With access to abortion at stake across the U.S., California is getting ready to become the nation’s abortion provider.
Democratic Gov. Gavin Newsom and legislative leaders have asked a group of reproductive health experts to propose policies to bolster the state’s abortion infrastructure and prepare it for more patients. Lawmakers plan to begin debating the ideas when they reconvene in January.
Abortion providers are already girding for a surge in demand. Dr. Janet Jacobson, medical director of Planned Parenthood of Orange and San Bernardino counties, said three or four out-of-state patients visit her clinics each day — about double the number that sought treatment before a near-total ban on abortion took effect in Texas in September.
Though the nine clinics can absorb that slow trickle, they expect up to 50 out-of-state patients a week if the U.S. Supreme Court’s conservative majority guts abortion rights nationally, Jacobson said. She bases her estimate on new data from the Guttmacher Institute, a research organization that supports reproductive health and abortion rights.
She is adding to her staff and appointment capacity, hoping to accommodate everyone.
“We have to make sure we can still continue to care for all of our California patients,” Jacobson said. “We don’t want them getting squeezed out” of appointments.
The Texas law bans nearly all abortions after about six weeks of pregnancy and empowers private citizens to sue anyone who performs or “aids and abets” an abortion after that time.
The Supreme Court heard arguments in that case Nov. 1 and is expected to announce a ruling on its constitutionality in June. Nonetheless, Florida and Ohio have announced plans for copycat laws.
Next month the high court will hear another abortion case with even broader implications, Dobbs vs. Jackson Women’s Health Organization, a lawsuit challenging the constitutionality of a 2018 Mississippi law that prohibited abortion after 15 weeks. If the court sides with Mississippi, its decision could overturn existing abortion rights confirmed by 1973’s landmark Roe vs. Wade case.
Should that happen, reproductive rights experts predict, 26 states will ban the procedure altogether and states with stronger protections for abortion — like California — will draw even more patients. There could be up to a 3,000% increase in people who “may drive to California for abortion care” each year, according to the Guttmacher data.
In 2017, the most recent year for which data is available from Guttmacher, California — by far the nation’s most populous state — had more abortion providers than any other state, with 419 hospitals, clinics or doctors’ offices performing the procedure. The next highest were New York, with 252, and Florida, with 85. Neighboring Arizona and Nevada each had 11.
Of the 862,320 abortions performed in the U.S. that year, 132,680, or about 15%, were in California. Planned Parenthood clinics in California say they already serve about 7,000 out-of-state patients a year and are expecting a surge of new ones, especially in travel hubs 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 backing from influential Democratic leaders including Newsom, state Senate leader Toni Atkins (D-San Diego) and Assembly Speaker Anthony Rendon (D-Lakewood).
The council is focused on increasing funding for abortion services, providing logistical and financial help for women who need to travel, increasing the number of healthcare providers who perform abortions and strengthening legal protections for them.
Increasing capacity could mean licensing more practitioners to provide abortions or directing more resources into telehealth so people can see a doctor online to prescribe pills for a medical abortion — a service California doctors currently can provide to patients only within the state.
The most important thing the state should do is fix its shortage of providers, especially those who perform second-trimester abortions, which are more expensive and complicated than first-trimester abortions, said council member Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health program at UC San Francisco.
It’s not feasible to place an abortion provider in every corner of the state, Grossman said. Instead, the council should focus on creating “hubs that can provide abortion care for large numbers of people” in easy-to-reach locations.
One of the council’s likely recommendations will be to increase the rate Medi-Cal pays for abortions so more providers will perform them, said council member Fabiola Carrión, interim director for reproductive and sexual health at the National Health Law Program.
This story was produced by Kaiser Health News, one of the three major operating programs at the nonprofit Kaiser Family Foundation.