabortion Massachusetts Family Institute.
Abortion opponents also object to the coalition’s proposal that the state invest money in “abortion funds” — grassroots, community-based organizations that help people pay for abortions, as well as travel and child care accommodations they may need to obtain them. That would mark the first time state money is budgeted for abortion, although Massachusetts is among the states that funds abortion through its Medicaid program for low-income residents. The Massachusetts Supreme Judicial Court ruled in 1981 that women eligible for Medicaid have a constitutionally protected right to funding for abortion.
Direct taxpayer funding for abortions, which is prohibited on the federal level under the Hyde Amendment, has often drawn sharp resistance.
“However people feel about abortion, a majority of Americans — and I’d warrant a majority of folks in the Bay State — don’t believe we should be using taxpayer dollars,” Beckwith said.
But state legislative leaders on Friday expressed no such reservations and have already committed to investing in reproductive health care access, infrastructure, and security. The House recently passed a budget committing $500,000 to that purpose and the Senate budget would increase that to $2 million.
“We passed that initiative in the House budget days before the leak [of the draft opinion of the Supreme Court ruling],” said Representative Aaron Michlewitz, chair of the House Ways and Means Committee. “It was another example of our commitment to providing safe health care. That’s what we’re talking about. We’re talking about health care for women’s reproductive rights in this state.”
The coalition is also calling for legislation to require no-cost insurance coverage of all forms of emergency contraception — medication that can prevent a pregnancy if used within a short window of time. Emergency contraception is now available over the counter but at a much higher cost than the prescription versions that are covered by insurance and take longer to dispense. The bill, now before the House Ways and Means Committee, would make all forms readily available with no out-of-pocket costs. “It’s certainly something we’re going to move to the top of the list,” Michlewitz said.
A second proposal would require that abortion pills be dispensed at the campus health centers at the state’s public universities, some of which are hours away from abortion clinics on public transit. Now the most common form of abortion in Massachusetts, medication abortion is a two-step protocol of prescriptions that can be used to end a pregnancy until 10 weeks.
Advocates are also drafting a measure to protect Massachusetts residents and abortion providers from prosecution under a law like Texas’s SB8, said Rebecca Hart Holder, executive director of Reproductive Equity Now. That law deputizes private citizens to sue anyone who helps provide an abortion after about six weeks of pregnancy.
“It’s definitely something that is weighing on our minds,” said Ireland, the OB-GYN. “I don’t think that we as physicians should be held criminally or civilly liable for doing our jobs the way that we are legally bound to do in the states in which we practice.”