What a Roe v. Wade reversal would mean for abortion access in Colorado

Dr. Warren Hern of Boulder, one of the only people in the country who performs legal abortions later in pregnancy, has seen his patient load double since the fall. He returned home from a conference Monday night to learn of a leaked, drafted U.S. Supreme Court decision to overturn Roe v. Wade, and thought about how much more pressure this will put on him and on abortion providers everywhere.

Colorado affirms the right to legal abortion in state law, but it’s mostly surrounded by states that do not. Several of its border states are in fact  prepared to ban abortion if and when Roe v. Wade is officially overturned.

“Every clinic or physician’s office in Colorado is seeing more patients than it saw before, and that will continue to increase, and that’s true for all the clinics in all the states where they don’t have these draconian laws,” he said. “Everybody is working hard to expand their staff, but these are often very small clinics where you don’t have very much flexibility and very limited availability.”

But he knows that can’t and won’t happen quickly. Meeting the demand would require workforce development that takes time and economic empowerment for people out of state who in many cases will be unable to travel to Colorado for an abortion. With more demand within Colorado and with more challenges for out-of-state patents to access care, Hern has no question as to the upshot of a potential Roe v. Wade reversal.

“Killing women,” he said.

Advocates for reproductive freedom pride themselves on Colorado being a “safe haven” for people who need that care, but providers like Hern know they will not have enough capacity or resources to see everyone who needs it.

“Any kind of one-on-one medical procedure where healthcare providers need to see a patient can be really hard to scale up,” said Dr. Rebecca Cohen, medical director at Comprehensive Women’s Health Center, an outpatient clinic focused on abortion and contraceptive care and an abortion care provider. “We are prioritizing people who are later in pregnancy because their window for care is shorter.”

She said that is already leading to delayed appointments for people who are trying to end their pregnancies earlier in the process.

“Our usual time was about five days and we’re out about two weeks at this point,” Cohen added. “We’re making sure we’re not impacting safety so prioritizing those later (abortions), but we know it’s an inconvenience to have to wait longer, and it can emotionally be very difficult.”

Cohen and others are concerned that those who are most vulnerable may not be able to make trips to Colorado or other states that guarantee abortions because of the cost of travel expenses, taking time off work and even finding child care.

Pregnancy is not a benign condition, and waiting even a few extra days for an abortion can carry serious health effects, including death. Hern noted that the death rate due to pregnancy is 3-5 times higher for women of color in the U.S. than it is for white women.

“We hear really tough stories from the people that aren’t able to make it and they are often young people or people of color,” Cohen said. “We know we aren’t seeing undocumented people as much as if they were able to access care at home because they can’t get on a flight, maybe or have other barriers. We have colleagues doing research looking at what has changed and they have seen that it is people of means that are able to make the trip.”

“The body is not going to wait”

The service organizations that support abortion patients are also stretched thin. The Colorado Doula Project, which arranges logistical and sometimes financial support for patients — for example, emotional support, car rides to clinics and places to stay for people traveling to access care — can barely meet its demand today.

“We’re afraid from a logistical perspective,” said board member Isabel Cruz.

“It really does pain us,” she added, “when people reach out to us asking for a hotel room or for gas money to be able to drive up from Texas and we can’t do that.”

Volunteer-run organizations like hers will struggle to scale up quickly, she said. The scale-up challenge will be much harder for actual providers, who need advanced degrees. That’s not something that could be resolved quickly at the legislature, no matter how motivated the Democrats who control it may be, Hern said.

“I have been on the faculty of the University of Colorado medical center since 1988. Ask me how many young doctors, residents and medical students I have trained in the operating room to perform abortion,” Hern said. “Zero.”

The only doctor in the legislature, pediatrician and state Rep. Yadira Caraveo of Thornton, knows why that is, because she experienced it firsthand.

“When I was in medical school, I remember that for most procedures we didn’t have a choice as to whether we were going to observe or learn them, or not,” she said. “When I was on my OB/GYN rotation, we had a choice as to whether or not to witness an abortion, and most students, myself included, chose not to.”

Caraveo, now the Democratic nominee for Colorado’s 8th Congressional District, was raised Catholic and said her view of abortion changed over time. Like a tonsillectomy, she said, it’s simply another procedure that medical students should learn about in environments free of stigma.

She said Colorado should consider legislation to create grant programs or other financial incentives to attract abortion providers from out of state who could help address elevated patient demand here.

Caraveo now worries about the people in and out of the state who will wait or miss out entirely on abortion care as a result of the capacity deficit here and the demand from elsewhere.

State Rep. Dafna Michaelson Jenet, a Commerce City Democrat, had an abortion about seven years ago. She was 20 weeks pregnant and the baby inside of her had died in the womb, she said.

If she hadn’t been able to access safe and legal abortion quickly, she said, “I would have very likely died.”

She shudders to think of herself having to wait even one more day for that procedure. She wonders what would’ve happened if she hadn’t had the $500 the hospital asked for before the procedure.

“I am horrified at the idea that people will have to wait. The body is not going to wait. The process is going to continue. Whatever the reason (for someone’s abortion) is none of my (expletive) business. When you need it, you need it,” she said.

Cohen said she and other abortion providers want to ensure they continue seeing as many patients as they can. She’s also working to connect people with groups such as Cobalt’s Abortion Fund to help those who need access with finances to get care.

No ballot measure this year

This year’s legislative session will end next week, and there is virtually no chance of any new laws related to abortion before then. Now that HB22-1279 is law, Democratic lawmakers are wondering if they didn’t miss an opportunity by limiting that bill to basic codification of existing policy.

“We didn’t have conversations that we should have about just how stringent things could become across the country and how much of a sanctuary Colorado could become,” Caraveo said.

Michaelson Jenet said what’s needed is a ballot measure to allow Medicaid to pay for abortion and for state dollars to go toward abortion care and research — something that is not currently allowed.

Lawmakers and advocates expect an enormous groundswell of support for legal abortion in these coming days and months, but Democrats plan to wait until 2024 to hit the ballot on this issue.

House Majority Leader Daneya Esgar, a Pueblo Democrat who sponsored this year’s Colorado abortion law, said her side doesn’t have the money or capacity to do it all this year.

They have spent tens of millions defeating anti-abortion ballot measures such as Proposition 115 in 2020. Placing their own measure on the ballot would also cost millions, since signature gathering and campaign operations can and do get expensive.

“Any time we raise money, we’ve had to use it to go out and defend,” she said. “It’s not like we just have a big pot of money sitting there.”

President of Cobalt Advocates Karen Middleton called trying to pass a constitutional ballot measure in a midterm election year “chancey.”

“We need more time to plan,” she said. “We need more time to really kind of make our case to voters and I think running it during a presidential election year gives us a much wider audience of voters to talk to who will be going out to the ballot. And when they go to the ballot, we want to make sure they know about our issue.”