After Roe, health care inequities will worsen, experts say

Experts have explored the new legal landscape of reproductive health care in America following the Supreme Court’s decision to remove Roe v. Wade, during a webinar hosted by the Brookings Institution on Tuesday.

One of the main consequences of Dobbs v. Jackson Women’s Health Org The solution is that it will exacerbate health care inequities, said Dr. Camille Busset, senior fellow for economic and governance research at the Brookings Institution.

In a recent blog post, Busset and colleagues wrote that Dobbs the decision “will not only limit access to reproductive health care, it will also fuel a public health syndrome characterized by disease clusters that are shaped by social, economic, and political determinants that lead to health care inequities and inequities.” .

The “syndemic” can lead to “very poor life outcomes, very poor well-being outcomes” and “very poor outcomes overall for the children who live in these communities,” Busset noted during the webinar.

She pointed out that most of the states that have enacted “trigger bans” — laws banning abortion that took effect after the repeal of Rowe — and those considering them have “some of the lowest child health and well-being scores in the country,” a trend that will only be accelerated by this decision.

For the US as a whole, Bussett predicts the emergence of a “permanent underclass of … low-income people and communities of color who will not only lack access to reproductive health care… [but] any other health care … and then you’re going to have kids growing up in these … communities who have little access to any options, in addition to health care.”

“And … you’re just going to repeat the cycle of generational poverty, low [economic] mobility and everything else that comes with it,” she added.

Interstate travel, medical abortion

Bernadette Mailer, associate dean for research and intellectual life at Stanford Law School in California, highlighted the specific challenges of navigating the array of abortion laws in different states.

One avenue for states to punish women for abortions is through civil liability, in which a private individual files a lawsuit against another person who had an abortion, or another person who performed the abortion or participated in the process. The Texas law, Senate Bill 8, is one such example.

The concern is that if a doctor in California were to perform an abortion on a person traveling from another state that criminalizes abortion, such as Texas, there could be a lawsuit and legal questions about whether the courts can “exercise jurisdiction” over that doctor, Mailer said that although California has expressly passed a law stating that persons performing abortions or participating in abortions are exempt from “judgments or enforcement of sentences” handed down in other states.

She expects lawsuits over the extent to which California can exempt itself from the Constitution’s “full faith and credit clause,” which calls on states to respect decisions handed down in courts from other states.

For states that have taken a different path — imposing criminal penalties on women who seek out-of-state abortions or those who perform abortions on out-of-state women — there are also questions about whether the laws can be applied “extraterritorially,” or beyond the individual country to which they passed.

“So if … someone performs an abortion in California and it’s criminalized in Texas, there are going to be serious questions about whether they can be tried in Texas,” Mailer noted, noting that the Sixth Amendment states that defendants for crimes they have the right to a trial “proximity to the crime”.

As for medical abortion, Mailer pointed out that the FDA has said the drug can be shipped across state lines to complete an abortion, which could preempt state regulation. “It’s going to be another … ongoing legal battle,” she said.

Such cases are not filed by Dobbs decision, but one current case in Mississippi, GenBioPro v. Dobbsis exploring the issue of preemption and will likely intersect with the Supreme Court’s efforts to “reduce the administrative burden,” Mailer said.

Pro-choice states are fighting back

A third panelist, Ariana B. Kelly (D) of the Maryland House of Delegates, stressed that pro-abortion-rights states must decide how to address the increased need for abortion care for out-of-state residents and visitors, as well as surrounding stigma.

“The anti-choice or forced-birth movement has really worked to stigmatize both abortions and abortion providers” through “legislative terrorism,” she noted. The main goal of some anti-abortion states writing new laws that punish people seeking abortions in other states is not necessarily to prosecute them, but to raise questions about whether prosecution is possible, which is an “act of terrorism.”

“This creates fear among patients who may want to travel and among clinicians who may be working in a safe state, but [are] they are terribly afraid that a civil or criminal conviction will come after them,” she said.

To address this problem in Maryland, Kelly helped pass the “Access to Abortion Care Act,” which helps remove financial and logistical barriers to access to care and went into effect on July 1. This law amended the existing Abortion Care Act, which codified protections for Roe v. Wade 30 years ago.

The new law states that advanced practice clinicians — including nurse practitioners, physician assistants and nurse midwives — can provide medical abortion, a move she hopes every state supporting abortion rights will take.

About 15 states have already passed similar laws, she noted.

Maryland’s law also requires abortion insurance coverage without cost-sharing, which can delay care and create stigma, including for Medicaid beneficiaries, and created a “nation-first clinical training program” investing $3.5 million annually to training physicians and other advanced practice clinicians, Kelly explained.

With 44 percent of residences in states expected to either ban or restrict abortion, according to a recent study, it’s important that states like Maryland fill that gap, she said, and that “other states follow suit.”

The next big step will be adding “reproductive freedom” to the state constitution, a measure that passed the House and that Kelly expects to pass the Senate this year before moving to a statewide referendum.

Vermont, California, New York and Illinois are seeking to adopt or have adopted similar measures.

  • Shannon Firth has reported on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s entrepreneurial and investigative reporting team. I follow

Leave a Comment

Your email address will not be published.