Editor’s note: On May 2, Politico obtained an initial draft majority opinion in Dobbs v. Jackson Women’s Health Organization indicating that the Supreme Court had voted to strike down Roe v. Wade. In light of that news, we are resharing this story, which reports on what New York has done—and still needs to do—to protect access to reproductive health care.
Six in 10 Americans support the constitutionally protected right to end a pregnancy, and nearly a quarter of women and pregnant people seek abortion care at some point in their lives—legally or illegally. But these realities are largely ignored in US public policy. According to the Guttmacher Institute, states across the country have enacted more than 1,300 abortion restrictions since the Supreme Court’s 1973 Roe v. Wade decision guaranteed the right to an abortion within 24 weeks of pregnancy. Almost half of those have come since 2011, and 2021 was the worst year on record for state legislative restrictions.
“Abortion is legal in all 50 states. However, there is a very broad range of restrictions state by state that impact how real the access is,” says Danielle Castaldi-Micca, vice president of political and government affairs at National Institute for Reproductive Health (NIRH), a reproductive health and rights organization that works at the state and local level to change public policy and normalize decisions about abortion and contraception.
In 2019, during a Trump presidency that ushered in three conservative justices to the high court, New York State finally passed the Reproductive Health Act, codifying Roe v. Wade’s 24-week window of abortion availability in the state constitution—a backstop protection in the event that abortion is criminalized at the federal level. Although many other states have been chipping away at access for decades, placing burdens on patients and providers alike, the current acceleration of bolder restrictions is startling. Last year, Texas passed a near-total ban on abortion procedures after just six weeks (when many pregnant people don’t yet know that they’re pregnant) and deputizing citizens to enforce it. Florida just passed a 15-week ban that is expected to be signed into law. Dozens of other states have or will soon introduce bills that similarly erode reproductive rights. With another case currently before the Supreme Court—Mississippi’s 15-week ban proposed in Dobbs v. Jackson Women’s Health Organization—the half-century of legal precedent set by Roe is likely to go out the window if, or likely when, the 6-3 conservative-leaning Supreme Court renders its decision later this year.
On the most extreme end of the ideological spectrum is a mix of voices who want to go back in time to fully criminalize abortion; force unplanned, unwanted, or unsafe pregnancies to be carried to term; and even see that miscarriages be investigated to determine culpability, and ideally, punished.
Given the national landscape, New York might seem like a haven for out-of-state abortion-seekers. But the Empire State is far from an abortion utopia. While the RHA is an important step, advocate organizations like NIRH’s Action Fund, New York Civil Liberties Union, National Council of Jewish Women New York Section, National Asian Pacific American Women’s Forum, National Latina Institute for Reproductive Justice, and others are working with members of New York’s Democratic supermajority not just to keep abortion legal, but to ensure abortion care is truly accessible. Embedded in that mission is verifying that the public is fully aware of local treatment options, and that unnecessary barriers to care are removed for the majority of abortion-seekers who are already parents and the 75 percent of abortion patients with low incomes. There is a push to guarantee that everything from emergency contraception, like the morning-after pill, to medication abortion and surgical abortion procedures throughout pregnancy are available and affordable for everyone who needs them.
Addressing stigma, disinformation, and provider shortages that prevent critical abortion care later in pregnancy is also key, the latter of which is arguably most urgent. For the underinsured and uninsured, new legislation proposes the creation of practical safeguards, and a progressive infrastructure to facilitate donor-fueled funds through income-tax filings is being explored. In more ambitious appeals, calls to fund abortion with state dollars have come from advocates and New York Attorney General Tish James, and some lawmakers are pushing to fortify abortion rights in the state constitution under the banner of equality, in the old-but-new-again arena of sex discrimination.
Addressing Provider and Information Shortages
If someone decides to have an abortion, the first things they will likely want to know are where care is available and how much it might cost. Unfortunately, hospitals and county health departments don’t always publicize the services they offer, and if they do, it can be challenging for potential patients to understand their options.
Under Roe’s guidelines, abortion through the full duration of pregnancy is legal if the health or life of the pregnant person is at risk, or if there are fetal indicators. But because there are few providers who can perform procedures if an individual discovers after 24 weeks that their pregnancy isn’t viable, expectant New Yorkers often have to travel out of state for procedures later in pregnancy, making an already painful situation more grueling.
“There is a ton of interest among providers, both hospital and clinic-based, in working to expand access to later care in the state of New York so that people don’t have to ever leave,“ says Castaldi-Micca. But there is still lingering residue from the pre-RHA days, when abortion was regulated under the penal code, which materializes as anything from individual facility limits to stigma around care. “There are some regulatory reforms, or guidance, that the Department of Health still needs to issue in the wake of the RHA that is being worked on,” Castaldi-Micca says.
This recurring challenge in addressing access to reproductive health care is an administrative one: while providers want to offer later-care abortions, doing so requires changes to hospital policy—and like the government, Castaldi-Micca points out, hospital bureaucracy often moves slowly. These delays, and a general lack of clear patient-facing communication, create unnecessary barriers for people seeking abortions, especially low-income women and people of color.
In an attempt to prevent confusion, the New York City Department of Health and Mental Hygiene recently updated its website to be more upfront and clear about abortion care. “Part of that was removing academic or medicalized language and instead saying ‘abortion,’” Castaldi-Micca says. (Not hearing elected officials say the word abortion has been a sticking point for advocates for years.)
New York City’s Department of Health webpage on abortion also acknowledges the existence of fake clinics, and that they should be avoided. Often referred to as Crisis Pregnancy Centers or CPCs, fake clinics can offer pregnancy tests, information, and sometimes ultrasounds, but their main goal is to dissuade abortion-seekers from terminating a pregnancy. Planned Parenthood’s Crisis Pregnancy Center Map identifies 92 CPCs throughout New York State, 17 of which are in the Hudson Valley and Capital regions.
Navigating an Evolving Healthcare Landscape
As we’ve witnessed during the COVID-19 pandemic, health disinformation is common, but actual abortion clinics have experienced additional operational challenges separate from the intentional propaganda launched against them. For one, abortion clinics are hemorrhaging staff, often to larger, better-paying hospital systems. In turn, these safety-net providers are forced to reduce their hours. In her 2022 State of the State book released in January, Governor Kathy Hochul vowed to support community health centers and diagnostic and treatment centers, “many of which provide much-needed reproductive health services.”
“I think safety-net providers are incredibly important,” Hudson Valley state Senator Michelle Hinchey says. “If we’re going to say that we support community healthcare centers and we support healthcare facilities that are going to help people, we should make sure they’re funded.”
Hinchey notes that financial struggles have forced some smaller upstate general hospitals to merge with religious hospitals in order to survive. “What we’re seeing are hospitals that have historically provided abortion care and access to abortions, [and] with these mergers, are now losing those services.”
Abortion is on the continuum of reproductive health care that also includes birth control methods like implants, tubal ligation, and several different procedures used in miscarriage management. Knowing where these services are offered is vital for patients, especially since miscarriages and ectopic pregnancies can require immediate medical invention. “If you’re miscarrying, you might have to wait until your life is in danger for [a Catholic hospital] to help you finish that miscarriage, and there’s no reason for you to have to wait that long,” says Castaldi-Micca.
Another bill, sponsored by Senator Hinchey and Queens Assembly member Nily Rozic, tackles hospital transparency about reproductive services they offer. The bill directs New York’s Department of Health to collect a list of “policy-based exclusions” from every general hospital across the state on an annual basis and then publish that information on its website. If it becomes law, the data collected by the bill will also help lawmakers get a more accurate sense of the reproductive healthcare landscape around the state.
“No matter who you are, where you live, what your means, you should be able to find access to an abortion, and right now, we just don’t even know where those gaps are,” Hinchey says. “We don’t know what we need to do to fix them.” Laying the groundwork now prior to Roe v. Wade being potentially overturned, she argues, is essential. “There’s still a lot more that we need to do in New York, especially as we start to see, possibly, an influx of people to our state who are seeking health care.”
Removing Financial Barriers
In April of 2020, as the pandemic’s first wave was in full throttle, then 28-year-old Tamar Hedges of Ulster County started to experience abnormal pelvic pain and bleeding, so she contacted her local Planned Parenthood affiliate for a virtual appointment. At the healthcare nonprofit’s urging, she masked up and went in for in-person tests, where it was determined that her intrauterine device had recently expired and she was suffering from an ectopic pregnancy. The staff encouraged her to visit a hospital immediately.
After waiting in the emergency room at Vassar Hospital for four hours, Hedges learned that her health issue, albeit painful, had been caught early and could be treated with a shot of a drug called methotrexate. “I was very fortunate in that it wasn’t a complete risk to my life at that point, because nothing [significant] had started to grow,” she says.
Looking back on it, Hedges, who works as a shipping and receiving clerk, found her experience to be relatively positive: the Planned Parenthood visits, the ER and overnight hospital stay, multiple OB-GYN follow ups, and weekly blood tests for a month were all covered by state-funded Medicaid. New Yorkers are lucky in this sense: the American Civil Liberties Union reports that 10 states have banned abortion’s inclusion of comprehensive coverage, and 25 states have banned coverage in their respective health insurance exchanges. New York, however, is one of over a dozen states that include medically necessary abortion in Medicaid coverage.
When asked to consider being in a similar situation where—in a different hospital, in a different county, or in a post-Roe reality, she’d have been refused reproductive care—Hedges says her frightening experience would have been unimaginably gut-wrenching. “I have trouble thinking about [the status of Roe v. Wade] too in-depth even though I know I have to,” she says, acknowledging the possibility of future pregnancy complications. “Everyone deserves care without having to justify their positions.”
“The judicial attack on Roe is not the end, it is absolutely just the beginning,” says Castaldi-Micca. “What we’re going to see is greater criminalization of pregnancy loss and the actions of pregnant people. We’ve already seen attempts to track who is miscarrying and why, and as the laws go further to reduce women and other people with uteruses to a sort of incubator status, we’re going to see more punishments for things like miscarriage and stillbirth.”
Similar to other national issues, like climate and voting rights, that have seen significant rollbacks over many decades, advocates in the fight for reproductive health care and justice know that engaging the public on worst-case Roe outcomes is critical. In addition to ensuring there are enough providers in clinics and hospitals, that also means making abortion affordable, covered by insurance, and funded not just on a grassroots level, but ideally by state and federal government.
Abortion coverage varies quite a bit depending on what health insurance plan an individual has. Federal insurance programs like the Federal Employees Health Benefits Program, the military TRICARE program, and the Peace Corps are barred from covering most abortions. In New York, abortion care for low-income people can be paid for through nonfederal Medicaid, and many insurers, but not all, cover the procedure under maternity care. For Affordable Care Act and private employer-sponsored plans that don’t cover abortion in the state, there is a coalition working on both legislative and state budget strategies to see that remedied.
“As the law stands currently, [dissenting and federal] insurers are only required to cover abortion care in cases of rape, incest, or fetal malformation,” Rochester state Senator Samra Brouk says over email. “What that does is create a dichotomy of which abortions are justifiable, and which are not. This leaves women who choose to have an abortion for any reason other than the above at risk of not receiving the care they need or needing to pay exorbitant out of pocket fees, making the care inaccessible.”
Senator Brouk and Queens Assembly member Jessica González-Rojas currently sponsor a bill that would require all New York State insurers to cover abortion. Governor Hochul’s executive budget proposal shares the same goals as the proposed legislation, signaling that the state could soon fortify abortion insurance coverage in the face of increased threats to access.
In the meantime, donor-supported abortion funds are providing a crucial safety net for people who might otherwise struggle to pay for reproductive health care. The National Network of Abortion Funds builds power with members around the country to “remove financial and logistical barriers to abortion access by centering people who have abortions and organizing at the intersections of racial, economic, and reproductive justice.” Its network of local, autonomous organizations have decades of experience working with clinics to help pay for abortions and offer supportive services directly to abortion-seekers who have to travel to receive care, like lodging, transportation, childcare, and translation.
Bronx and Westchester state Senator Alessandra Biaggi and Assembly member Karines Reyes have introduced a bill to normalize donating to groups who directly fund abortions and abortion care through individuals’ income tax forms. “The money that they donate—whether it’s $1 or $100 or $100,000—goes into the operational and programmatic expenses of not-for-profits that are providing the logistical and also the financial support to people who need abortions,” Biaggi told City & State in September.
“I think it’s important that abortion access shows up on the same kind of list of causes that are on our tax forms,” says NIRH’s Castaldi-Micca, equating it to assorted donor-driven funds for veterans, environmental causes, and breast cancer research. “It shouldn’t be left off just because it’s being stigmatized.”
In 2019, the same year that the RHA passed, New York City allocated $250,000 in its 2020 municipal budget to fund the volunteer-run New York Abortion Access Fund. It was the first US city to fund abortions directly, “just like they would fund little league teams and libraries and street cleanup, but also how [the city budget] funds many healthcare organizations,” Castaldi-Micca says. Could New York State be next, taking voluntary Medicaid funding of abortion to the next level? Time will tell.
Abortion Rights in the Months to Come
As the total number of abortions has declined nationwide over the years, the use of medication abortion has gone from 5 percent of all abortions in 2001 to 54 percent in 2020. This past December, the Food and Drug Administration changed its rules for the medication abortion pill RU-486, also known as Mifepristone, allowing individuals to receive the drug by mail through a certified prescriber or pharmacy within the first 10 weeks of pregnancy. With this rule change, patients will have easier access to Mifepristone than they have in the past, circumventing clinics and doctors’ office visits to get pills. But the laws in each patient’s state govern the drug’s access, and sending medication abortion pills across states lines remains a legal grey area. (As this piece is being published, Georgia and Iowa are considering banning abortion pills being sent in the mail.)
On the federal level, a Trump-era ban known as the “gag rule” that prevented federally funded family-planning clinics from making abortion referrals was recently reversed, permitting doctors and other medical providers to share abortion information with patients again. A true game-changer, however, would have been the Women’s Health Protection Act, a federal bill that would protect an individual’s access to abortion if Roe fell, regardless of what state they live in. The WHPA would ostensibly supersede individual states’ medically unnecessary restrictions and bans, allowing providers to offer, and patients to receive, abortion care. But after passing in the House in September, it was blocked by Republicans in the Senate on February 28. Like other recent marquee legislation for Democrats, the WHPA’s successful passage was reliant upon the filibuster being reformed or eliminated. Overturning the Hyde Amendment, which currently bans federal dollars funding abortions through Medicare, doesn’t look promising either.
Back to you, New York.
“One of the biggest things that the state can do is amend the state constitution to include proactive protections against discrimination for pregnancy and pregnancy outcomes,” says Castaldi-Micca, noting that state Senator Liz Krueger has a bill in committee, the Equality Amendment, that would do that. “That is the next step after the RHA in terms of large-scale change.”
Roe v. Wade was decided not on the premise of discrimination against a sex or gender, but on the basis of privacy. In these uncertain times, there is a rallying cry for legislation that explicitly clarifies once and for all that discrimination based on a person’s pregnancy or pregnancy outcome is sex discrimination. “If women and pregnant people are not able to control the outcomes of those pregnancies, they are getting set back in society in a way that’s discriminatory,” Castaldi-Micca says.
Despite ongoing efforts to politicize abortion, treat it as a separate medical service, and segregate it from the health insurance system, abortion is health care. And there is a consensus among advocates that individual restrictions imposed by states are intentionally designed to disproportionately impact low-income and underrepresented communities.
Like insurance coverage for abortion and supporting safety-net providers, Governor Hochul has signaled she supports Senator Krueger’s Equality Amendment in the executive budget, noting “the enduring inequalities that women, people of color, and other marginalized communities continue to face.”
For now, on the local level, Castaldi-Micca says counties and municipalities in New York can reaffirm their support for abortion through resolutions, monitor restrictive hospital policies for any changes, and take clinic harassment more seriously. “There was what’s called a ‘red rose invasion’ at a clinic in White Plains in December that took nearly four hours to have trespassers removed from a medical facility, which I think shows at the very least, on behalf of that police department, an unwillingness to support abortion access, in violation of the law.”
Reproductive health literacy and the prevention of unwanted pregnancies often starts with sex education and access to contraception. Bundled with the RHA in 2019’s historic bill package was the Comprehensive Contraception Coverage Act, a state law that, among other things, makes insurance coverage of emergency contraception like the Plan B pill available over the counter without a prescription. New legislation introduced by Senator Hinchey and Westchester Assembly member Amy Paulin would allow people to access forms of emergency contraception that work for a larger subset of the population, and also to receive it from more healthcare workers, including New York State pharmacists, registered nurses, and licensed midwives.
The new bill would legalize a form of emergency contraception called Ella that can be used up to five days after sex (Plan B is limited to three days), and works for women and pregnant people of a higher weight. (Plan B’s estimated weight limit is around 155 pounds, whereas Ella is most effective for those who weigh between 155 and 195 pounds.) “It closes some of the gaps that we’ve seen over the last two years of the CCCA being law,” Senator Hinchey says.
“People who are pregnant and don’t want to be pregnant anymore are often pretty committed to figuring out how to do that—we saw that pre-Roe, we will see that post-Roe, we see that now,” says Castaldi-Micca. “My concern is making sure that, once they have decided to have an abortion, that they are able to do so safely, affordably, legally, and frankly, conveniently. Nobody should have to travel between states to access medical care. No one should travel out of their community to access medical care.”