With the Supreme Court expected to overturn or severely weaken its landmark Roe v. Wade decision, clinics in Colorado are preparing for an increase in the number of out-of-state residents seeking abortions, and lawmakers are cementing abortion access protections in state law.
Colorado is one of the few states without any restrictions on when in pregnancy an abortion can occur and is one of the few states in the region without a mandatory waiting period of up to 72 hours after required abortion counseling.
When the Supreme Court heard arguments in December on a Mississippi law that restricts access to abortion, questions from the new conservative majority appeared sympathetic to the notion that states should be allowed to decide their abortion policies. While legislatures in many Mountain West and Great Plains states are working to dismantle abortion rights, Colorado lawmakers are reinforcing the state's safeguards. If the justices overturn the 49-year-old decision that protects the right to an abortion, the expectation is that the demand for abortions in Colorado from people who live in those nearby states where abortion is being restricted will rise.
"We're planning on it," said Margie Andersohn, practice manager at Healthy Futures for Women, a clinic in the Denver area that is trying to hire more staffers and recently purchased equipment that will enable it to perform abortions later than 20 weeks into pregnancy.
"We really do anticipate a lot more demand over the summer, unfortunately," said Dr. Rebecca Cohen, medical director of the Comprehensive Women's Health Center in Denver, referring to the potential effect of the Supreme Court decision.
Andersohn said demand at the Healthy Futures for Women clinic increased after Texas passed a law that bans most abortions after about six weeks of pregnancy and offers a reward to people who successfully sue someone who provided an abortion or helped a patient get one. The Supreme Court refused to block the law in early challenges. (Idaho recently passed a similar law.) At the clinic, appointments are being scheduled several days in advance, instead of the clinic's preferred 24- to 48-hour window.
"Women are flooding in from Texas," she said.
At the Comprehensive Women's Health Clinic, Texans make up a fifth of all patients on some days, and appointments are backlogged for several weeks, according to Cohen. She said the out-of-state patients tend to be further along in pregnancy, either because they needed time to sort out their work and travel logistics to get to a clinic with available appointments or because they encountered problems later in pregnancy that put their health or the fetus in danger, like their water breaking early.
"They can develop heavy bleeding, they can develop infection, and there’s also a very high risk that the fetus won't survive," Cohen said. "The safest thing to do is to end the pregnancy, but they’re just not able to access that care in Texas."
The Texas law permits abortions after six weeks when a pregnancy threatens the woman's life or threatens a medical emergency.
The influx of out-of-staters coming to Colorado for abortions is creating a "domino effect," pushing Colorado residents — especially in parts of the state with few clinics — to travel farther to find care, said Amanda Carlson, director of the Cobalt Abortion Fund. Cobalt helps people pay for travel, accommodations, and child care while they are seeking an abortion in Colorado. In late 2021, a third of its recipients were Texans.
Some Colorado clinics are struggling to keep up with the rising demand. Cohen's clinic has launched a telehealth program to accommodate people who are eligible for medication abortions but need to be physically in Colorado for their consultation and when taking the medication. Health care worker shortages are making finding qualified staffers difficult, Cohen said.
The effects of the Texas law on Colorado may be just the beginning. Three of Colorado's immediate neighbors are "certain or likely to attempt to ban abortion immediately" if Roe v. Wade is compromised, the Guttmacher Institute, a research organization that supports abortion rights, projects. A fourth, Kansas, will ask voters in August to decide whether to change its constitution so that abortion is no longer considered a fundamental right.
About 10,400 people received abortions in Colorado in 2020, and about 13% of them came from out of state, according to the most recent data available from the Colorado health department.
Traveling to Colorado may become the best option for people seeking abortions from a wider range of states if Roe is struck down. Kari White, a researcher at the University of Texas-Austin, said the early part of the covid-19 pandemic offered a glimpse of how demand would look in a post-Roe nation, because states including Oklahoma, Louisiana, and Texas temporarily prohibited abortion, deeming it a nonessential procedure.
During that time, most Texans who needed abortions traveled to New Mexico, Colorado, or Kansas, White said — patterns that could be a sign of what's to come.
"Your ability to exercise your reproductive autonomy is going to be incredibly dependent on where you live," White said.
White found that in the four months after Texas implemented its law in 2021, the number of Texans seeking abortions out of state was 5,500, compared with 500 during the same period in 2019. Nearly half went to Oklahoma, which is now advancing several anti-abortion bills modeled on the Texas bill. Some also went to Kansas — which provided half of all its abortions in 2019 to out-of-staters.
Colorado, with about 20 abortion clinics, offers much more access than Oklahoma, Kansas, and New Mexico, each of which has about five. It would be one of the few states west of the Mississippi River that plans to protect abortion access in the event the Supreme Court overturns Roe v. Wade.
In that landscape, Colorado is viewed as "a safe state for abortion access and reproductive health," said Katherine Riley, policy director for the Colorado Organization for Latina Opportunity and Reproductive Rights, or COLOR.
But Colorado state law doesn't explicitly guarantee access to an abortion. Legislators in the Democratic-controlled General Assembly just passed a bill that establishes that every pregnant individual "has a fundamental right to continue a pregnancy and give birth or to have an abortion." Democratic Gov. Jared Polis has said he would sign it into law.
The bill does not include any funding for low-income women to get abortions, which abortion rights proponents say will continue to limit access. A constitutional amendment from the 1980s forbids public funding of abortion, and that means low-income residents often are forced to pay out-of-pocket. Federal Medicaid funds also can't be used to cover abortions. But Medicaid is a joint federal-state program, and 16 states use their own Medicaid funds to cover the procedure.
Rep. Meg Froelich, a Democrat from Greenwood Village, Colorado, who is one of the bill's sponsors, said the measure would prevent counties, municipalities, or any local entity from reversing abortion protections if Roe falls. "That was one of the main reasons why we felt it was really important to get this on the books," Froelich said.
But COLOR's Riley said the new Colorado bill is not enough to permanently protect abortion access, pointing to the strong opposition by Republican lawmakers. She sees the bill as a stopgap measure until 2024, when abortion-rights advocates hope to present Coloradans with a ballot measure that would enshrine access in the state constitution.
"This will hold us," Froelich said of the bill. "We do feel like this carries us into 2024."
Conservative lawmakers in states considering abortion bans have recognized that residents may look to states such as Colorado in the future. In Missouri, where a state law banning most abortions after eight weeks of pregnancy is being challenged in court, one legislator is trying to make it illegal to help a Missouri resident get an abortion, regardless of what state it occurs in.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.