Amid US abortion crackdown, California seeks to be a ‘sanctuary’

Los Angeles, California, US – Advocates in California are seeking to transform the US state into an abortion haven, as millions of people across the United States may soon need to travel thousands of kilometres in search of care.

The conservative-leaning US Supreme Court is expected to deliver a decision by June in a direct challenge to Roe v Wade, the precedent-setting ruling that has guaranteed the right to abortion in the US for nearly 50 years.

If it is overturned, more than two dozen states are expected to quickly ban abortion, which will prompt a surge of people to cross state lines to access the procedure. But many of them will face challenges including paying out-of-pocket for healthcare costs, travel and childcare.

“What keeps me up at night, really, is that folks aren’t going to be able to get here,” Lisa Matsubara, vice president of policy and general counsel at Planned Parenthood Affiliates of California, told Al Jazeera.

Planned Parenthood is one of more than 40 groups that recently joined forces to issue a report (PDF) outlining measures California must take to increase abortion access. The coalition, known as the California Future of Abortion Council, says without these changes, the system will likely be overwhelmed by those travelling from out of state.

“We really want to make sure that there’s equitable access to abortion care,” Matsubara said. “Abortion bans really disproportionately impact people who are already marginalised or have low income, or are from communities of colour.”

The report, which also serves as a blueprint for other states, has prompted 13 bills that are currently pending in the California state legislature.

If passed, they would fund abortions, travel and lodging for people who cannot afford the high costs; train and fund more healthcare workers to perform procedures, and add legal protections so that people are not held liable for their pregnancy outcomes.

California lawmakers and Governor Gavin Newsom are working with the group to pass bills as quickly as possible before the legislative session ends in August. Their goal is to make California a haven for people in need of care. In December, Newsom told The Associated Press news agency, “We’ll be a sanctuary.”

Already, demand for abortions is increasing in California. In the first four months after Texas bill Senate Bill 8 – a law that allows private citizens to sue anyone who “aids or abets” abortion – came into effect on September 1, 2021, Planned Parenthood Affiliates of California told Al Jazeera they saw an anecdotal increase in Texan patients travelling to their state to get abortions.

Arizona residents also continue to cross into California to get abortions, and Planned Parenthood expects those numbers to grow now that a 15-week ban is coming into effect there.

California ‘stepping up’

The Supreme Court overturning Roe v Wade is a matter of when, not if, experts say.

When it is overturned, 26 states are certain or likely to quickly outlaw abortion, affecting 36 million women of reproductive age who may need to cross state lines to access abortion care, according to the Guttmacher Institute, a sexual and reproductive health rights advocacy organisation. That number rises even higher when including transgender and non-binary people, but exact figures are unavailable.

Citing Guttmacher data in their report, the California Future of Abortion Council says the number of out-of-state patients whose nearest clinic would be in California, if travelling by car, would increase from 46,000 to 1.4 million — a nearly 3,000 percent increase.

“This will be massive,” said Elizabeth Nash, state policy expert for the Guttmacher Institute.

She described a near future in which people in need of care will be forced to drive and fly from conservative states in the Midwest, Great Plains and South to liberal states along the coasts. They will flood an already overloaded system that anti-abortion activists have successfully eroded in recent decades. Wait lists are already weeks long in some places, and those will only increase, Nash said.

“What’s happening in California is incredibly important. It’s stepping up in a major way,” she added. California Assembly Bill 2223, which aims to shield people from civil and criminal liability if they have a miscarriage or abortion, is a recent example of legislative efforts in the state. Two women have recently faced prosecution in the state for experiencing miscarriages.

“We need other states to do what California is doing — making it crystal clear that pregnancy outcomes are a health issue and not a policing issue,” Nash said.

Distance the ‘number-one barrier’

Currently, there are no mandatory waiting periods and no need for parental consent to get an abortion in California. The state also guarantees privacy and the right to obtain an abortion. California’s low-income health insurance plan, Medi-Cal, covers abortion, unlike other states, and it just enacted legislation called SB-245 to eliminate out-of-pocket abortion costs that can amount to more than $1,000.

“This means that not only will abortions be covered, but the copays and deductibles are also going to be absorbed by the insurance plan, which is fantastic,” explained Fabiola Carrion, director of reproductive and sexual health at the National Health Law Program, which is on the steering committee of the California Future of Abortion Council.

But California is also a vast state with abortion providers concentrated in urban areas, meaning even residents must travel hundreds of miles for care. Carrion believes the biggest challenge California faces in becoming a sanctuary state is that people with few resources will need to travel a long way.

“Our number-one barrier in California is distance,” she said. “At the centre of this are people who are most marginalised – Black, Indigenous and other people of colour, people who are working to make ends meet, undocumented immigrants, young people,” she added.

If someone is low-income, uninsured, and cannot afford an abortion, “they usually are forced to carry a pregnancy to term, or they have to make some sacrifices like forgoing paying the rent, utilities or childcare”, said Carrion. She added that in other cases, people across the US, including in California, are sometimes forced to perform or manage their own abortions, including by obtaining lower-cost pills like mifepristone.

The council proposed Assembly Bill 2134, which would establish a programme to give grants to safety-net providers who offer reproductive healthcare to patients who are low-income, uninsured, or have plans that do not cover abortion. It is currently before the legislature. “What this plan will also do is offer some assistance for those who are coming [from] out of state,” Carrion said.

While Carrion is preparing herself for the Supreme Court to overturn Roe v Wade, she said the California Future of Abortion Council gives her hope. “We have the support of our governor, we have the support of our legislature, and we came up with things that are really bold,” she said.

“The fact that California is saying that, not only are we going to welcome people from out of state, but there is a high chance that we’re going to pay for your abortion — it’s incredible.”