California envisions post-egg world as abortion access declines elsewhere


With access to abortion on the line across America, California is gearing up to become the nation’s abortion provider.

Democratic Governor Gavin Newsom and legislative leaders have asked a panel of reproductive health experts to come up with policies to strengthen the state’s abortion infrastructure and prepare it to accommodate more female patients. Lawmakers plan to start debating ideas when they meet again in January.

Abortion clinics are already bracing for increased demand.

Janet Jacobson, medical director of Planned Parenthood in Orange and San Bernardino Counties, said three or four out-of-state patients visit her clinics each day – about double the number of people who requested treatment before the entry into force of an almost total ban on abortion. in Texas in September.

While the nine clinics can absorb this slow trickle, they expect to see up to 50 out-of-state patients per week if the conservative majority in the U.S. Supreme Court undermines abortion rights in the United States. nationwide, Jacobson said. She bases her estimate on new data from the Guttmacher Institute, a research organization that supports abortion rights and reproductive health.

She adds staff and a meeting capacity, hoping to accommodate everyone.

“We need to make sure that we can continue to care for all of our California patients,” Jacobson said. “We don’t want them to be kicked out” from the dates.

Texas law banned almost all abortions after about six weeks of pregnancy and allowed private citizens to sue anyone who performs or “aids and encourages” an abortion after that time. The Supreme Court heard arguments in the case on November 1 and is expected to announce a ruling on its constitutionality in June. Nonetheless, Florida and Ohio have announced plans for copy laws.

Next month, the High Court will hear another abortion case with even broader implications, Dobbs v. Jackson Women’s Health Organization, a lawsuit challenging the constitutionality of a 2018 Mississippi law that banned abortion after 15 weeks. If court sides with Mississippi, its ruling could overturn existing abortion rights set by benchmark Roe vs. Wade Case.

If that happens, reproductive rights experts predict, 26 states will ban the procedure altogether and states with stronger abortion protections, such as California, will attract even more patients. According to Guttmacher data, there could be up to 3,000% increase in the number of people who “could come to California for abortion care” each year.

In 2017, the most recent year for which data is available of Guttmacher, California – by far the most populous state in the country – had more abortion providers than any other state, with 419 hospitals, clinics or doctor’s offices performing the procedure. Next come New York, with 252 abortions, and Florida, with 85. Neighboring Arizona and Nevada each had 11. Of the 862,320 abortions performed in the United States that year, 132,680, approximately 15%, were in California.

Planned Parenthood clinics in California say they already serve about 7,000 out-of-state patients per year and expect a surge of new ones, especially in travel centers like the Los Angeles area.

In September, Planned Parenthood and groups such as Black Women for Wellness convened the California Future of Abortion Council with the support of influential Democratic leaders including Newsom, Head of the State Senate Toni Atkins and Speaker of the Assembly. Anthony Rendon.

Atkins, who was the director of a women’s health clinic in San Diego in the 1980s, said she spent time with women in states where it was difficult to have abortions. She said California is committed to ensuring access to abortion in the state and beyond.

The council focuses on increasing funding for abortion services, providing logistical and financial assistance to women who need to travel, increasing the number of health care providers who perform abortions, and increasing the number of health care providers who perform abortions. strengthening legal protections for them.

Increasing capacity could mean allowing more practitioners to perform abortions or injecting more resources into telehealth so people can visit a doctor online to prescribe pills for medical abortion – a service California doctors can currently provide to doctors. patients only in California.

The most important thing the state should do is address its shortage of providers, especially those who perform second trimester abortions, which are more expensive and more complicated than first trimester abortions, the member said. Counsel, Dr. Daniel Grossman, Director of Advancing New Standards. in the reproductive health program at the University of California-San Francisco.

It’s not possible to place an abortion provider in every corner of the state, Grossman said. Instead, the council should focus on creating “centers that can provide abortion care to a large number of people” in places that are easily accessible.

California struggle already to provide abortions to all who request them, especially low-income women covered by Medi-Cal, the Medicaid program in California. For example, 28 counties – houses 10% of Medi-Cal beneficiaries of childbearing age – do not have facilities that offer abortions to Medi-Cal patients.

A medical abortion, in which pills are used to terminate a pregnancy, costs California patients an average of $ 306 out of pocket, according to analysis by the California Health Benefits Review Program, but not available after 10 weeks. After that, the only option is a surgical abortion, which costs an average of $ 887 out of pocket in California.

One of the council’s recommendations will likely be to increase the rate Medi-Cal pays for abortions so that more providers perform them, said Fabiola Carrión, board member, acting director of reproductive and sexual health at the National. Health Law Program.

Medi-Cal pays $ 354.43 for a second trimester abortion. A 2020 study in the journal Contraception, states paid between $ 79 and $ 626 for a second trimester abortion in 2017.

The Medi-Cal rate increase will not help patients coming from outside California. Typically, private insurance does not cover out-of-state abortions, so most women will have to bear the full cost, and those enrolled in Medicaid programs in other states must also pay out of pocket. .

The council hopes to reduce costs for state residents and visitors, said Brandon Richards, communications director for Planned Parenthood Affiliates of California. “This is about making it easier for people to have abortion in California, whether they are residing here or coming from out of state,” he said.

One way to target costs is to fund hands-on support, like helping pay for transportation, child care, hotels or time off, said Jessica Pinckney, board member, executive director of Access Reproductive Justice, a fund that helps people pay for abortions.

Pinckney said she was working with Los Angeles County to set up a public abortion fund to cover some of these costs for anyone seeking an abortion in the county. It would be modeled on similar pots maintained by the cities of New York; Austin, Texas; and Portland, Ore., and could potentially be a model for the first statewide fund, Pinckney said.

Most Texans who have sought an abortion since that state’s law came into effect travel to neighboring states like Colorado, New Mexico and Oklahoma, said Sierra Harris, deputy director of network strategies. for the National Network of Abortion Funds. Women in these states, in turn, struggle to obtain care and turn to California for dates.

Practical support is important for out-of-state patients, said Alissa Perrucci, director of operations at the Women’s Options Center at Zuckerberg San Francisco General Hospital, one of five abortion clinics in California hospitals.

Perrucci’s clinic focuses on telemedicine, phone counseling, and other time-saving ways so that they can add appointments for out-of-state patients if needed.

But more slots are pointless if women can’t get to California. The clinic has booked about 10 appointments for Texans since the state’s ban went into effect, but only half have shown up, mostly women with family ties in California.

“Most people just don’t have the money to come here,” she said. “If the burden of abortion was primarily on the rich, yes, they would just fly here.”

This story was produced by KHN, which publishes California Health Line, an editorially independent service of the California Healthcare Foundation.

This article was reprinted from courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorial independent news service, is a program of the Kaiser Family Foundation, a non-partisan health policy research organization not affiliated with Kaiser Permanente.

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