This Saturday marks one year since the U.S. Supreme Court eliminated the federal right to abortion in its decision on Dobbs v. Jackson Women’s Health Organization. In the wake of that decision, bans and increasingly strict limits on abortion care have proliferated, decimating access across the country. But we must keep in mind that this is only the latest catastrophe in an ongoing crisis. The communities hit hardest—people struggling to make ends meet, people of color, individuals with disabilities, young people, and immigrants—have been without meaningful abortion access for decades.

This is because even with Roe in full effect, abortion protections were never sufficient. Under Roe, abortion seekers still faced mandatory waiting periods, discriminatory restrictions on insurance coverage, and were sometimes forced to travel hundreds of miles for health care that should be available in their own communities. That Roe has fallen as well has heaped even more rubble on that mountain of inequity and structural barriers—that much is clear from the loss of access since last June, as well as from the increasingly egregious ongoing attacks on abortion care. This post-Dobbs landscape, though, also provides a new opportunity: a chance to build towards a more bold vision of abortion justice.

This post-Dobbs landscape, though, also provides a new opportunity: a chance to build towards a more bold vision of abortion justice.

What Is Abortion Justice?

Abortion justice, as described by All* Above All, requires “a world where abortion care is affordable, available, and supported for everyone who needs it.” This paradigm shift means moving beyond the defensive tactics typically employed, and centering the right of every person to access abortion care. Now, this goal has the chance to become embodied in federal legislation: on Thursday, Representative Ayanna Pressley, along with Representatives Cori Bush, Nikema Williams, Veronica Escobar, and Maxwell Frost, introduced the Abortion Justice Act, which translates the bold vision of abortion justice into policy.

While so much of the fight for abortion access has been—by necessity—reactive and defensive, there has been little space for affirming the right to truly accessible abortion care in federal policy. The Abortion Justice Act not only meets this need, but it does so in a way that brings to the fore communities who are too often left at the margins. The bill recognizes that although bans and restrictions on abortion care may impact all people who can become pregnant, they do not do so equally: from an undocumented abortion seeker prevented from moving freely due to fear of immigration enforcement, to a minor unable to obtain parental consent, to a Medicaid enrollee whose abortion care is not covered because of the Hyde Amendment and cannot afford their care out-of-pocket, too many people have been prevented from accessing abortion care due to circumstances outside of their control.

The bill recognizes that although bans and restrictions on abortion care may impact all people who can become pregnant, they do not do so equally.

Meanwhile, forcing individuals to continue pregnancies by restricting abortion care has an even more dangerous impact on Black and Indigenous communities who bear the brunt of our nation’s worsening maternal health crisis. Abortion bans and restrictions, as well as the accompanying risk of pregnancy surveillance, only adds to an erosion of trust; people of color—for reasons based in a very real history of discrimination—may avoid seeking necessary health care because of this lack of trust. In moving beyond Roe to abortion justice, our solutions must meet the needs of the communities at the intersections of these oppressions.

What would the Abortion Justice Act do?

The Abortion Justice Act makes critical investments and uses innovative policy levers to make abortion care truly accessible. It does so in the following ways.

Funding for Individuals, Providers, and Research Institutions

The bill would provide funding to support individuals seeking abortion care, which is a huge unmet need, not least because of abortion coverage riders such as the Hyde Amendment, which create obstructions for people on Medicaid and others receiving insurance or care through the federal government. The need has until now received (at least partial) relief via abortion funds and practical support networks, but mutual aid alone should not have to fill the gap created by discriminatory policies. Funding would also support providers and reproductive health organizations directly.

The possibility of funding for providers comes at a time when many abortion providers are not only overwhelmed by an influx of patients, but also facing extreme risks to their physical and emotional well-being: data from 2022 shows sharp increases from the previous year in violence and harassment, including arson, death threats, and clinic invasions. The federal funding allocated in this bill, to support patients and providers, as well as research initiatives, is crucial to achieving equitable access to care.

Mandatory Abortion Coverage

By building on the EACH Act, the legislation also targets restrictions on abortion coverage directly. The bill mandates coverage of abortion care without cost-sharing—as well as information about abortion care—in health insurance. Ensuring abortion coverage is central to equity in abortion access, as existing coverage restrictions force most people to pay out-of-pocket for care. With the median cost of a first-trimester abortion around $600 and nearly $800 for second trimester care, this financial barrier can make abortion care inaccessible for many.

Justice for Immigrants

The Abortion Justice Act also enhances equity for immigrants and migrants, who face additional barriers to health care overall, and abortion care in particular. The bill expands Medicaid and CHIP eligibility for lawfully present immigrants, building off the critical HEAL for Immigrant Families Act. And it prohibits immigration enforcement activities within 2,000 feet of any health care facility, so that undocumented individuals will not have to choose between seeking necessary health care and risking arrest.

Increased Access to Care

The United States was already facing a shortage of abortion providers, and the Dobbs decision had an immediate and devastating impact on this ongoing crisis. This bill would increase the availability of care by requiring facilities receiving federal dollars to provide abortion care if it is within their scope, and referring out for care if not. It would also address barriers faced by college students—such as transportation hurdles and class schedules—by requiring that federally funded colleges provide abortion care on campus.

Increased Access to Training

The shortage of abortion providers, of course, can only be addressed if training for abortion care provision is adequately available. An estimated 28 percent of obstetrics and gynecology residency programs are based in states enforcing abortion bans, and this legal landscape impacts medical students’ decisions on where to pursue their training. This is concerning, too, given the already dire state of maternal health access in a country riddled with maternity care deserts. The Abortion Justice Act would bolster abortion training to support and grow the abortion provider workforce.

Protect Health Information

Even before the Dobbs decision—and increasingly so in its wake—pregnant people and abortion seekers face criminalization when presenting for health care. Whether a person is managing their pregnancy loss, has self-managed their abortion, or sought care from a provider, they should not have to fear the criminal legal system in doing so. In particular, Black and Brown communities, immigrants, and people with low incomes are over-policed and at greater risk of criminalization. The Abortion Justice Act would build on recent actions by the Biden–Harris administration to enhance privacy protections by prohibiting the disclosure of personal health information to law enforcement.

The past year has been a devastating one for abortion access, one that has only built on the crisis that existed even while Roe stood. The Abortion Justice Act would shift U.S. law decidedly away from our status quo, towards a new normal in federal policy that does not compromise, but rather envisions a future where every person can access abortion care that is affordable, supported, and available in their own communities.