Abortion payment options

A view of the medical bed and the procedure room where abortions once took place, inside Tulsa Women’s Clinic, in Tulsa, Oklahoma, U.S. June 20, 2022. REUTERS FILE PHOTO

Subscribe to our daily newsletter

Within an hour of news breaking that the U.S. Supreme Court had struck down Roe v. Wade, the phones at the Boulder Valley Women’s Health Center started ringing.

Not just one or two calls, but at least a dozen — coming from states where patients had appointments scheduled, but had to cancel them and scramble to find alternatives after the ruling stripped away constitutional protections for abortion and allowed states with trigger bans to immediately outlaw the procedure.

The Boulder clinic only performs abortion procedures on Fridays and usually has same-day appointments open. Now, two weeks after the ruling, they’re scheduled at least a week out and staff is double-booking in case of cancellations. Dr. Kelly Peters, the clinic’s medical director, said she’s grateful to live in a supportive state like Colorado, but it’s important to keep talking about the need for abortion services and compassionate care.

“The only good thing that I see right now is that it is making people angry and it’s making people motivated to get out and do what they can,” she said of the Dobbs v. Jackson Women’s Health Organization ruling. “We’ve had people show up at our door trying to give us donations and people calling and emailing about how can they help, what can they do?”

In the ruling’s wake, abortion providers across Colorado are seeing increased demand — and are coordinating to refer clients to each other in an effort to ensure people can be seen in a timely fashion, even if a particular clinic doesn’t have availability. They say they’ve been inundated with requests for abortion appointments and also are seeing an increase in appointments for birth control strategies such as vasectomies or intrauterine devices.

“A year ago, we rarely saw patients who needed to travel to Colorado for necessary medical care, whereas now up to a third of our patients are traveling from out of state — this means that each patient faces more anxiety and stress in navigating unfamiliar systems,” said Dr. Rebecca Cohen, a doctor at the University of Colorado Family Planning and OBGYN Clinic.

Health care providers have worried about overloading the state’s health care system, particularly after losing staff and resources during the pandemic, as Colorado stands as an abortion safe haven while other states immediately banned abortions or are expected to in the future. They also worry that, with fewer appointments available, women will be left to get abortions later in their pregnancies, creating more risk of hemorrhaging.

Cohen said she expects demand for abortion services in Colorado will only grow as more states ban or restrict abortion care.

The Boulder Women’s Health Center just hired a nurse and a doctor, and is looking to expand the number of days it performs abortions, Peters said.

The work is taking a toll on doctors and medical staff across the state who say they are exhausted and trying to do what they can to meet the needs of their clients. Peters said she has a hard time sleeping, laying awake thinking about what’s happening to people in other states. Her personal life is suffering, too, she said, and though her family supports the work she’s doing, it also makes them nervous.

But Peters, like other medical professionals and support staff, is willing to make the sacrifices. Some of the medical assistants in particular who work at her clinic could probably get higher-paid jobs at other facilities, “but because they care about what we do, then they’re willing to work for a little less and work a little harder,” she said.

Reproductive rights organization Cobalt provides an abortion fund for patients who cannot afford the procedure (providers are paid directly) in the state, as well as to provide money and resources for people coming from out of state.

In 2021, the fund helped 34 clients and provided $6,000 for non-procedural support, such as travel reimbursement, gas cards, groceries and hotel rooms. Since Roe was overturned, the fund has provided $25,888 for 71 clients, according to Abortion Fund Director Amanda Carlson.

Impacts felt before Roe overturned

Before Roe fell, Colorado providers already were seeing an increase in Texas patients after that state enacted a law last year, Senate Bill 8, that banned abortions as early as six weeks, which the state Supreme Court upheld in March . The law allows private citizens to sue people who aid or abet abortions.

Now, the number of patients coming from Texas and other states has gone up even more.

Dr. Nancy Fang said her clinic at Comprehensive Women’s Health Center in Denver provides about 300 abortions per month and anticipates expanding to twice as many over the next few months. They’re looking to hire more trained professionals to work as medical assistants, nurses and front-desk staff.

Fang’s clinic has seen about 30% of its clients come from out of state as of mid-June, and while the clinic isn’t turning people away, it is taking longer for patients to get in for appointments. They’re coming primarily from Texas, but also Oklahoma and South Dakota, which also ban the procedure.

“Access is inevitably going to be hindered and the people that are going to be most affected are those without the resources,” Fang said.

She added that she’s worried people with more complex medical situations will have a harder time finding clinics that have availability for them, and for those that can’t, they will continue high-risk pregnancies that could be dangerous for them.

Dr. Emily Schneider, the Colorado section chair of the American College of Obstetricians and Gynecologists, said clinics across the country are reporting increases in not only abortions, but miscarriage management, particularly from people in Texas. One woman came to Denver from Austin who was clearly having a miscarriage, Schneider said, but because there was a “flicker of a heartbeat,” doctors told her she couldn’t get treated in Texas because of the six-week ban.

Women have been driving from Texas and other states, sleeping in their cars, outside Colorado clinics, waiting for abortion appointment cancellations, Schneider said. Maternal-fetal medicine specialists also are seeing an increase in requests for appointments, and people are calling infertility clinics asking that embryos be transferred to Colorado, she added.

The hospital Schneider works at has been getting calls to the surgery unit asking for help with abortion appointments. She said she’s seen patients during annual exams ask if they have any medical conditions that would require hysterectomies because they want to just remove their uteruses so they don’t accidentally get pregnant.

After Texas implemented Senate Bill 8, the calls increased, with patients not being able to get in for appointments for two to three weeks in Schneider’s clinic. After the U.S. Supreme Court decision, that went up to three to four weeks.

Increase in demand for long-term contraception

In addition to abortion care, local doctors, including Cohen, are seeing more of a demand in the number of people seeking long-lasting or permanent contraceptive options.

“The risks of an unplanned pregnancy are unfortunately higher than ever,” Cohen said.

On the day of the Roe reversal, Schneider said her clinic received 10 calls for tubal ligations, far more than normal. Clinics across the state reported requests for more contraceptives, Schneider said, like the young woman who came into the clinic last week asking for the longest-lasting IUD because she was going to college in Texas.

Schneider said providers are trying to be “very thoughtful” about how they move forward.

“But… coming out of the pandemic, I felt like nobody has ever had a chance to really catch their breath,” she said. “And then this (decision), so I am afraid about provider burnout and staff burnout and that also is limiting access to care.”

Throughout all of this, Fang emphasized that abortion providers in Colorado have been preparing for an increase in patients for a long time, even before the Supreme Court decision.

On Wednesday, Gov. Jared Polis issued an executive order protecting people seeking abortions in the state and those aiding in performing them, such as doctors and nurses. The order said Colorado won’t cooperate with criminal or civil investigations against people who provide, assist with or receive abortions in the state, and it also requires the state Department of Regulatory Affairs to ensure people who work in Colorado don’t face disciplinary action against their professional licenses for those same reasons.

Colorado is one of four states to enshrine the right to abortion into state law . Thirteen states have “trigger bans” prohibiting abortions that would automatically go into effect within 30 days of Roe’s reversal, and at least eight states already have banned the procedure after the court’s decision.

Subscribe to bi-weekly newsletter to get health news sent straight to your inbox.

The Circular also mentions non-compete fees, late payment charges by utility providers of electricity, water or cancellation charges levied by railways, airlines, hotels, tour operators as examples of payments made towards the independent activity of tolerating an act.