Abortion Is Heading to the Supreme Court—Again
12.18.24
Click to skip ahead: In the Courts, the fight over Planned Parenthood and Medicaid is going to the Supreme Court. In the States, news from New York, Texas, Minnesota, Alaska and Virginia. In the Nation, RFK Jr promises Republicans their Project 2025 wish-list. OBGYN Exodus reminds us of the generational problem with abortion providers. Stats & Studies looks at new research showing that women are often surprised by pain when using abortion medication. Finally, in Anti-Abortion Strategy, be on the lookout for abortion ‘reporting’ mandates in state legislation.
In the Courts
The Supreme Court has announced that they’ll weigh in on South Carolina’s efforts to prevent Medicaid patients from visiting Planned Parenthood—a case with national implications for low-income patients across the country.
The short version is that South Carolina Republicans sparked a legal battle in 2018 when they prohibited Planned Parenthood from participating in its Medicaid program. This past March, an appeals court found in favor of the reproductive rights organization, ruling that patients have the right to choose any qualified healthcare provider. Today, SCOTUS said they’ll hear the case (Kerr v. Edwards).
As you likely know, public funding is prohibited from covering abortion care—save for cases of rape, incest or when the pregnant person’s life is endangered. But Planned Parenthood does get reimbursed when Medicaid patients go to them for treatment like birth control, cancer screenings and check-ups. Just like any other healthcare provider. But because Planned Parenthood provides abortions at all, Republicans want to prevent them from being reimbursed.
The attorney representing South Carolina, John Bursch, says, “Taxpayer dollars should never be used to fund facilities that make a profit off abortion.” (It will come as no surprise to you that Bursch is actually a lawyer with Alliance Defending Freedom—the group responsible for the end of Roe.)
Here’s the thing: This case and others like it are often framed as the ‘funding’ or ‘defunding’ of Planned Parenthood. But that gives Americans the impression that the organization is getting some sort of check from the government willy nilly. I don’t know that most voters understand that the Medicaid money Planned Parenthood gets is actually just reimbursement for medical services rendered.
In a moment when the American healthcare system is under fire and very much dominating the national conversation, it would do us well to remind the public what this case is actually about: Republicans trying to fuck over people who can’t afford healthcare.
In the States
Speaking of the Supreme Court, law professor Mary Ziegler predicts that Ken Paxton’s attack on a New York abortion provider is likely to end up there. Last week, the Texas Attorney General sued a physician who mailed abortion medication to a patient in the anti-choice state. (Read Abortion, Every Day’s coverage here.)
New York’s shield laws protect abortion provider Maggie Carpenter from Paxton’s bullshit, but Paxton will likely argue that this is his jurisdiction because the abortion took place in Texas. It will bring up all sorts of complicated legal questions—questions that Ziegler says are “certain” to be decided by the Supreme Court:
“Many of them land in enough of a legal gray area that predicting the outcome with any certainty is challenging, especially with conservative judges who are likely to sympathize with Texas’ view of reproductive rights.”
In the meantime, New York Democratic leaders have come out in support of Carpenter. Gov. Kathy Hochul said she’ll do “everything in my power” to protect the provider; Rep. Jerry Nadler said that New Yorkers “won’t be intimidated by bullies”; and Congressman Pat Ryan lauded Carpenter, saying, “AG Paxton chose the wrong person to mess with.”
We should be really grateful for providers like Carpenter, who are risking a whole lot in order to make sure people get care no matter what state they’re in.
While we’re on the issue of appreciation, consider saying thank you to an abortion navigator today. The Sahan Journal, reporting on how Minnesota abortion clinics are preparing for the new administration, shared this incredible statistic: Abortion navigators at Planned Parenthood North Central States have helped 5,400 patients get care, 80% of whom would not have made it to their destination without a navigator.
Organization CEO Ruth Richardson says they’ve seen a 110% increase in the number of people traveling from outside of the region in order to get care:
“You have spaces where people are oftentimes forced to travel three, four, five hours just to get access to care. It’s really concerning that we’re at this place where it’s more dangerous to be pregnant today in the United States than it was 30 years ago.”
In addition to bans, funding problems are also shuttering clinics—forcing patients to travel long distances for care. Just last week, for example, Juneau, Alaska lost their Planned Parenthood. The clinic closed in November for repairs, but patients got an email a few days ago that the location will not reopen. Alaska Public Media reports that there are no other abortion providers in Southeast Alaska.
Jennifer Martinez, a spokesperson for the regional Planned Parenthood, said the decision was based on the cost of building repairs, and reduced funding in a hostile political climate:
“We’ve been here for over 100 years. We’re going to keep fighting and do whatever it takes so that the patients in Juneau, Alaska, and the country, continue to receive the care that they need and deserve.”
Patients will still be able to get some types of care via telehealth.
Finally, the cruelty is the point in Virginia, where Gov. Glenn Youngkin’s proposed budget would prohibit Medicaid patients from accessing abortion in cases of severe fetal diagnoses. If this budget were approved, low-income women carrying doomed pregnancies would be forced to continue their pregnancies to term. That is, unless they could cover the cost of the procedure themselves.
What’s more, this is the third year that Youngkin has pushed for this mandate. Jamie Lockhart, executive director of Planned Parenthood Advocates of Virginia, called the budget proposal “shameful.”
“This policy will disproportionately harm people of color and low-income Virginians, forcing them to carry pregnancies that will result in stillbirth or the birth of a baby who cannot survive. Governor Youngkin’s actions make it clear: he thinks it’s acceptable for low-income Virginians to be forced to endure pregnancies filled with pain and suffering.”
If you’re a regular reader, you know that I’ve spent a lot of time digging into this conservative obsession with forcing women to carry nonviable pregnancies to term—from the way they’re sowing distrust in prenatal tests to calling fetuses with fatal abnormalities ‘children with disabilities.’ For more, read my “Calculated Cruelty” series. Part I below, and click for Parts II and III.
A few last bits of state news: The 19th reports on Idaho’s maternal health care deserts; Pennsylvania Republicans are trying to pass a ‘heartbeat’ abortion ban; WAMU reports on later abortion patients in Maryland; And States Newsroom does a postmortem with ballot measure organizers in Arkansas, Florida, Nebraska and South Dakota.
In the Nation
Republicans’ initial hesitation over RFK Jr. as Donald Trump’s pick for head of the Department of Health and Human Services (HHS) appears to have waned: Despite the initial uproar over Kennedy potentially being too pro-choice, the brainwormed nominee has reassured Republicans by promising to fully support their extreme anti-abortion agenda if appointed.
Over on Twitter, Sen. Josh Hawley (husband to Alliance Defending freedom attorney, Erin Hawley), wrote that Kennedy “committed to me to reinstate President Trump’s pro-life policies at HHS.”
What are those policies? Hawley tweeted that Kennedy promised to hire all ‘pro-life’ deputies; reinstate the Global Gag Rule and ‘conscience’ protections; ban Title X funds from going to groups that “promote abortion”; reverse a Biden-era nondiscrimination rule; and end “taxpayer funding” for abortions (which isn’t really a thing).
Now, if it sounds like this list of attacks was taken directly from Project 2025, that’s because it was! Remember, HHS played a major part in Project 2025’s plan for attacking abortion: they even want the department to be renamed the Department for Life.
Basically, what Hawley is giving us—in tweets, no less—is assurances that Kennedy will do whatever Republicans want on abortion. Which is not really a surprise to me: Last month, I speculated that Kennedy was being coached or advised by Susan B. Anthony Pro-Life America. His most recent comments on abortion and ‘consensus’ absolutely reeked of their talking points.
For more on conservatives’ plans for HHS and abortion, read Abortion, Every Day’s explainer:
We know Republicans are dying to attack Planned Parenthood once Trump takes office. In addition to that South Carolina case headed to SCOTUS, conservatives plan to target Title X funding. (As Hawley’s tweets and Project 2025 make plain.) In fact, billionaire man-baby Elon Musk and Vivek Ramaswamy already wrote a Wall Street Journal op-ed saying that their new DOGE department will target the “nearly $300 million to progressive groups like Planned Parenthood.”
But Alice Miranda Ollstein at POLITICO points out that the last time Republicans tried to strip funding from Planned Parenthood, the Congressional Budget Office found that it would end up costing the government $130 million dollars. Because without Planned Parenthood’s work providing services like contraception, the “the number of births in the Medicaid program would increase by several thousand per year.”
And when the last Trump administration pushed Planned Parenthood out of the Title X program, Republicans promises that other healthcare providers would step up fell flat. The federal family planning program ended up serving 844,083 fewer clients. “In particular, 225,688 fewer patients received oral contraceptives; 49,803 fewer received hormonal implants; and 86,008 fewer clients received intrauterine devices,” Ollstein writes.
As I said at the top of the newsletter: in addition to the misogyny, racism and patriarchal bullshit, this is about our nation’s terrible healthcare system. And if Americans can’t go to Planned Parenthood for birth control, many won’t get contraception at all. (Or cancer screenings! And STI testing!)
“In questions of people’s essential freedoms, it is not sustainable for the country to be divided between freedom in some states and unfreedom in others. The two world views—between liberty and restriction, equality and hierarchy enforced by law—cannot abide one another. The country must choose.”
- Moira Donegan, The Guardian
OBGYN Exodus
It’s no secret that OBGYNs, maternal fetal medicine specialists and other types of reproductive healthcare workers are fleeing anti-abortion states—often with great guilt. Healthcare providers don’t want to leave vulnerable women without care, but they’re also terrified of working in a state where they could go to prison just for doing their jobs.
A related issue is generational: these states aren’t just having a hard time retaining doctors, but recruiting new ones. Tennessee, for example, has seen a 21% drop in OBGYN residency applications; Texas (where 1 in 5 OBGYNs are considering leaving) has seen a 16% drop.
“We’re an aging workforce,” Austin-based OBGYN Dr. John Thoppil tells KXAN. “I think about half of OB-GYNs are over 55, so we’re aging out, and if we don’t have young new docs coming to the state, we’re going to have a serious crisis,” he says.
That’s to say nothing of the loss of generational knowledge. Even when med students and residents do stay in anti-abortion states, they won’t get the comprehensive training that they need. Students are having to leave their states to learn abortion care—which is a necessary skill in order to be an accredited OBGYN.
Some are learning on models like papayas, while others take limited programs while staying hotels on their own dime. From Dr. Anitra Beasley, OBGYN and assistant dean at Baylor College of Medicine:
“I think when the residents are going there, they’re getting a really good experience, but they’re getting a really good experience for three to four weeks, and that does not substitute for the comprehensive, longitudinal experience that they would get if abortion care were available in Texas.”
As I’ve said before: who would you rather have treating your miscarriage? Someone who has performed an abortion multiple times, who can do the procedure like muscle memory? Or someone who only got a few weeks training on a model? As incredible as these doctors are who are fighting to make sure they get the education they need, we all know it’s not enough.
For more, check out my conversation with Pamela Merritt, executive director of Medical Students for Choice.
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Stats & Studies
A new study out of the UK found that nearly half of women who use abortion medication were surprised by the amount of pain involved with ending their pregnancies. While some respondents did relay that their pain level was something akin to period cramps, others described such descriptions as being “downplayed or sugar-coated.”
Lead author Hannah McCulloch says that women want “more detailed, realistic” information about what ending a pregnancy with medication is like, and told NBC News, “What’s important here is the acknowledgement that everyone’s experience of pain during a medical abortion will be different.”
The study also found that about 1 in 8 women said that if they were to end another pregnancy, they’d chose a procedural abortion—with 83% citing pain as a factor.
This research comes at the same time as there’s a conversation in the U.S. about women’s pain during reproductive health procedures—like IUD insertion. The broad feeling is that patients frequently aren’t fully informed, or that their pain isn’t adequately treated.
When it comes to abortion medication, I’m sure it’s true that patients aren’t always given a full picture about the potential pain and bleeding. In part that’s due to broader issues around the way women’s pain is treated, but I also think it’s because some folks in the field worry about contributing to stigma or feeding into conservative myths about abortion. I understand the inclination, but we need to talk about the reality of abortion medication regardless—and not just because it’s the right thing to do.
In addition to the fact that patients have a right to be fully informed, neglecting to get into the nitty gritty details of what ending a pregnancy looks and feels like increases the chances that women will head to an emergency room to be checked out unnecessarily. That can be dangerous these days: We know that hospitals are often where criminalization kicks off; when people are turned in for abortion, it’s most often a health care provider who does it.
And as I’ve written previously, Republicans have started to use hospital visits as proof of abortion medication ‘complications’—even when women don’t get treatment of any kind!
Anti-Abortion Strategy
Just a reminder that conservatives are hot-to-trot on abortion ‘reporting’ and data manipulation. It’s something that’s coming up in all sorts of places—from Project 2025 to the mifepristone lawsuit. That’s why it’s so important that we’re keeping an eye out on proposed legislation, as well.
For example, a Missouri Republican has filed a constitutional amendment that would undo Amendment 3, ban abortion after a fetal ‘heartbeat,’ and—you guessed it—mandate abortion and abortion ‘complication’ reporting.
The goal here is to eradicate patient privacy, institute a chilling effect that makes women too afraid to seek care, and collect misleading data to ‘prove’ abortion is dangerous despite all evidence to the contrary. Republicans will say it’s to keep women safe, so it’s vital that we’re pointing out the truth as often as they’re bending it.
Thank you for the discussion about abortion meds. I was given Zofran when I had to take mifepristone to start the abortion process before my D&E and it saved me - mifepristone had me puking every hour. It might have just been me - I also had terrible morning sickness and am hugely sensitive to medication - but I think about that experience and how scary it would be to order the pills and not have access to Zofran or a doctor to let you know what’s going on. I am so glad we’re able to get pills to women in red states and that the pills have been a lifesaver for so many women - but it makes me livid that we can’t just live in a world where women can receive comprehensive care in these situations.
For many years earlier in my career I couldn’t afford health insurance so got basic care at Planned Parenthood. They picked up an ominous rise in high blood pressure. I am grateful to them as I was able to dodge the worst of long term damage to my body by going on medication.