By the time word spread of the U.S. Supreme Court’s June 24 decision to reverse the landmark abortion rights case Roe v. Wade, an Illinois-based hotline for one of the country’s largest abortion support funds was already about to close for the weekend.
When it reopened Monday morning, the staff was stunned to find 200 missed calls for help waiting for them. Overwhelmed, they had to shut down the line for the week — the first time in the Midwest Access Coalition’s 8-year history — just to catch up.
“We opened up the following Monday and, since then, we’ve been servicing about 50 clients a week,” said Alison Dreith, the coalition’s director of strategic partnerships. “We’ve finally started to average out and feel a bit more consistent but those first three weeks to a month were very chaotic…”
As Illinois begins to take its place as an island for abortion rights amid a sea of surrounding states banning the controversial procedure in the wake of the Supreme Court’s latest ruling, everyone from lawmakers to healthcare providers to advocates are bracing for record-shattering numbers of people seeking abortions.
Applications for physician licenses are already spiking, although its unclear how much of the increase is directly related to abortion services. Illinois legislation aimed at protecting abortion rights and providers is being debated.
President Joe Biden signed executive orders aimed at protecting abortion rights for travelers. Gov. J.B. Pritzker increased funding to protect access for those less able to afford it. Chicago Mayor Lori Lightfoot set aside money to pay for lodging and travel services. Healthcare providers are pushing for more resources to meet a need they expect will break all state records as out-of-state patients cross over state lines seeking help.
Some of those records are already being broken.
One clinic in the Illinois suburbs of St. Louis saw a nearly 30% increase in those seeking abortions from June to August. In Chicago, one non-profit abortion support group served 4,000 clients this year, already 1,000 more than all of 2021.
“We’re expecting tens of thousands more people to come to Illinois,” said Alicia Hurtado, communications and advocacy manager at the Chicago Abortion Fund, a non-profit group to support abortion access. “We’re just hopeful we can continue to be there for our neighbors, but it’s going to take deep investment.”
Since it was founded in 2014, the Midwest Access Coalition supported a total of 3,000 abortion patients. Last year, across a 12-state midwest region, the coalition spent $120,000 on hotels, $15,000 for food and $55,000 on flights, according to its 2021 impact report.
The coalition’s fund helped 800 people in all of 2021. This year, they hit that number in July. As of Sept. 2, the coalition served 1,050 clients with meals, hotels and travel expenses, Dreith said.
“This is a healthcare issue, this is a basic human rights issue and we are in a crisis moment and Illinois needs to act legislatively like we’re in a crisis moment,” said Dreith. “Lives are on the line as far as freedom goes as we see more and more criminalization for providing and accessing health care.
“Access to abortion and these protections is not just about abortion.”
Abortion funding increased
Nearly 50 years after the right to an abortion was legally recognized throughout the U.S., the Supreme Court in June toppled the landmark decision with their 6-3 ruling in Dobbs v. Jackson Women’s Health Organization.
The ruling was the culmination of a decades-long strategy by abortion opponents who say life begins at conception. The decision kicked off nationwide protests about the loss of a Constitutional right, and how low-income patients — especially those living in more remote areas of the country — will be the most affected.
More than half the states in the country — including the five surrounding Illinois — have moved to ban or severely restrict access to abortion. Indiana’s ban goes into effect Sept. 15. In Iowa, abortions are banned after 20 weeks of pregnancy and a more restrictive ban is working its way through the courts.
The only states in the midwest where no abortion limits are being considered are Illinois and Minnesota.
“It’s time to look at this area of healthcare and make sure we have the infrastructure we need,” said Brigid Leahy, vice president of public policy for Planned Parenthood Illinois.
She said the state is already invested in being a leader in abortion access, and she hopes this newest crisis will renew that commitment with encouraging new clinics across the state and more funding for abortion support.
“There are two different parts of the conversation,” said Ameri Klafeta, a top official at the American Civil Liberties Union of Illinois. “One is what are the things that can happen right now or in the short term to help providers who are on the ground, and then there are those things that add additional protections, like shield laws with additional privacy protections. All are being evaluated.”
Klafeta, director of the Women’s and Reproductive Rights Project, said one positive step was Pritzker’s post-Dobbs decision in August to increase state medicaid reimbursements by 20%. That decision, according to one Pritzker news release, will help “to recoup more costs and enable providers and clinics to provide more care without financial strain.”
Pritzker also announced an additional $2 million in state money investment for family planning services for low-income people and families.
Shortly after the Dobbs decision, Pritzker and the top Democratic leaders even considered convening a special session of the General Assembly to consider new laws protecting abortion rights. However, it appears unlikely lawmakers will be called to Springfield before the midterm elections in November.
At an Aug. 30 news conference, Pritzker addressed his decision not to call the session, saying votes there would require Republican support he does not have.
“There are things that the legislature really does need to do, we need it enshrined into law,” Pritzker said. “And so again, those things are all being worked out where we’re talking to the legislature, working with the Attorney General’s office, but making sure that we’re making progress…”
Some of the measures lawmakers are being pushed to adopt include increased funding for existing clinics as well as new ones; more protections for providers who may come from other states to provide abortions; and legislation to allow advanced practice nurses and physicians assistants to perform abortions, according to BGA interviews with advocate groups.
“It’s clear that Pritzker is publicly in favor of protecting abortion access in Illinois and we’re hopeful he’ll listen to these policy pritoirities,” said Hurtado, of the Chicago Abortion Fund.
But she said it’s going to take more than “waves of support to sustain us through this new reality.”
Mayor Lori Lightfoot put $500,000 toward helping organizations like Chicago Abortion Fund and Midwest Access Coalition support people’s lodging and travel needs.
A City Council committee advanced legislation barring the Chicago Police Department and other city departments from assisting in investigations of those who come from out of state to get or provide an abortion related to laws in other states that restrict “an individual’s bodily autonomy,” the ordinance reads in part.
Some records already broken
Hurtado said the fund’s work has shifted since the Dobbs decision.
While the non-profit has always supported people from out of state, they’ve started to get calls from states they hadn’t helped before, like Arizona and Texas, as well as an increase from states across the region, like Wisconsin, Tennessee, Ohio and Missouri.
The abortion fund’s budget for patients jumped from $16,000 a week in the first three months of 2022 to around $25,000 after a draft of the Dobbs decision was leaked in May.
“And now, post-Dobbs, our weekly budget [for financial and logistical support] is between $35,000 and $45,000 each week,” Hurtado said. “It’s a really massive increase in scale and not just because of more people calling, but having many more cases requiring that deep case management, full-scale support, paying for people to travel longer distances.”
She spoke in support of mandating that private insurance plans cover abortion care without a co-pay, allow for advanced nursing and physician staff to provide abortions and for the state to invest in resources like the Chicago fund because they “make abortion access a reality, even in the face of a hostile landscape.”
The number of people they’ve heard from so far this year has already hit a record 4,000, 1,000 people more than the number of people served in all of 2021. In 2018, the number of people supported was 183. Currently the fund attempts to support 100% of the people they reach on their helpline, but Hurtado worries that may change without outside support.
At the downstate Fairview Heights clinic, which is under the umbrella of the Planned Parenthood Saint Louis Region, workers there have seen a nearly 30% increase in patients seeking abortions from June to August, going from 620 to 804.
The total number of patients in June, July and August rose to 2,130 this year, up from 1,689 last year, according to figures from the clinic shared with the BGA.
The clinic also saw an enormous spike since June in the number of patients coming from states outside Missouri and Illinois, two states in its service area. From June through August this year, the clinic served 698 abortion patients, up from 69 last year, according to data provided by Planned Parenthood officials.
The clinic is now open 10 hours a day on most days to accommodate the demand.
The BGA also sought metrics from state government to help illustrate the increasing demand, but they are more difficult to pin down because of a reluctance to single out clinics and physicians performing abortions.
More generally, however, the state saw a large spike in the number of physicians’ license applications since Dobbs, according to statistics provided by the Illinois Department of Financial and Professional Regulation.
From June 24, the day the final Dobbs decision was released, to July 26 the department received 375 applications from Illinois and out-of-state residents for physician licenses, a 31% increase from the same month in 2021 — one that saw 286 applications.
In that same time frame, the state nearly doubled the number of physicians’ licenses it awarded, from 346 in 2021 to 662 licenses this year, though that number includes licenses awarded to applicants who applied before the BGA made its request.
Other states moving quicker
Jessica Davenport-Williams, a co-founder of Black Girls Break Bread, said part of her group’s abortion advocacy centers on equitable access to all.
Davenport-Williams pointed to state figures from March on maternal and child health services that show since 2016, there have been 16 obstetric unit closures, six facility closures and three facilities opened hospitals closures in Illinois — 4 full facility closures, and 14 facilities that closed their obstetric units — and three new hospitals that opened and provide obstetric services, reducing the number of places people who can give birth can go.
Those numbers are higher in economically disadvantaged communities and she and others at the non-profit hope that features into the state’s conversation around abortion access.
“It’s one thing to shore up what the rights are but that does not ensure equitable access,” Davenport-Williams said. “So I think there has to be a multi-pronged approach in having more stakeholders at the table.
“What does it mean for the low-income patient who is trying to get access at a health system or a local clinic? How does this trickle down and ensure that that person is able to receive the best quality and affordable care? There’s a huge data issue in Illinois — not just on abortions but on women’s health.”
State Rep. Kelly Cassidy, D-Chicago, leader of a state taskforce to consider the legislative response to Dobbs, said government responses fall into three categories: protection, capacity and access.
“This is uncharted territory,” Cassidy said. “The stakes are incredibly high so we have to get this right.”
She said the major focus is on a “need to craft legislation that we can pass” — from creating the smoothest path possible to keeping a license and making sure actions by other states don’t deter access in Illinois.
Cassidy said bills are in various phases of readiness and are being tweaked as the taskforce continues to hear new concerns or questions from stakeholders.
The ACLU’s Klafeta, and others who spoke to the BGA, said they’re watching and learning from what other states are doing — both good and bad — to “make sure we can do everything we can to help accommodate the people who come to Illinois for care.”.
One such state is Massachusetts, which last month invested $2 million into abortion infrastructure and set aside more funds for abortion providers. In California, a new law passed in June protects providers from civil liability from states with abortion bans.
“The reality is, in places like Southern Illinois and Central Illinois, border cities where we’re going to see more and more clinics opening,” said Dreith, of the Midwest Access Coalition. “I think we stand to have a lot more risk and what is the legislature going to do to make sure we can provide abortion care in Illinois?”
“I’ve seen for a few legislative cycles that Democrats in Illinois continually say that they don’t want to focus on abortion,” Dreith said, “but they’re going to have to.”