In the wake of the U.S. Supreme Court’s opinion in the Dobbs v. Jackson Women’s Health Organization (JWHO) case that overturned Roe v. Wade, it has become clear that access to legal abortion in the United States is in grave danger. As it stands, abortion is now completely banned in at least eight states, with trigger bans expected to go into effect in several more. By turning the issue of abortion rights back to the states, the Supreme Court has put the reproductive freedom of the roughly 40 million women of reproductive age who live in states hostile to abortion rights in jeopardy. However, there are a number of levers that states can take to protect and expand access to abortion, whether that is expanding prescriptive authority, removing reporting requirements, or implementing state coverage mandates.
Spotlight on Illinois
There are 2.9 million women of reproductive age in Illinois who may at some point need an abortion. That is not counting those living in neighboring states that are less friendly to abortion access, such as Missouri, Kentucky, or Wisconsin. As of now, every state bordering Illinois has either banned abortion or is expected to ban it soon. People from these states may travel across state lines in order to access care in Illinois, especially because Illinois is the only state in the Midwest without a mandatory waiting period. It must be emphasized that, as in all states across the United States, the people that are most negatively impacted by the fall of Roe v. Wade and the ensuing unraveling of abortion rights are women and birthing people of color and low-income people.
In 2017, there were twenty-five clinics in Illinois providing abortions. Unfortunately, 90 percent of counties in the state still lack an abortion provider. With a majority of abortion providers in Illinois clustered in the Chicago metro area, many rural parts of the state—especially along the borders shared with neighboring states—-are left without providers.
In Illinois, a number of proactive abortion policies do exist. State Medicaid funds cover abortion; private insurance is required to cover abortion; and qualified health care providers outside of physicians can perform abortions. In 2019, Illinois became the second state in the United States to enact a statutory protection for abortion as a fundamental right after the Reproductive Health Act was signed into law. In 2021, Governor J. B. Pritzker signed the Youth Health and Safety Act into law, repealing the Parental Notice of Abortion Act and ending required parental consent for a young person to receive abortion care. The Illinois Supreme Court also recognizes the right to abortion under the state’s constitution. However, there are also some restrictions—for example, Illinois bans abortion at fetal viability, with exceptions if the patient’s life or health is endangered. While the Reproductive Health Act allows for advanced practice providers to perform abortions, Illinois still has not updated its regulations to reflect the new legislation. What’s more, the rate of Medicaid reimbursement for abortion care in Illinois has been less than satisfactory for providers.
Additional Levers for Protecting and Expanding Access
Following the Dobbs decision, there are a number of people of reproductive age living in nearby states who may now rely upon Illinois for abortion access. This was the case even before the most recent Supreme Court decision. Since 2014, the number of out-of-state residents who receive abortion care in Illinois has been steadily increasing. Without Roe in place, Planned Parenthood of Illinois has estimated an additional 20,000 to 30,000 more abortion patients will annually cross state lines into Illinois. A continued influx of people from other states could also create access challenges for Illinois residents seeking abortion care, as wait times for appointments potentially increase. There are some actions that the Illinois state government can take in order to bolster equitable access to abortion care.
- Improve Medicaid reimbursement rates for abortion. Current Medicaid reimbursement for abortion services in Illinois is $465 for medication-assisted and $660 for procedural abortion care. The median out-of-pocket patient cost for a first- and second-trimester abortion in the United States is $490 and $750, respectively. While providers across Illinois have voiced their support for Medicaid reimbursement of abortion, they have also raised concerns about the financial implications. In one study, nearly all participating providers stated that the reimbursement rates were “outdated and insufficient for covering costs of providing abortion care.” Due to a majority of the patients at abortion clinics in Illinois being Medicaid-eligible or insured by Medicaid, some clinics have had to close their doors or temporarily discontinue their services, with clinic administrators directly citing low Medicaid reimbursement rates as a contributing factor. With the influx of abortion patients anticipated to seek care in Illinois in the wake of Dobbs v. JWHO, the state cannot afford to have clinics closing. Illinois must improve the Medicaid reimbursement rates for abortion to match the actual cost of care.
- Amend state rules so that advanced practice providers can provide procedural abortion care. In anticipation of the influx of abortion patients from out of state, Illinois providers have been lobbying the Illinois attorney general and state regulators to change the state rules to allow nurse practitioners and other advanced practice providers to provide abortion care, in alignment with the changed law in the Reproductive Health Act. While the Reproductive Health Act eliminated a 1975 requirement that only physicians can provide abortion care, it did not specifically outline who else could. Research indicates that first-trimester abortion care is equally safe when provided by advanced practice providers as when provided by physicians, and the expansion of abortion care providers has also been supported by the American College of Obstetricians and Gynecologists.
- Increase state funds directed to clinics. While Governor J. B. Pritzker has been a lauded partner in the movement for reproductive rights in Illinois, there is still more than can be done to bolster and expand access to abortion care through the allocation of state funds. Abortion providers in Illinois have asked for Governor Pritzker and his administration to immediately allocate millions in additional funding toward improving security outside clinics, expanding facilities, and offsetting travel costs for those coming to Illinois from other states to access care. Examples that Illinois should look to in other states include Oregon’s $15 million reproductive health equity fund and the New York governor’s executive action directing $35 million toward increasing staff and security at abortion clinics.
In addition to these measures specifically for lawmakers, advocates and nonprofit organizations can help facilitate equitable access to abortion care by highlighting the critically important role that abortion funds and independent clinics have played and will continue to play in the absence of Roe.
Even with legal access, abortion is still often out of reach for many people. Abortion funds make accessing care financially possible for those who may not be able to afford it otherwise. The Chicago Abortion Fund and the Midwest Access Coalition work to provide financial, logistical, and emotional support to those seeking abortions not only in Illinois, but also across the Midwest. The Chicago Abortion Fund regularly hears from over 500 people each month, and in 2022, over 80 percent of their grantees were from out-of-state. The Midwest Access Coalition helps people traveling to, from, and within the Midwest access safe, legal abortion.
Independent clinics are where three out of five patients in the United States go to access abortion care. They are community-based clinics staffed by highly trained health care professionals that provide time-sensitive abortion services, often to low-income pregnant people or those with the fewest resources to access care. In Illinois, the carafem health center in Skokie, Hope Clinic for Women in Granite City, and Women’s Aid Center in Chicago are all independent clinics offering abortion care.
Reproductive justice (RJ) groups are also important voices to uplift in the fight for abortion rights. The RJ movement was started by and is led by women of color and uses holistic approaches to achieving health equity and justice for all people. In Illinois, re.ad.just is an RJ alliance forged by the Chicago Abortion Fund, EverThrive Illinois, the Illinois Caucus for Adolescent Health, and the National Asian Pacific American Women’s Forum. Their vision is for a world in which all people have the social, political, and economic power, rights, access, and resources they need to make their own decisions about their bodies, gender, sexualities, families, and lives.
In the days, weeks, and months following the Dobbs decision, proactive state-level policy efforts and community care in the form of uplifting abortion funds, independent clinics, and RJ organizations in order to protect and expand abortion access will be necessary to accomodate the influx of out-of-state patients seeking care from states where abortion is expected to become criminalized. In a post-Roe world, everyone still deserves access to safe, equitable, and compassionate abortion care, regardless of what state they live in.