🔒If Roe falls: Central Mass. abortion providers plan for the anticipated reversal of federal protections

The right to an abortion is codified into Massachusetts law, even if Roe v. Wade gets overturned by the U.S. Supreme Court later this summer.

But as the fate of the 1973 abortion rights ruling hangs in limbo, local abortion advocates said they worry about the ability of patients both in and out of the commonwealth to access care.

After a draft from the Supreme Court overturning Roe v. Wade was leaked to Politico and published May 2, a flood of donations and tons of new volunteer interest came into the Jane Fund, a nonprofit abortion fund in Central Massachusetts, Vikky Angelico, the organization’s board president, told Central Massachusetts HEALTH.

While it’s great that the Jane Fund received so much financial support following the leak, Angelico said, the draft opinion was not a surprise. A lot of parts of the U.S. and communities even within Massachusetts are already living in a world where access to abortion is either limited or nonexistent, she said, and organizations, particularly those run by Black and queer women, have been sounding the alarm on that for years.

“They have been screaming and warning people for a very long time,” Angelico said. “In the past five years or so, mainstream pro-choice people have started listening and moving toward being pro-abortion. I think this leak was a real shock to a lot of people, but it should not have been a shock at all.”

Legal in Massachusetts

Abortion will be legal in Massachusetts, no matter what happens at the federal level. The ROE Act, which was passed in 2020 after the state legislature overrode Gov. Charlie Baker’s veto, lowered the age at which people can seek abortions without a parent’s permission from 18 to 16. The act allows for pregnancy termination beyond 24 weeks if medically necessary.

Still, even with legal abortion, there are still plenty of barriers to care, Angelico said. An average first trimester abortion, for example, can cost $700 out of pocket for the procedure alone, she said. It’s about $200 for the abortion pill, which is the most cost-effective option, but if a two-day surgical procedure is necessary, that can cost between $1,500 and $2,000, she said. And that’s excluding travel expenses, child care, or any other fees that might arise.

Abortion is covered by MassHealth, the state’s Medicaid program, but the Hyde Amendment prevents federal Medicaid funding for abortion services, according to reproductive health nonprofit Planned Parenthood.

Private insurers cover the procedure, and about 80-85% of Planned Parenthood abortion patients in Massachusetts have health coverage, Jennifer Childs-Roshak, president and CEO of Planned Parenthood League of Massachusetts, said.

But there still are plenty of people – particularly people of color, who already face barriers to health care – who can’t access the abortion services they need, Childs-Roshak said.

The Jane Fund pledged $56,541 to clinics to pay for abortions last year, an increase over $44,601 the year before, according to the organization’s 2022 annual report. The Jane Fund succeeded in fully meeting the financial gap with each caller from Central Massachusetts, according to the report.

However, there’s still work to be done, Dr. Tara Kumaraswami, a doctor of obstetrics and gynecology at UMass Memorial Medical Center in Worcester, said.

“Abortion is health care. It shouldn’t be restricted, based on zip code or insurance coverage, to be able to access the service,” Kumaraswami said.

Out of state influx

If Roe does get overturned, Childs-Roshak said she expects to see more patients who live outside of the commonwealth cross state lines to access abortion. Several states, including Arkansas, South Dakota, and Idaho have so-called trigger laws to ban or even criminalize abortion in the event Roe gets overturned.

It’s pretty common for people who have connections to Massachusetts – whether it’s through family or because they went to college here – to come if they do find themselves in need of an abortion, Childs-Roshak said. Telehealth appointments, where providers typically prescribe the abortion pill to terminate a pregnancy, are becoming more common, she said.

“Patients are used to and expect to see telemedicine care now, including care over the phone or over the internet, and virtual visits,” she said. “I certainly expect that patients will be more interested in telehealth.”

But as legislators in some states propose passing laws to penalize out-of-state doctors for performing abortions if Roe falls, it’s not exactly clear what the path forward will be.

Angelico said Jane Fund volunteers are thinking about how far they’re willing to go to help people who call asking for help.

“It’s a huge ask, to ask one of our hotline volunteers to be named in a lawsuit,” she said. “It’s something on an individual level. They have to decide what they might be willing to do.”

Already strained

Andy Saltzberg joined Planned Parenthood in Worcester as part of the organization’s Raíz constituency program about eight months ago. In their role, Saltzberg helps to connect the Latinx community with Planned Parenthood’s reproductive care. They also help make sure Planned Parenthood’s lens extends to people who don’t speak English or who may be undocumented.

The problem is that oftentimes, Planned Parenthood workers are overworked and underpaid, Saltzberg said. They currently get paid an hourly wage of $24.25, but some of their coworkers, including health care assistants, get paid $19 per hour, even in the Boston area.

Saltzberg is one of the Planned Parenthood workers who filed to join 1199 SEIU Healthcare Workers East, part of the Service Employees International Union. The Roe draft was part of the reason for unionizing, a press release said, and Saltzberg said they think Massachusetts is likely to see a surge of out-of-state patients should the law be overturned.

“We really believe that the folks on the ground providing abortions know how to best provide abortion care, and that folks on the ground have to have more of a say on decisions in the organization,” they said. “We’re doing it for ourselves as workers, but also for patients that come to get care.”

Childs-Roshak said in a statement Planned Parenthood does not believe a union is the best course of action for its workforce, because as Roe v. Wade is poised to be overturned, “we’ll need to be even more creative, nimble, and collaborative in how we deliver care and how we operate as an organization.”

“PPLM respects its workers’ right to organize in favor of a union, which is why we are actively working with the [National Labor Relations Board] to facilitate an election later this month,” she said. “PPLM will honor the results of that election.”

But as all the details fall into place, Kumaraswami said she’s most concerned about people who already face significant barriers to health care.

“We know that people with the means will always have access to safe abortion, but I worry that those who are most vulnerable, like LGBTQ patients, patients of color, or patients without insurance. Those are going to be the ones to suffer,” she said.