The abrupt illegality of most abortions in Texas means more than just an exponential surge in patients spilling over to neighboring states’ clinics — though that’s happening too.
It also means patients who are stressed over missing many days of work or finding lodging or maneuvering the long trip out-of-state with children in tow, and without the support system they may have had back home.
“We’re dealing with both a much higher volume and with patients who are in crisis at a much higher rate,” Emily Wales, interim president & CEO of Planned Parenthood Great Plains, told TPM.
And while the states near Texas may not have the draconian six-week ban that the Supreme Court allowed to stand before it hears the case, many are still hostile to abortion rights. Oklahoma requires an ultrasound and 72-hour waiting period. Kansas has a 24-hour waiting period and both private insurance (without an additionally purchased rider) and plans in the state’s health exchange only cover the procedure in cases of life endangerment. Arkansas has a 72-hour waiting period that only begins after an in-person, state-directed counseling session aimed at dissuading the patient from having the abortion.
And all of those states are actively trying to pass more restrictions.
That leaves what few abortion providers have thus far survived years of onslaught from Republican-led legislatures with an enormous, double-pronged task: to cope with the droves of patients coming from Texas while preparing as best they can for attempts to further restrict abortion rights made with renewed vigor in their own states.
“We’re in a trial run for a post-Roe world right now,” Jessie Hill, associate dean and professor at Case Western Reserve University School of Law, told TPM.
A New ‘Level Of Intensity’
Clinics in Texas’ neighboring states, already few in number due to sustained state-level efforts to heap restrictions upon them, are being overrun with patients further along than the six week threshold currently allowed under state law. That’s before many women know they’re pregnant, and precludes 85 to 90 percent of procedures done in Texas, according to lawyers for the clinics in court documents.
“We saw over 300 Texans last month just in our Oklahoma facilities,” Wales said. “We saw just a little more than that throughout all of last year.”
“In August of this year, we saw one Texas patient in our Wichita clinic. In September, we saw 51,” Zack Gingrich-Gaylord, interim communication director at Trust Women, which has clinics in Oklahoma City and Wichita, told TPM.
The influx is being acutely felt in services that orbit the providers too. Fund Texas Choice is a non-profit organization that helps subsidize the costs associated with obtaining an abortion: travel, lodging, meals.
“We funded an average of $400 per client before SB 8,” Sarah, Fund Texas Choice’s manager of programs, told TPM of the six-week abortion law. “We’ve seen an increase in more high-dollar clients who cost more money to stay longer and travel further,” she said, pegging the new price tags at “$700, $800, $1,000.”
(Sarah asked that TPM not use her last name, out of security concerns since the law’s passage. SB 8 threatens all who “aid and abet” an abortion in Texas past six weeks with criminal liability, and has deputized individuals to turn those people in, creating a legion of, as Justice Sonia Sotomayor put it, “bounty hunters.” Those individuals get a $10,000 reward for a successful suit and legal fees recouped; defendants get nothing if the suit fails.)
Prior to the influx of Texans, Sarah handled client work by herself. Fund Texas Choice has since had to scale up its staff. But, for abortion-adjacent organizations, boosting staff presents its own challenges.
“It’s difficult to hire for abortion care in this area — not because there aren’t great people, but because the stigma makes it difficult for people to even seek this employment out,” Gingrich-Gaylord said. “Also, there’s a little ongoing pandemic, so health care is tough sell.”
‘Constant Uncertainty’
While these clinics and orbiting services are trying to bulk up to handle the increased need, they’re also navigating a patchwork of restrictive state laws, including new ones which could shut them down or limit their resources — often at a moment’s notice.
Oklahoma has multiple laws caught up in litigation at the moment. The state Supreme Court just temporarily blocked three of them: one would have required all abortion providers in the state to be board-certified OB/GYNs, and the other two restrict abortions induced by medication. A lawyer for clinics in the lawsuit said that the OB/GYN provision alone would disqualify over half of the providers in the state; many are family medicine practitioners.
An Oklahoma judge had previously temporarily blocked two other laws, one of which would ban abortion after six weeks. So far, the relief is only short-term, pending further rulings.
In neighboring Arkansas, a state lawmaker has already drafted a Texas copycat law, and plans to introduce it in a legislative special session.
In a mark of how hostile the surrounding terrain is, Gingrich-Gaylord considers Kansas the current “safe state.”
“Our Kansas problems don’t happen until next year,” he said. “There’s an amendment ballot proposal next year to remove the state’s constitutional right to abortion.”
All of these are just skirmishes compared to the primary theater: the United States Supreme Court. The Court is hearing the Texas law on an expedited timeline, though it may avoid ruling on its constitutionality. While the survival of the Texas law would certainly encourage more copycats in Republican-majority states, it pales in comparison to a 15-week ban out of Mississippi that will force the Court to rule directly on its constitutionality and potentially upend Roe v. Wade and Casey v. Planned Parenthood.
“This is all in the shadow of the Dobbs case,” Case Western Law’s Hill said of Missippi’s Dobbs v. Jackson Women’s Health Organization.
Abortion providers in red states are by definition beleagured, for years subject to attack by state laws and wearily accustomed to navigating the stops and starts of litigation as courts uphold these laws, block them, or strike them down. But even those used to the bellicose rhythms are feeling a tempo change now.
“This is the moment,” Hill said. “Everything’s on the line right now.”
