Abortion Information

Are you surprised? A recent Guttmacher Institute report systematically documents anti-choice laws and the research that debunks their claims.

A recently released Guttmacher Institute report finds that at least ten common categories of state laws and policies restricting abortion run contrary to science.

These anti-evidence laws are prevalent across the country, leaving almost a third of all U.S. women of reproductive age (ages 15-44) living in a state with at least five such restrictions.

This conclusion may sound obvious to those familiar with the hostile legislative landscape regarding reproductive rights and health. But “Flouting the Facts: State Abortion Restrictions Flying in the Face of Science” systematically documents the sheer scope of policies that ignore public health and social science research about the safety of abortion, among other issues. In this political environment—where anti-science attitudes at the state level are increasingly echoed by the Trump administration—researchers must keep reiterating there are such things as evidence and actual facts.

Rachel Benson Gold, Guttmacher vice president for public policy, and Elizabeth Nash, senior state issues manager, co-wrote the report, which was released in May. They note that “much of the anti-abortion universe has long been an evidence-free zone.”

This analysis comes just a year after the U.S. Supreme Court used research to declare some Texas abortion restrictions unconstitutional in Whole Woman’s Health v. Hellerstedt. In its 5-3 decision, the Court clearly was convinced that there were no public health reasons undergirding Texas’ admitting privileges and ambulatory surgical center provisions, which required abortion providers to obtain rights to admit patients to a hospital within 30 miles of their practice and forced clinics to have hospital-like facilities. The Court decided that the provisions did not improve women’s health, but actually worked to impede access to abortion.

The data-driven decision apparently didn’t sway many state legislators. According to Guttmacher datareleased in June, 1,257 reproductive health-related provisions were introduced in statehouses across the country in 2017; more than 40 that restrict abortion were enacted.

Those provisions join a deluge of pre-existing anti-choice legislation, which the May report categorized into three broad areas: those that target abortion providers, require various types of counseling or waiting periods, or use fetal pain as a pretext for restricting abortion access.

For each policy identified, scientific evidence or consensus contradicts the legislation’s claims or purpose:

  • Ambulatory surgical center and hospital admitting privileges requirements: These two restrictions at the center of the Whole Women’s Health case have been shown to restrict care without improving safety. While some states have blocked these restrictions by court order, some before and others after the Whole Woman’s Health decision, 18 states still have ambulatory surgical center requirements in place, and three still have admitting privileges laws. Both provisions place onerous facility requirements on providers and contributed to the closing of 16 of Texas’ 41 abortion clinics.
  • Telemedicine bans for abortion: Despite a 2014 joint American College of Obstetricians and Gynecologists (ACOG) and Society of Family Planning practice bulletin and recent studies asserting the safety and effectiveness of using telemedicine in abortion provision, 18 states still ban the use of telemedicine for abortion care.
  • Restrictions on medical staff who can perform abortions: In 38 states, equipped health-care providers—such as physician assistants, nurse practitioners, and certified nurse midwives—are prohibited from performing abortions in the absence of a doctor. The World Health Organization’s 2012 guidelines disagree with such restrictions, and studies in various states have concluded that these health-care professionals can equally and safely provide abortion care.
  • “20-week bans” and fetal pain bills: The two most common pieces of legislation built on the fetal pain pretext are “20-week bans,” which exist in 17 states, and policies that require a woman to be informed that a fetus can feel pain, which are on the books in 13 states. Bans at 20 weeks are unconstitutional, arbitrary, and counter to statements and recommendations published by leading U.S. and international OB-GYN groups.
  • Mandatory waiting periods: These laws exist in 27 states and require people to wait between 18 and 72 hours after receiving counseling to have an abortion. Framed as a way to provide possible patients with time to consider whether they want to have an abortion, research has disproven this narrative. A 2008 survey found that 92 percent of women were confident about their choice to have an abortion when they made the initial appointment. A subsequent 2017 study found the majority of patients’ decisions to be unaffected by waiting period laws, and in some cases the laws only increased rates of confidence in decisions to have an abortion.
  • Mandatory counseling: Three of the remaining policies require a doctor to counsel their patients about the effects that abortion can have on their mental health, breast cancer risk, or future fertility—all claims that have been roundly contradicted by research. A 2015 statement of facts from ACOG affirmed there is no link between abortion and breast cancer or future fertility; nor is there an increased risk of mental health conditions. The National Cancer Institute, American Cancer Society, and other medical organizations have all come to the same conclusions about the connection between having an abortion and one’s increased risk of breast cancer: There isn’t one.

Overall, 28 states have at least two of these restrictions in place. These restrictions are harmful: intervening in the patient-provider relationship, greatly limiting access to abortion care, or spreading misinformation. Individually or en masse, such restrictions amount to an unnecessary mountain of barriers for people seeking abortion care.

Nikki Madsen, executive director of Abortion Care Network, said in a press release:

Since 2010, state lawmakers have been engaged in a relentless crusade to push abortion out of reach: They’ve quietly passed more than 334 new restrictions on abortion. It doesn’t come as a surprise to abortion care providers or the women who seek their services that these laws aren’t based on science—but it should be a shocking wake-up call to lawmakers. We see what you’re doing, and it has nothing to do with women’s health and safety. This study shows that there’s no claim too specious for an anti-abortion lawmaker to use to justify taking away a woman’s health care.

While the Guttmacher report focuses on state level restrictions, it acknowledges that changes at the federal level are also of concern—and essentially create a compounding anti-abortion effect.

Various administration appointments and federal policy efforts are promoting anti-science rhetoric and action. In particular, the Trump administration has appointed individuals who subscribe to anti-choice, anti-science beliefs and whose track records show a commitment to restricting abortion access. President Donald Trump is packing the Department of Health and Human Services (HHS) with a science-denying cast; HHS Secretary Tom Price has previously that stated “there’s not one” woman who can’t afford birth control, and Charmaine Yoest was appointed as HHS assistant secretary for public affairs. Yoest previously worked as president and CEO for Americans United for Life, a prominent anti-choice organization that, as Rewire’s Ally Boguhn detailed last month, has been the architect of some of the legislation outlined in the Guttmacher report.

Combined with these federal appointments, the state-level policies outlined by Guttmacher paint a clear picture of an ever-present and overarching anti-choice agenda. Guttmacher’s sobering report illustrates that each law, policy, or court case is not an isolated example of “alternative facts.”


Senate Bill 8 will likely face a lawsuit this summer. The problem for abortion-rights advocates is that legislation often moves faster than the courts.

“Why don’t we just stop passing unconstitutional laws?” asked an exasperated Representative Chris Turner, D-Grand Prairie. He spoke in May as the House debated a sweeping new anti-abortion bill that Governor Greg Abbott has since signed into law. Turner didn’t really get an answer to his question and he probably didn’t expect to, but it is an interesting one. So why do anti-abortion lawmakers keep passing unconstitutional laws? One answer is: because it works.

Five hours and 25 amendments after the debate started, what began as a limited set of requirements emerged as Senate Bill 8, an omnibus measure that mandates burdensome clinic regulations and outlaws a safe, common abortion procedure. Abortion-rights advocates and their opponents alike call Texas’ new anti-abortion law the most sweeping since House Bill 2 was passed four years ago. It comes less than one year after the U.S. Supreme Court struck two major provisions from the 2013 law for placing an unconstitutional burden on abortion access. Reproductive-rights attorneys say the state will face a similar lawsuit against SB 8 this summer.

The HB 2 saga left both sides something to claim as a victory. The Supreme Court gave reproductive-rights groups a decisive win, but plenty of damage was already done. HB 2 forced the closure of more than half the state’s abortion clinics, and only three have reopened since. The problem for abortion-rights advocates is that legislation often moves faster than the courts.

The fallout from SB 8 could be similar. “We’re looking at again the possibility of clinic closures and other restrictions that force women to leave the state if they need abortion care,” said Amanda Allen, senior state legislative counsel at the Center for Reproductive Rights, which filed the lawsuit against HB 2 and has pledged to fight SB 8. “In terms of access on the ground, this presents a huge threat to Texas.”

State Representative Donna Howard, D-Austin, speaks against SB 8 Friday evening.  SAM DEGRAVE

Reproductive-rights attorneys are focused on two provisions that would most restrict abortion access: a requirement that fetal remains be buried or cremated, and a ban on “dismemberment abortions” — a nonmedical term that refers to dilation and evacuation (D&E) abortions, the most common type of second trimester procedure.

Abortion clinics may not be able to find third-party vendors to comply with the funeral-like requirements for fetal tissue disposal, and costs could be prohibitive, attorneys say. Failure to comply could cause more clinic closures. Meanwhile, the D&E ban could effectively prohibit abortions after 13 weeks.

“This is going be another sweeping, sweeping anti-abortion restriction if it takes effect,” Allen told the Observer.

Those who battled HB 2 take comfort in the fact that both measures have already been successfully challenged in court. In January, a federal judge blocked new Texas regulations that would’ve required burials for fetal remains. And D&E abortion bans have been halted in four other states.

These restrictions are “more of the same” as HB 2, so similar legal arguments can be expected, said Stephanie Toti, the former Center for Reproductive Rights attorney who argued last year’s Supreme Court case.

But if SB 8 plays out the same way as HB 2, that’s bad news for those who favor abortion access. Anti-abortion advocates are prepared for a long fight, and win or lose in court, SB 8 could have lasting consequences.

“I’m not concerned about [a lawsuit] at all. That’s what we need,” said John Seago, legislative director of Texas Right to Life, an anti-abortion advocacy group aligned with the far-right House Freedom Caucus. “The pro-life movement is ultimately set on overturning Roe v. Wade. You have to do that in court.”

Seago wants to push the D&E ban — his priority legislation — all the way to the Supreme Court. He says this would force a conversation centered around protecting the fetus rather than regulating clinics.

“The courts recognize state interests in prohibiting elective abortion that have nothing to do with maternal health, but with protecting unborn life,” he told the Observer, pointing to Gonzales v. Carhart, the 2007 Supreme Court case that upheld the partial-birth abortion ban.

Other anti-abortion advocates favor a more incremental approach. This faction wants to chip away at access with HB 2-like restrictions until the makeup of the Supreme Court changes in their favor.


“It’s very clear now that [Justice Kennedy] will not uphold any state or federal provision that makes abortion less accessible, that’s the unfortunate reality,” said Joe Pojman, executive director of Texas Alliance for Life, an anti-abortion group aligned with House leadership. His group lobbied the Texas Legislature against the D&E ban, saying it would be struck down and the state would again face hefty legal fees.

“Let’s not pass it at this time, but wait until we have more votes on the Supreme Court that understand the U.S. Constitution allows states to regulate abortion,” Pojman told the Observer. “We’re not at that point now.”

The fetal remains requirement was Pojman’s top priority this session. He says it will ultimately withstand a court challenge, even though a federal judge in Austin has ruled otherwise. The U.S. Fifth Circuit Court of Appeals is likely to be more sympathetic than the Austin district court, Pojman said.

“It’s typical modus operandi [for judges in the Western District of Texas] to strike down these laws,” he said. “But the 5th Circuit has done a very good job of overruling them, realizing the state has every basis for passing a law like this.”

“We need to push the case higher,” Seago agreed, his sights set on the Supreme Court.

Saying “Abortion is not family planning,” the United States rejected part of a United Nations resolution designed to help female victims of violence around the world. The one point of contention is the portion of the resolution calling on countries to provide abortions to women who’ve been abused and to give information about abortions.

The U.S. objection to the abortion provision is in keeping with the Trump administration’s pro-life position. For example, in January, President Trump signed an executive order banning international agencies from providing abortion services or offering information about abortions if they receive US funding.

Thursday the U.N. Human Rights Council unanimously adopted a resolution condemning the abuse and discrimination of women and girls, particularly in war-torn countries. The measure says the Council, made up of 47 countries, feels “outrage at the persistence and pervasiveness of all forms of violence against women and girls worldwide”, and suggests countries change their policies to help females who have been victimized or neglected.

The U.S. representative, Jason Mack, voiced strong support for the overall “spirit” of the resolution, telling the council “The United States fully supports the principle of voluntary choice regarding maternal and child health, and family planning.”

However, he told the council the United States does not agree with the portion in the resolution which advocates the killing of unborn children. Mack said that the U.S. “must dissociate from the consensus” specifically on abortions.

The clause in the resolution states that countries should make sure their health care systems provide “quality comprehensive sexual and reproductive health care services,” including “safe abortion where such services are permitted by national law”.

“The United States fully supports the principle of voluntary choice regarding maternal and child health and family planning,” Mack said, adding however, “we do not recognize abortion as a method of family planning, nor do we support abortion in our reproductive health assistance,” he read in a statement to the council in Geneva, according to the Christian Post.

WASHINGTON — The Senate health care bill contains sweeping new restrictions on abortion coverage and defunds Planned Parenthood, setting up a complicated fight that could potentially imperil its passage.

Under the Better Care Reconciliation Act released by Republicans on Thursday, insurance plans that customers can buy on the individual market with tax credits would be banned from covering abortion services, with exceptions for rape, incest and the health of the mother. The House bill contained a similar provision.

The Senate bill also cuts off funding next year to Planned Parenthood, which is already barred from receiving federal money for abortion but is reimbursed by Medicaid for providing other health services.

The ongoing policy standoff contains echoes of Obamacare’s passage in 2009 and 2010, which featured a series of negotiations to bring pro-life Democrats on board who were concerned that the bill’s new subsidies could be used to fund abortion.

“It was a huge flashpoint which almost killed the bill in the House and Senate in 2010,” John McDonough, a public health professor at Harvard who was a Senate aide at the time, told NBC News. “That fight is erupting again.”

Bernie Sanders on Health Care Bill: Thousands will Die 3:16

Pro-choice groups immediately condemned the bill, which would cause private insurers who participate in the health care exchanges to drop abortion coverage en masse.

NARAL Pro-Choice America President Ilyse Hogue decried the legislation as “a savage attack on women’s healthcare.”

Making matters more complicated, blue states like California and New York currently require insurers to cover abortion. Unless the states changed their laws to comply, the House and Senate bills would potentially block subsidies for all insurance plans on the individual market.

IMAGE: Susan Collins
Sen. Susan Collins, R-Maine, speaks during a news conference on Capitol Hill in Washington, Tuesday, June 21, 2016, to unveil a new gun legislation proposal. Evan Vucci / AP

But there’s a strong chance the abortion ban on private plans could be stripped by the Senate parliamentarian for failing to meet reconciliation rules, which require that legislative items directly impact the budget.

Key moderate Republicans, including Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), have also expressed opposition to the measure targeting Planned Parenthood.

With these challenges in mind, pro-life activists cautiously hailed the proposed legislation on Friday.

“The Senate discussion draft includes these pro-life priorities, but we remain very concerned that either of these priorities could be removed from the bill for procedural or political reasons,” Family Research Council President Tony Perkins and Susan B. Anthony List President Marjorie Dannenfelser said in a joint statement.

On Wednesday, 30 members of conservative House Republican Study Committee sent Senate Majority Leader Mitch McConnell (R-Ky.) a set of four demands for any bill that included defunding Planned Parenthood and the restriction on abortion coverage. Leaving out the items “may jeopardize final passage” in the House, they warned.

Under the longstanding Hyde Amendment, federal funding cannot go toward abortion. President Barack Obama eventually worked out a compromise in which only money from premiums could cover abortion through a separate fund, upsetting activists on both sides of the issue, but securing enough key votes to enable the bill’s passage.

Beyond the abortion measures, reproductive health is emerging as a rallying cry for Democrats and activists opposed to the bill.

Both the House and Senate bills allow states to waive Obamacare’s requirements that insurers cover items like maternity care, which was frequently left out of private plans before Obamacare went into effect. According to the nonpartisan Congressional Budget Office, the House’s changes could increase out of pocket costs for pregnancy-related expenses by “thousands of dollars in a given year” as a result.

Gonzalo Arroyo Moreno/Getty Images News/Getty Images

After multiple incidents of vandalism over the past few months resulting in some major damage to its building, a Cleveland, Ohio abortion clinic is taking a standagainst anti-choice harassment as it tries to raise money for repairs.

Preterm, the only abortion clinic in Cleveland, has seen multiple windows broken by what police and employees believe to be a repeat offender targeting the clinic.

Preterm’s executive director Chrisse France told local news that ten windows have been broken in eight incidents over the last three months, with the latest occurring earlier this week. This most recent incident was caught on surveillance video — a shirtless man was seen throwing bricks at the building.

As France told reporters, she believes the repeated incidents are meant as an attack on abortion providers:

Just the same, as the clinic looks toward their repair costs, France promises that they are “not going to be intimidated.” The clinic has a reputation for being unapologetic advocates for choice, known in the area for abortion-positive billboards that proudly proclaim “I’m grateful for my abortion.”

 That same spirit of defiance carries over to the description on its crowd-funding page where representatives from the clinic explained their lofty $20,000 goal:

The damage to Preterm is, for many, considered a symptom of a larger cultural problem surrounding abortion in the United States. With a growing anti-abortion presence in positions of political power and reports of “increased violence and threats of violence” to abortion clinics around the country, pro-choice advocates see attacks on clinics as a dangerous progression.

Furthermore, Preterm insists that the vandalism is another act of intimidation that can’t be ignored. Such violent actions work only to make the space seem less safe for patients seeking healthcare that they’re legally entitled to access.

As Cleveland Police continue searching for the person behind the brick-throwing, one thing remains certain: The advocates, employees, and volunteers at Preterm refuse to be rattled.

“People living at the intersections ultimately are the ones who suffer under this bill, although again, I think we can’t forget that they’re coming for you if you have private coverage too.”4212

Congressional Republicans want to use their Obamacare repeal bill to prohibit any health insurance plan, private or public, from covering abortion care.

But that goal could sink under the weight of its own ambition.

The American Health Care Act (AHCA) in the U.S. House of Representatives and the Better Care Reconciliation Act (BCRA) in the U.S. Senate prevent private health insurance plans, individual plans, and at least some employer-sponsored plans, from covering abortion. Republicans impose the restrictions through federal tax credits that are less generous than those enacted under the Affordable Care Act (ACA), President Obama’s signature health-care reform law. The structure of the tax credits differ between the two chambers.

Senate Republicans included the restrictions in the BCRA discussion draft they released Thursday morning, contradicting initial projections by theWashington Post and other news outlets. The working group of 13 Republican men and zero Republican women who crafted the repeal plan behind closed doors had toyed with the restrictions, given concerns that they might not have the procedural power to limit abortion access. Ultimately, they pulled the restrictions from the version that their counterparts across the Capitol forced through the House in May.

Overtly partisan abortion restrictions could violate the rules of the special fast-track “budget reconciliation” process that Republicans are using to pass a repeal bill in the Senate with a simple 51-vote majority, rather than the 60 votes typically needed in that chamber for controversial legislation. Banning abortion coverage so broadly appears to be on the same uncertain footing as a separate provision in both the House and Senate versions “defunding” Planned Parenthood via a one-year moratorium on reimbursements for Medicaid patients.

Senior GOP Senate staff told reporters on a press call Thursday that Republicans will continue discussions about the hits to abortion and Planned Parenthood access with the parliamentarian, the arbiter of the chamber’s rules and procedures.

Senate Republicans turned to other House GOP provisions that reproductive rights advocates have said will disproportionately hurt women. Both versions of the health-care bill allow states to waive guaranteed essential health benefits (EHBs), including maternity care.

“If states can waive the EHB requirements, millions of women could be left without the coverage they need or forced to pay more for plans that include the coverage of critical services, such as maternity care, prescription drugs and mental health services,” National Partnership for Women and Families President Debra Ness said in a statement.

Ness pointed to a nonpartisan Congressional Budget Office (CBO) forecast that detailed the vast human cost of the House-passed AHCA. The CBO estimated that maternity coverage could cost more than $1,000 per month.

GOP Sens. Ted Cruz (TX), Ron Johnson (WI), Mike Lee (UT), and Rand Paul (KY) issued a joint statement saying they were “not ready to vote for this bill” because it didn’t go far enough to repeal Obamacare. Two other Republicans, Sens. Susan Collins (ME) and Lisa Murkowski (AK), may defect over the Planned Parenthood provision. Senate Majority Leader Mitch McConnell (R-KY) can still pass the bill if he loses two votes and brings in Vice President Mike Pence to break the tie, mimicking what happened in March when the GOP shredded Obama-era Title X family planning protections.

Destiny Lopez, co-director of All* Above All, a reproductive justice group that fights the Hyde Amendment and other discriminatory abortion restrictions, identified the hypocrisy underlying Senate Republicans’ plan.

“Not only is this bill going to make it harder to prevent unintended pregnancy and nearly impossible to get an abortion covered by insurance, they’ve also added provisions that would penalize folks for having children,” she said in a phone interview. So, you’re kind of damned if you do, damned if you don’t.”

The Senate’s BCRA phases out Medicaid expansion over a longer period than the House-passed AHCA but cuts the program more deeply. Andy Slavitt, the former acting administrator for the Centers for Medicare and Medicaid Services under President Obama, described on Twitter how Senate Republicans provide incentives to decimate Medicaid through state waivers.

Provisions like these will disproportionately hurt people living at the intersection of marginalized groups.

“We know that low-income people, in particular communities of color, gender nonconforming folks, are the ones who bear the brunt of these kinds of political ploys,” Lopez said, adding that one in five U.S. women of reproductive age enrolled in Medicaid breaks down to one in three Black women of reproductive age and one in four Latina women of reproductive age.

“People living at the intersections ultimately are the ones who suffer under this bill, although again, I think we can’t forget that they’re coming for you if you have private coverage too,” Lopez said.

That warning circles back to the abortion restrictions that could leave even those with private insurance on the hook for the cost of what can be a cost-prohibitive procedure. Will congressional Republicans ultimately place abortion out of reach for all but the wealthiest or most privileged Americans who can pay for it in full?

#ThrowbackThursday Abortion Restrictions Burden Women

For all of House and Senate Republicans’ bluster about abortion, they’re recycling the anti-choice playbook from the original Obamacare debates in 2009 and 2010.

The abortion restrictions in the House-passed AHCA mirror the ACA’s failed Stupak-Pitts Amendment, according to Guttmacher Institute Senior Policy Manager Adam Sonfield, who spoke with Rewire in the lead-up to Thursday’s reveal in the Senate. Senate Republicans also appear to rely on the Stupak-Pitts model.

For the uninitiated, then-Reps. Bart Stupak (D-MI) and Joe Pitts (R-PA) in 2009 played into the GOP myth that taxpayer money is fungible. Their amendment sought to bar the ACA’s tax credits from subsidizing any health insurance plan that covers abortion, not just abortion care itself in compliance with longstanding federal policy. The amendment passed the House with the help of 64 Democrats.

Congress ultimately went with the Nelson Amendment from then-Sen. Ben Nelson (D-NE). The ACA’s tax credits can subsidize any plan that covers abortion as long as insurers wall off abortion care into a separate fund that only draws money from individuals’ or employers’ private contributions to premiums.

“The way it works in practice is that the insurance company has to segregate the dollars and make sure that the federal dollars aren’t touching abortion,” Sonfield told Rewire.

That’s bad enough from Sonfield’s perspective; the Nelson Amendment empowered legislators in 25 states to enact restrictions of abortion coverage in their exchanges. Ten of those states apply the restrictions to all private health insurance plans that they regulate and are available in their borders. Two states, California and New York, require private plans to cover abortion care, and AHCA puts them “in an untenable position,” Sonfield wrote in an article for Health Affairs. “They might be forced to reverse or stop enforcing their abortion coverage requirement, or state residents might find themselves unable to use federal subsidies to buy any insurance plan offered in the state— effectively, an abortion surcharge of thousands of dollars.”

If congressional Republicans get their way, they’ll apply the restrictions to the tax credits for all private health insurance plans sold to people and families available in the United States, à la Stupak-Pitts. Republicans will hold the existing ACA subsidies, including those for small businesses that offer employer-sponsored plans, to the restrictions until phasing them out, per Sonfield’s article. Doing so “could have a chilling effect on some employers’ willingness to include abortion coverage in the plans they sponsor,” Sonfield warned.

The bottom line: Republicans “are trying to make it the norm for insurance plans to exclude abortion,” Sonfield said.

That’s already the norm for cisgender women, transgender people, and gender nonconforming people enrolled in public insurance plans like Medicaid and a companion program, the Children’s Health Insurance Program (CHIP). For 7.5 million women of reproductive age, more than half of whom are women of color, legal abortion is often a right in name only, according to Guttmacher figures from January.

People with private insurance could soon join their ranks.

Four in ten abortion patients who have private insurance use it to pay for abortion care, according to Sonfield’s Health Affairs article. Those who don’t use it may face high deductibles or any number of hurdles, including abortion stigma.

Republicans may try to claim that people can purchase a separate “rider” at additional cost to cover abortion care. Rep. John Shimkus (R-IL) sparked an uproar in March when he suggested that women buy maternity riders, even though insurance works by pooling risks, not by spinning off specific benefits. The disconnect became all the more evident after Michigan in 2013 banned private insurance from covering abortion care—and no insurance companies subsequently stepped up to offer abortion riders on the individual market. A limited number of insurance companies offered the riders for employer-sponsored plans.

And employers aren’t going to want to buy separate abortion coverage for their employees with so many disincentives at play, warned Andrea Flynn, a women’s economic security policy expert and fellow at the Roosevelt Institute.

“What you’re seeing now is that the government is basically saying, ‘You can either have our subsidies or provide abortion coverage,’ and that’s a tough place to put small businesses in,” Flynn said in a phone interview. It’s a tough place for women, too, she said, since so many work for small businesses.

Where does that leave them?

Abortion, Planned Parenthood Provisions Face Test

There is good reason to believe that restricting abortion access and defunding Planned Parenthood won’t get through Congress—at least, not in their current forms.

Both are on the Senate parliamentarian’s radar. The parliamentarian has “flagged” the abortion restrictions, according to a June 8 report in The Hill. The report, citing unnamed Senate sources, indicated that the parliamentarian had issued a formal warning to Republicans, who were undeterred.

“There’s still not a clear ruling from the parliamentarian about the House Hyde language…I don’t think we go to contingencies or Plan Bs until we know that. But I do think there’s been some gaming out of how you address it if the House language isn’t acceptable,” Sen. John Thune (R-SD), a member of the group, told Politico the same day as The Hill report.

Republicans are trying to figure out how to maneuver around the Byrd rule, the linchpin of budget reconciliation. The Byrd rule kills provisions that are “merely incidental” to the budget. In other words, Congress can’t wield the reconciliation process with a lower vote threshold for the sake of a political agenda—or a partisan vendetta against abortion and Planned Parenthood.

One potential workaround for some of the abortion restrictions: The Senate bill funnels a “stability fund”of more than $100 billion at the expense of taxpayers to brace for the impact of dismantling the ACA’s state exchanges through CHIP, which can’t cover abortion care due to the Hyde Amendment. Doing so prevents that money from going to abortion coverage too, Guttmacher’s Sonfield said.

The anti-abortion restrictions baked into the tax credits for private insurance remain.

It’s hard to know how the parliamentarian will rule on any of the restrictions. Elizabeth MacDonough, who was appointed to the role by then-Senate Majority Leader Harry Reid (D-NV) in 2012, now serves at the behest of Senate Majority Leader Mitch McConnell (R-KY). MacDonough in 2015 gave the green lightfor the ACA repeal bill that defunded Planned Parenthood for one year. Obama vetoed that bill.

But this time around, reproductive rights advocates appear to have the CBO on their side. The CBO unequivocally determined that Republicans intend to defund Planned Parenthood, and only Planned Parenthood in the House-passed AHCA bill. Many Senate aides believe that violates the rules of reconciliation, according to a recent CNN report.

“Experts agree the ‘defund’ Planned Parenthood provision is a violation of the Byrd Rule because it is politically-motivated policy, similar to the tax credit provision related to abortion,” Planned Parenthood Federation of America said in a statement.

“It has no place on reconciliation because it violates these rules, and it has no place on any legislation because it is the epitome of a mean-spirited policy that hurts millions of women.”

All* Above All’s Lopez advised people to remain vigilant, regardless of the short-term outcome. If the abortion restrictions on the state stability fund fail to pass muster with the parliamentarian, she said, Republicans could try to include them in must-pass CHIP reauthorization this September.

“I don’t know that there aren’t some tricks that they could figure out to make that not be the case,” she said. “That’s how it would normally be—this is not a normal political environment that we’re working in.”

No one can predict with certainty the fate of the abortion restrictions—or for that matter, the fate of the Planned Parenthood provision. Only the consequences of Republicans’ anti-abortion machinations are clear, per a new Kaiser Family Foundation report that now seemingly applies to the Senate’s BCRA too: “If the AHCA’s restriction of the use of tax credits for any plan that covers abortion beyond the Hyde restrictions becomes law, there will be very limited abortion coverage in private plans in all states.”

In Louisiana, women seeking abortions must receive an ultrasound. They must visit a clinic at least twice — once for counseling about the abortion, and then again for the procedure itself, which cannot take place until 24 hours have passed since their first visit. And if they wait more than 22 weeks after their last periods before getting their abortions, they can’t get abortions in Louisiana at all.

Louisiana is currently neck-and-neck with Mississippi for the title of being the most restrictive state in the nation when it comes to abortion, according to the Guttmacher Institute, which tracks and supports abortion rights. Now, lawyers are trying to stop the state from adding even more restrictions by putting every single anti-abortion measure passed by Louisiana lawmakers in 2016 on trial.

In an unusual legal maneuver, the lawsuit against Louisiana doesn’t just challenge each measure’s individual impact on women’s ability to access an abortion. Instead, it argues that all seven restrictions “by themselves and together impose unconstitutional restrictions on the right to abortion,” said Zoe Levine, an attorney for the Center for Reproductive Rights, which brought the case on behalf of one of Louisiana’s last three abortion clinics.

No recent lawsuit against abortion restrictions has challenged so many laws in one case, and that cumulative approach more closely mirrors the actual experiences of Louisiana women seeking abortions, who must grapple with all of the restrictions at once.

On Friday, the lawyers went to court to get it started. Overall, the lawsuit — filed on behalf of one of Louisiana’s last three abortion clinics — seeks to roll back seven abortion restrictions, including:

  • Banning “dilation and evacuation” procedures, which are generally seen as the safest way to perform second-trimester abortions
  • Requiring fetal remains from abortions to be given burial rites
  • Criminalizing “knowingly and for money” buying, selling, or transporting fetal tissue from abortions for medical research, even if that tissue is donated
  • Mandating that abortion providers give women seeking abortions an “informational document” about “fetal genetic abnormalities” and “children born with disabilities” — and banning any woman whose fetus has been diagnosed with a potential “genetic abnormality” from getting an abortions 20 weeks after the fetus was fertilized
  • Extending the time between a woman must wait between her first trip to an abortion clinic and her actual abortion from 24 hours to 72 (with some exceptions)
  • Requiring that the only physicians who can provide abortions are trainee residents, OB-GYNs or family medicine doctors
  • Prohibiting all state or local government agencies from contracting with groups that perform abortions, or even any third-party entities that perform abortions, with some exceptions

“If you had to pick a handful of restrictions that have been trends in recent years, these are what you would pick,” explained Elizabeth Nash, a policy analyst for the Guttmacher Institute, adding that the ban on dilation and evacuation abortions and the extending women’s waiting period have been particularly popular. “If these restrictions all get struck down, that could be useful for other states challenging their own restrictions.”

Louisiana officials are arguing the abortion clinic failed to prove sufficient harm would be caused by the laws, and asked U.S. District Judge Brian Watson to dismiss most of the lawsuit’s claims on Friday.

“Louisiana really never gives up, and they’re always sort of among the leaders of the pack in terms of finding ways to restrict women’s access to abortion,” said Zoe Levine, an attorney for the Center for Reproductive Rights, which brought the case on behalf of one of Louisiana’s last three abortion clinics. (A second abortion clinic was also involved in the lawsuit, until it shut down.) “This is not, by any means, the first time that we’ve had to go to court to try to fight back against restrictions that the Louisiana legislature has passed.”

Right now, an agreement between the state and the plaintiffs is keeping the new restrictions from going into effect.

Legislation around the handling of fetal tissue drew national scrutiny after a series of videos purporting to show that Planned Parenthood employees illegally sold fetal remains for profit were leaked in 2015, though later investigations found no evidence to support that claim.

But more than 45 states saw lawmakers introduce bills this session to restrict fetal tissue donation and research, according to the Guttmacher Institute. So far this year, only Wyoming has passed such a measure.

Then there’s Louisiana’s attempt to stop government agencies from contracting with abortion providers, which essentially amounts to “defunding Planned Parenthood,” anti-abortion advocates say. Louisiana’s version of law, however, goes much further than many states’ attempts to strip Planned Parenthood of funds — those merely sought to cut Planned Parenthood out of Medicaid family planning programs.

In court documents, lawyers for the Louisiana abortion clinic argue that this law alone could shut down all abortion providers in Louisiana, since so few businesses would want to risk losing state funds. U.S. District Judge Brian Jackson appeared to acknowledge far-reaching consequences in court on Friday, when he asked an attorney with the Louisiana attorney general’s office if the law could, say, even stop an office supply company from letting an abortion clinic use its copy paper.

When the attorney told Jackson that the state didn’t interpret the law to apply to “basic services,” Jackson pointed out, “That’s not what the statute said.”

But even without considering its larger implications, the case’s stakes are already high for abortion rights advocates: If it fails, it’s unclear what exactly will happen to the agreement not to enforce these seven restrictions — but Louisiana could finally become the state with the most restrictions on abortion.

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