As restrictions on accessing an abortion in Missouri have steadily tightened, nearly 9,800 Missourians travelled to Kansas and Illinois to receive abortions in 2020, compared to only 167 procedures that occurred within state lines that year.
That number could drop even further if the U.S. Supreme Court overturns the 1973 Roe v. Wade decision that legalized abortion — causing a Missouri law to kick in that would ban the procedure except in medical emergencies.
And after years of limiting access to abortion in Missouri, lawmakers are now eyeing policy for a world in which the constitutional protections for the procedure are no more.
“Nationally, everybody is looking to a post-Roe world,” said Rep. Mary Elizabeth Coleman, R-Arnold. “In Missouri, we’re almost already there.”
Proposals have been floated this legislative session to allow lawsuits to be filed against anyone aiding Missourians to obtain an abortion across state lines, to target the distribution of abortion-inducing drugsand to declare the right to an abortion doesn’t exist in the state constitution.
But as the nation waits in anticipation of how the country’s highest court will rule, the GOP-controlled Missouri legislature finds itself at an inflection point of its own.
“How much do you do now, as opposed to how much do you do down the road when states have more freedom to regulate abortion than they do now?” said Sam Lee, a longtime lobbyist for Campaign Life Missouri. “It’s a debatable point.”
Proposals that mirror Texas’ recent abortion restrictions have grabbed national headlines, but they have yet to gain significant traction in the legislature — which is more than halfway through the session that ends May 13.
Meanwhile, a yearslong effort to limit public funds from going to abortion providers and their affiliates has steadily marched forward, once again locking reproductive health providers and the state in litigation.
“Not only are Missouri politicians showing us what it’s going to look like post Roe v. Wade,” said Bonyen Lee-Gilmore, a spokeswoman for Planned Parenthood of the St. Louis Region and Southwest Missouri, “but they’re also showing us their intent to go after all other comprehensive reproductive health care.”
Lee called the effort to defund Planned Parenthood “the most likely pro-life bill that’s going to pass this year.”
“It’s practically universal among every Republican that I’ve talked to, whatever caucus they’re in or whatever they call themselves,” he said. “That’s the law that they want to pass. And I’ve seen that discussed over and over.”
Proposals this session
Republican lawmakers have opened up new fronts this session, taking aim at abortions occurring outside of state lines and introducing measures modeled off of Texas’ law that banned abortions after fetal cardiac activity is detected — which can be as early as six weeks before most women know they are pregnant.
While Idaho was the first to sign legislation mirroring Texas’ law, it remains to be seen if Missouri lawmakers are on board with adopting a similar private enforcement mechanism.
On Wednesday, the Senate Committee on Seniors, Families, Veterans & Military Affairs debated a bill that would mirror Texas’ law and another that would allow women to be held criminally responsible “for the death or attempted death of her child” for receiving an abortion.
A string of supporters urged lawmakers Wednesday to outlaw abortion in its entirety. While opponents, like Maggie Olivia, a policy manager with Pro-Choice Missouri, said allowing private lawsuits would give abusers financial incentives to surveil their victims.
A bill filed by Sen. Andrew Koenig, R-Manchester, that has yet to be heard in committee would also extend Missouri’s abortion laws outside of state lines in certain circumstances, such as when the procedure involves a Missouri resident, which the bills also defines as “an unborn child.”
Last week, the House avoided a vote on an amendment proposed by Coleman that would have made it illegal to perform or “aid or abet” an abortion for a Missouri resident — regardless of where the procedure occurs. The provision, which would have allowed for exceptions in the case of life-threatening conditions, would have been enforced through private lawsuits, and not the state.
A rare procedural move was used to overwrite Coleman’s language.
Bills passed this session will be able to “start to be challenged to see where those parameters are,” in a post-Roe v. Wade world, Coleman said.
But not all anti-abortion advocates are in agreement.
Lee said he doesn’t believe Texas’ private enforcement mechanism is the right tactic, noting Democratic states, like California, have used the same concept to propose legislation to allow private citizens to sue gun manufacturers.
“I don’t think it’s a sustainable approach,” Lee said. “I don’t think in the long run, it’s an approach that the courts are going to favor.”
What’s more, under the current enforcement by the state, abortions have fallen, Lee said. According to preliminary data, last year only 151 abortions occurred in Missouri, which includes those in hospitals, Lisa Cox, a spokeswoman for the Department of Health and Senior Services said.
The constitutionality of a 2019 Missouri law that banned abortions after eight weeks also has yet to be decided, as the Eighth U.S. Circuit Court of Appeals in St. Louis weighs arguments. Lee said it would be premature to pass new laws that may repeal or interfere with those statutes before the case is decided.
When asked during Wednesday’s committee hearing if language allowing for private enforcement would affect the law before the courts, Susan Klein, Missouri Right to Life’s executive director said, “we don’t believe that it would.”
Amending Missouri’s constitution
If Roe v. Wade is overturned and a near-total ban on abortions under the provisions of Missouri’s 2019 law goes into effect, anti-abortion advocates expect a court challenge would be imminent.
In anticipation of one, a handful of bills filed this session would allow voters to decide whether to amend Missouri’s Constitution to make clear that: “Nothing in this constitution shall be construed to secure or protect a right to abortion.”
“I believe this is an ounce of prevention against an activist courtroom in this area,” Sen. Bob Onder, R-Lake St. Louis and sponsor of SJR 53, said Wednesday during a committee hearing.
In Kansas, voters will be asked this August whether to amend the state’s constitution to reverse a Kansas Supreme Court decision that found women had a constitutional right to abortion in Kansas. Meanwhile in anticipation of Roe v. Wade’s possible reversal, Democratic strongholds have moved in the opposite direction, with Colorado affirming a right to abortion exists in their state under a new law signed Monday.
Koenig, whose bill also touches on taxpayer funds going toward abortion, said the language would make Missouri’s Constitution “abortion neutral” and leave the authority over abortion policy in lawmakers’ hands.
“To me, that is not exactly neutral,” said Sen. Jill Schupp, D-Creve Coeur.
Taxpayer funds
Meanwhile, Republican lawmakers have continued their efforts to bar taxpayer funds from going to abortion providers and their affiliates.
On Thursday, the Missouri House passed budget bills that included $0 line items for abortion providers and their affiliates and barred them from being reimbursed through the state’s Medicaid program. A similar provision signed by Gov. Mike Parson in a supplemental budget bill has already been met with a lawsuit by Planned Parenthood.
But lawmakers still hope to pass similar language through statute, noting the Missouri Supreme Court previously struck down prior attempts to do so through the state budget. Provisions were included in an omnibus abortion bill passed out of the House Wednesday.
“I don’t think when you’re talking about saving lives,” Klein said, “that you should have just one track.”
Missouri’s Medicaid program only pays for abortions in the instances of rape, incest or to save the mother’s life. Reproductive health advocates have stressed that limiting funding to Planned Parenthood providers will stretch a safety net that’s already over capacity.
In 2021, the two Planned Parenthood health centers that participated in Missouri Family Health Council’s family planning services served 52% of the nearly 44,000 patients seen, said Michelle Trupiano, the nonprofit’s executive director.
M’Evie Mead, Planned Parenthood Advocates in Missouri’s director, said it will put people in a “a terrible but intentional bind” in a world where abortion is illegal if Roe v. Wade is overturned.
“They can no longer access the care of the provider of their choice where they can actually prevent unintended pregnancy or keep themselves healthy,” Mead said, “and if they happen to get pregnant unintentionally they have no recourse.”
States like Kansas and Illinois that have the right to an abortion enshrined in their state laws may be fortified as abortion safe havens if Roe v. Wade is overturned, and clinics have already seen their numbers increase as access is restricted in other states.
Planned Parenthood Great Plains’ clinics in Oklahoma, Kansas and Arkansas saw over 1,100 patients from Texas from September to December 2021 after Texas’ fetal cardiac activity law was passed, a spokeswoman said, compared to only 50 Texans during that same period a year earlier.
Similarly, a regional logistics center in Fairview Heights just past the Illinois-Missouri border, has seen a 133% increase in patients that are traveling from outside Missouri and Illinois, Lee-Gilmore said.
“Figuring out, how do we get the patient to the health center? Where do they stay while they’re here? Do they have money to eat?” Lee-Gilmore said, “All of these questions are now regularly becoming a part of abortion care.”