Colorado, now an abortion “safe haven,” prepares for new challenges

Fourth-generation Texan Leah Payne moved to Denver last year in the wake of a new Texas abortion law that imposed some of the strictest abortion restrictions in the nation.

"We left our family, friends, sold our house. We couldn't live somewhere where abortion access was constantly under attack," Payne told The Denver Post.

At 19, Payne, who was on birth control, got pregnant. She didn't have insurance at the time and decided to have an abortion at a Planned Parenthood clinic.

"It was put out there as this big, bad thing that was traumatizing, but I never felt that," Payne said. "Now, I'm 32, I'm a homeowner here in Denver and have a really successful career, a great partner, and I don't think any of those things would have happened if I had not had an abortion at 19."

Payne chose her new home after learning about access to reproductive care in the state, and many Americans who woke up on Friday with fewer rights than they had a day prior may be forced to make similar choices. The U.S. Supreme Court struck down the landmark Roe v. Wade ruling on Friday in Dobbs v. Jackson Women's Health Organization, leaving it up to the states to regulate abortions. For about half the country, abortions will be banned or severely restricted. Colorado passed a law this year that guaranteed the right to an abortion in the state, but advocates and lawmakers say there's more to be done now that so many other states won't allow their residents that option.

A coalition of local organizations dedicated to protecting abortion access held an afternoon virtual news conference Friday, mourning Roe's fall and mapping out next steps to bolster abortion rights in Colorado.

Overwhelmingly, leaders on the call wanted Coloradans to know they can still access safe, legal abortions in the state. They are also working on a ballot measure in 2024 to enshrine the right to abortions in the state constitution, so future legislatures can't overturn the law passed this year.

President of reproductive rights organization Cobalt Karen Middleton said that a network of abortion care providers is meeting and collaborating about how to move forward and support one another.

Passing more protections

Democrats Sen. Julie Gonzales of Denver and Rep. Meg Froelich of Englewood said they are working on a bill for the next legislative session that would protect the state's abortion providers and those seeking abortions in Colorado.

Froelich told The Denver Post in an interview that they are still working on the details of the legislation, but they hope it will protect those who perform and receive abortions in Colorado from legal action and prosecution. It's still unclear whether that will include extradition, lawsuits, subpoenas or other types of legal action.

Policy Director Jack Teter of Planned Parenthood of the Rocky Mountains said the country is "entering an era of unknown risk," with some states like California and Connecticut seeking to pass laws that would block extradition, for example.

"We're seeing the potential for activist prosecutors in states that ban abortion trying to reach into other states," he said in an interview.

Another issue Teter told The Denver Post may be worth reviewing in Colorado is provider protections related to licensure, especially because a doctor may receive a complaint for providing an abortion in one state that affects their licensure in other states.

"Influx of tens of thousands of abortion patients"

In addition to banning abortions, Teter said some of those same states are trying to ban IUDs through state Medicare programs or contraceptive methods, so other states are trying to preemptively pass laws that would prevent such actions. But he said the effectiveness of these types of legal strategies is still unknown.

"The biggest challenge Colorado is going to face here is going to be the influx of tens of thousands of abortion patients from other states, and the impact that's going to have on our broader primary care and family planning infrastructure in the state," Teter said.

He said he can't sleep at night because he's so devastated thinking about the impacts of Roe v. Wade on people in other states. But he said Colorado providers will also have to prepare for how that will affect Coloradans' appointments for other reproductive care and health services, facing much longer wait times in an already strained system.

Only about 10% of the region's Planned Parenthood patients go to clinics for abortions, while the majority go in for other types of care.

Teter said wait times for certain services have already stretched to a few weeks and are expected to grow.

The state will have to figure out how to expand its statewide contraceptive and family planning infrastructure, as well as other types of routine health care infrastructure, Teter said.

"Right now we are seeing every patient who needs us, but there will come a time over the next several months, over the next year, when there are simply too many patients," he said.

To put in perspective, even with the restrictions on abortions in Texas last year, more than 55,000 patients got abortions. In Colorado, that number was close to 11,000.

Teter said wait times for certain services have already stretched to a few weeks and are expected to grow.

Self-reported data from Cobalt's abortion fund, which provides financial assistance to those seeking abortions, showed that 20% of clients came from out of state, with a third from Texas, followed by Wyoming and South Dakota. In the last four months of 2021, the fund provided assistance to four times more Texans than in the eight months prior.

OBGYNs are reporting similar statistics. Dr. Nancy Fang who provides abortions in Colorado said in an interview that as of April, about 20% of her clinic's clients were from out of state, an increase from the prior year.

Dr. Fang testified before the state legislature this year in favor of the law codifying the right to abortions, sharing the story of a Texas patient who came to her for an abortion. Her water broke early in her pregnancy and her doctors told her it would not be viable, but because of Texas law, they couldn't do anything for her and she just had to wait out.

The patient instead flew to Colorado, risking going into labor, and saw Dr. Fang. The OBGYN treated her, not worrying about Texas' law, which allows Texans to sue people who aid in abortions.

Her priority, she said, was her patient.

That's why advocates like Teter want the state to convene an emergency public health task force to figure out how to deal with the increase in patient volume and how to triage patients across the state as more people seek care.

Policy changes

Teter hopes the state legislature will start to tackle issues such as increasing funding for family planning, addressing "fake health centers" that target people seeking abortions, increasing reimbursement rates to providers, making sure incarcerated people get access to abortions and implementing legislation that has already passed to ensure victims of rape and incest can access covered abortions closer to where they live.

Teter also said regulatory changes will need to be addressed regarding patient privacy with electronic records and removing restrictions in Colorado such as not allowing Medicaid patients with miscarriages to get abortion medication.

Froelich said lawmakers will be working in the 2023 session to address some of these issues, but the Taxpayer Bill of Rights limits how much they can do when it comes to funding.

Abortion and reproductive rights advocates, including Planned Parenthood, are also hoping to ask voters in the 2024 ballot measure they're pursuing to remove Colorado's constitutional public funding ban. It passed in 1984 and prevents public funds, including Medicaid, from covering abortions, regardless of the reasons for the abortions.

Disproportionate effects

Even with the option to travel to Colorado to get an abortion, access will be limited to those who have enough financial resources, according to advocates. Not everyone can take time off work, afford to travel, find and pay for child care, and pay for lodging in another state to get the procedure.

"This will disproportionately affect those who are either marginalized or don't have the means by which to get out of state if they need to, to access care in Colorado," said Dr. Savita Ginde, interim executive healthcare strategy executive at Boulder Valley Women's Health Center.

Ginde worked as a Planned Parenthood chief medical officer for 14 years, and she said providers are going to have to rebalance their services to ensure they can help everyone who needs it.

"Accessibility to reproductive health and abortion care is essential, and forcing those who need to access that care to take extraordinary measures if they're in a state where there's going to be a ban or significant restrictions, is really something that I would want people to think about deeply," she said.

Denver resident Gwen Lassen, who is 38 and now has a 2-year-old with her wife, got an abortion at 18 while in college.

She was living in Arizona at the time, got pregnant and was able to cobble together enough money to pay for the medication to induce the abortion. She said she has no regrets and doesn't think her life would have taken a similar path if she didn't have the abortion.

Raising a child requires copious energy and resources, and if people are forced to have children but don't have the capacity to raise them in that way, the families will suffer, she said.

"The (ruling) is devastating," Lassen said. "It's horrifying that you can't have that kind of agency."

Providers like Dr. Fang are also say that even with abortions becoming illegal in other states, patients who don't have the resources to go elsewhere to get them will just obtain them illegally, endangering their own lives.

When Payne, the former Texas resident, heard the Supreme Court's ruling Friday morning, she took the day off work.

"I had prepared for it, but I put it like this to a coworker," Payne said. "We all know our loved ones will die one day, but it's still sad when they die. That's how I'm feeling. I'm so thankful to be here in Colorado … but I worry about my friends and family back home in Texas, and I worry about all the people who will be impacted by this."

Other rights

The Supreme Court ruling has also left some worried about other constitutional rights that could be overturned, including same-sex marriage, interracial marriage and the right to contraception.

"This decision by five Republican-appointed Justices is a travesty of justice, a perversion of our Constitution, and a tragedy for the American people," said Rep. Daneya Esgar, a Pueblo Democrat, and a sponsor of the Colorado abortion rights law, in a statement. "In a ruling that restricts the rights of all Americans and opens the door to ban marriage equality and contraception, the Court has stripped millions of women of our bodily autonomy, reproductive freedom, and the rights that have been the law of the land for over fifty years."

The justices are divided on what the decision to strike down abortion rights could mean for other civil rights, but Justice Clarence Thomas wrote that he agrees with a legal theory that could remove the right to other protections as well based on "substantive due process." That refers to the Constitution's due process protections also protecting other basic rights, including those not specifically written in the Constitution, according to The 19th .

"We should reconsider all of this Court's substantive due process precedents, including Griswold, Lawrence, and Obergefell," the justice wrote. "Because any substantive due process decision is 'demonstrably erroneous,' … we have a duty to 'correct the error' established in those precedents."

Executive Director Nadine Bridges of One Colorado, which advocates on behalf of LGBTQ people, said in a statement that the policing of bodies isn't new to poor people, Black people, Indigenous people or Latinx people.

"It's no coincidence that the same people calling for the inspection of young bodies to determine whether or not they can play on a sports team and the incarceration of families who support these young bodies, are the same folks working to control our personal sexual and reproductive health decisions and incarcerate those who dare to defy them," she said.

Overturning Roe also affects LGBTQ people, the group said, and bodily autonomy is at the core of their movement. The nonprofit's advocates also say that even though Colorado has some of the best protections for LGBTQ people, they will continue to fight for them at the national level, too.