In another strategy, the professors say, the federal government could fund broadband infrastructure to increase telemedicine access in digital deserts while states enter into “licensure compacts” that allow a provider in one state to prescribe abortion pills to a patient in another via the Internet. In addition, states that enact post-Roe abortion bans may have federal land—largely exempt from state-level civil laws and potentially from state-level criminal laws, too—that Cohen, Donley, and Rebouché say Biden could try leasing to abortion providers.
Their objectives, the professors tell SELF in a joint interview, attempt to minimize damage— particularly for marginalized and rural communities—in the immediate aftermath of Roe’s undoing while pursuing a reproductive justice vision. One of their long-term goals, for example, would end the Hyde Amendment’s decades-long chokehold over federal Medicaid dollars for abortion. Reproductive justice groups over the past decade have shifted a majority of Democrats from accepting the Hyde Amendment as the cost of doing business on Capitol Hill to fighting its addition in congressional spending bills, and there’s a proactive bill to end it for good.
Meanwhile, the 16 states that, by law or court order, put their Medicaid dollars toward patients’ abortion services could raise their notoriously low reimbursement rates, the professors say. Biden’s Centers for Medicare and Medicaid Services, which approves each state’s rate structure, could encourage those states to pay clinics more for Medicaid-covered abortion care and encourage clinics to serve more patients with low incomes.
On the local and state government level:
Local and state governments likewise can do much more than they’re doing. In 2019, Austin became the first U.S. city to budget for residents’ associated abortion costs, including childcare and travel expenses, excluding the abortion itself. In Atlanta, discussions have turned to municipal funding for abortion directly in addition to associated costs thanks to a city council-created advisory board, the Reproductive Justice Commission. “We know it can happen in the South because it happened in Austin,” Njoku says. To that end, Cohen, Donley, and Rebouché urge blue states to fund abortion clinics instead of anti-abortion fake clinics—crisis pregnancy centers that routinely lie to coerce people into continuing their pregnancies. Pennsylvania, their home state, awarded more than $7 million to an anti-abortion program called “Real Alternatives” under Governor Tom Wolf, a Democrat, in 2021.
Outside of clinical settings, abortion researchers expect rising interest in and demand for self-managed medication abortions. Medical experts have long agreed that the method is a safe and effective way to end an early pregnancy, and perhaps those “beyond the first trimester—particularly in legally restrictive settings,” according to a 2020 article in the peer-reviewed journal Contraception. But varying state legal rights and risks have led to prosecutions of people self-managing later abortions, miscarrying, and attempting suicide while pregnant.
Without Roe’s legality, however threadbare, criminalization for these abortions will weigh the heaviest, as always, on pregnant people of color and visibly pregnant people further along in their gestation, stress Erika Christensen and Garin Marschall, co-directors of nonprofit organization Patient Forward that works to decriminalize abortion and pregnancy outcomes. People already self-manage their abortions by choice or out of necessity due to restrictive state laws and booked-up out-of-state clinics. Later discovery of pregnancy, a common contributor to later abortion care, may push them beyond a state’s gestational limits, according to Patient Forward’s WhoNotWhen project.