As restrictions on accessing an abortion in Missouri have steadily tightened, nearly 9,800 Missourians traveled 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 鈥� 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.
鈥淣ationally, everybody is looking to a post-Roe world,鈥� said Rep. Mary Elizabeth Coleman, R-Arnold. 鈥淚n Missouri, we鈥檙e almost already there.鈥�
Proposals have been floated this legislative session to obtain an abortion across state lines, to target and to in the state constitution.
But as the nation waits in anticipation of how the country鈥檚 highest court will rule, the GOP-controlled Missouri legislature finds itself at an inflection point of its own.
鈥淗ow 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?鈥� said Sam Lee, a longtime lobbyist for Campaign Life Missouri. 鈥淚t鈥檚 a debatable point.鈥�
Proposals that mirror Texas鈥� recent abortion restrictions have grabbed national headlines, but they have yet to gain significant traction in the legislature 鈥� 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 .
鈥淣ot only are Missouri politicians showing us what it鈥檚 going to look like post Roe v. Wade,鈥� said Bonyen Lee-Gilmore, a spokeswoman for Planned Parenthood of the St. Louis Region and Southwest Missouri, 鈥渂ut they鈥檙e also showing us their intent to go after all other comprehensive reproductive health care.鈥�
Lee called the effort to defund Planned Parenthood 鈥渢he most likely pro-life bill that鈥檚 going to pass this year.鈥�
鈥淚t鈥檚 practically universal among every Republican that I鈥檝e talked to, whatever caucus they鈥檙e in or whatever they call themselves,鈥� he said. 鈥淭hat鈥檚 the law that they want to pass. And I鈥檝e seen that discussed over and over.鈥�
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 after fetal cardiac activity is detected 鈥� which can be as early as six weeks before most women know they are pregnant.
While Idaho , 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 and another that 鈥渇or the death or attempted death of her child鈥� 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 , R-Manchester, that has yet to be heard in committee would also extend Missouri鈥檚 abortion laws outside of state lines in certain circumstances, such as when the procedure involves a Missouri resident, which the bills also defines as 鈥渁n unborn child.鈥�
Last week, the House avoided a vote on an amendment proposed by Coleman that would have made it illegal to perform or 鈥渁id or abet鈥� an abortion for a Missouri resident 鈥� 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 .
Bills passed this session will be able to 鈥渟tart to be challenged to see where those parameters are,鈥� in a post-Roe v. Wade world, Coleman said.
But not all anti-abortion advocates are in agreement.
Lee said he doesn鈥檛 believe Texas鈥� private enforcement mechanism is the right tactic, noting Democratic states, like California, have used the same concept .
鈥淚 don鈥檛 think it鈥檚 a sustainable approach,鈥� Lee said. 鈥淚 don鈥檛 think in the long run, it鈥檚 an approach that the courts are going to favor.鈥�
What鈥檚 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 , 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鈥檚 committee hearing if language allowing for private enforcement would affect the law before the courts, Susan Klein, Missouri Right to Life鈥檚 executive director said, 鈥渨e don鈥檛 believe that it would.鈥�
Amending Missouri鈥檚 Constitution
If Roe v. Wade is overturned and a near-total ban on abortions under the provisions of Missouri鈥檚 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鈥檚 Constitution to make clear that: 鈥淣othing in this constitution shall be construed to secure or protect a right to abortion.鈥�
鈥淚 believe this is an ounce of prevention against an activist courtroom in this area,鈥� Sen. Bob Onder, R-Lake St. Louis and sponsor of , said Wednesday during a committee hearing.
In Kansas, whether to amend the state鈥檚 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鈥檚 possible reversal, Democratic strongholds have moved in the opposite direction, with under a new law signed Monday.
Koenig, also touches on taxpayer funds going toward abortion, said the language would make Missouri鈥檚 Constitution 鈥渁bortion neutral鈥� and leave the authority over abortion policy in lawmakers鈥� hands.
鈥淭o me, that is not exactly neutral,鈥� said Sen. Jill Schupp, D-Creve Coeur.
Meanwhile, Republican lawmakers have continued their efforts to bar taxpayer funds from going to abortion providers and their affiliates.
On Thursday, the Missouri House for abortion providers and their affiliates and barred them from being reimbursed through the state鈥檚 Medicaid program. A similar provision has already been met .
But lawmakers still hope to pass similar language through statute, noting the Missouri Supreme Court through the state budget. Provisions were included in passed out of the House Wednesday.
鈥淚 don鈥檛 think when you鈥檙e talking about saving lives,鈥� Klein said, 鈥渢hat you should have just one track.鈥�
Missouri鈥檚 Medicaid program only pays for abortions in the instances of rape, incest or to save the mother鈥檚 life. Reproductive health advocates to Planned Parenthood providers will stretch a safety net that鈥檚 already over capacity.
In 2021, the two Planned Parenthood health centers that participated in Missouri Family Health Council鈥檚 family planning services served 52% of the nearly 44,000 patients seen, said Michelle Trupiano, the nonprofit鈥檚 executive director.
M鈥橢vie Mead, Planned Parenthood Advocates in Missouri鈥檚 director, said it will put people in a 鈥渁 terrible but intentional bind鈥� in a world where abortion is illegal if Roe v. Wade is overturned.
鈥淭hey can no longer access the care of the provider of their choice where they can actually prevent unintended pregnancy or keep themselves healthy,鈥� Mead said, 鈥渁nd if they happen to get pregnant unintentionally they have no recourse.鈥�
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鈥� clinics in Oklahoma, Kansas and Arkansas saw over 1,100 patients from Texas from September to December 2021 after Texas鈥� fetal cardiac activity law was passed, a spokeswoman said, compared to only 50 Texans during that same period a year earlier.
Similarly, just past the Illinois-Missouri border, has seen a 133% increase in patients that are traveling from outside Missouri and Illinois, Lee-Gilmore said.
鈥淔iguring out, how do we get the patient to the health center? Where do they stay while they鈥檙e here? Do they have money to eat?鈥� Lee-Gilmore said, 鈥淎ll of these questions are now regularly becoming a part of abortion care.鈥�
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