Maryland prepares to increase its abortion capacity as future of Roe v. Wade in doubt

Long before Monday night’s revelation that five U.S. Supreme Court justices are likely to overturn 50 years of legal precedent in Roe v. Wade, Democratic legislators had begun preparations for Maryland to accept more abortion-seekers from out of state.

As of July 1, a new law will allow nurse practitioners, physician assistants and midwives — not just physicians — to perform abortions in Maryland. The law was vetoed by Republican Gov. Larry Hogan, but that decision was overridden by the heavily Democratic state legislature.

The idea was to ease access to abortions for Maryland residents, particularly in more rural parts of the state where physicians are fewer in number. As of 2017, more than two-thirds of Maryland counties, which 29% of Maryland women call home, did not have clinics that provided abortions, according to the Guttmacher Institute, a pro-choice research group.

But the new law also will provide more opportunities for non-Maryland residents, particularly from nearby red states like West Virginia, to travel here for an abortion if Roe is reversed, said Del. Ariana Kelly, the Montgomery County Democrat who sponsored the House version of the legislation.

“The more of our Maryland patients we can handle with their local provider — the same person they get their contraception from, the same person they get their primary care from — the more capacity we have in our abortion clinic network for out-of-state patients,” Kelly said.

In Washington, Maryland Democrats said Tuesday they are seeking a broader remedy in case the Supreme Court follows through and strikes down Roe v. Wade.

The Women’s Health Protection Act — aimed at protecting abortion rights nationally — passed the U.S. House 218-211 last September, but did not receive a vote in the Senate, where Maryland Democrats Chris Van Hollen and Ben Cardin are co-sponsors.

Maryland’s seven House Democrats voted for the bill. Rep. Andy Harris, the only Republican in the state’s congressional delegation, voted against it, as did every other House Republican.

Senate filibuster rules would require that 60 members support it, a number the bill’s proponents could not reach.

“I urge the Senate to take urgently needed action to protect the rights of women, remove the filibuster, and codify Roe v. Wade into law as soon as possible,” said Rep. Steny Hoyer, the House Majority Leader and Southern Maryland Democrat, on Tuesday.

The U.S. House acted after Texas passed its restrictive abortion law last year, limiting the procedure to the first 5 to 6 weeks of pregnancy. A University of Texas study found that wait times at abortion clinics in neighboring states were frequently as long as two weeks.

“That’s what we’re trying to avoid in Maryland,” said Kelly, a member of a newly formed pro-choice caucus in Annapolis that’s “currently in conversations about what next steps might need to be.”

Planned Parenthood of Maryland has been seeing one to two patients from Texas per week since that state’s law took effect, said Kyle Bukowski, the group’s chief medical officer.

But Maryland’s new bill will not necessarily generate a new workforce overnight, said Julie Jenkins — a registered nurse and consultant to the National Abortion Federation — because many providers will need to be trained.

The legislation provides for a state-funded training program, but it’s unlikely to be ready by July, Kelly said.

The governor is required to allocate $3.5 million to the program annually, beginning with next year’s budget. Hogan could choose to make that initial allocation sooner, but it is not required by the new law, Kelly said.

“Gov. Hogan would have to release that money, so the ball is in his court as to if the clinical training program starts in 2022 or 2023,” Kelly said.

In a statement, Michael Ricci, a spokesman for Hogan, said the funding isn’t likely to be expedited, adding that it “was not included in the bipartisan budget agreement with legislative leaders.”

Bukowski said Planned Parenthood will have at least one nurse practitioner ready to perform the procedure by July 1, but training in larger numbers is still to come.

Laura Bogley, director of legislation for Maryland Right to Life, an anti-abortion organization, said she was frustrated by the General Assembly’s choice to use taxpayer dollars to expand the number of abortion providers in the state rather than for things like prenatal care.

The new law calls on the Maryland Department of Health to select a nonprofit with abortion care experience to administer the training in at least two community-based sites, and dole out grant funding for other training programs where funding is available.

Some of the health care providers newly eligible to provide abortions in Maryland may be adequately trained by the summertime, Kelly said, especially since many abortions simply require the administration of medication.

“A nurse practitioner can go to clinical training for a day — two days, maybe — and learn how to appropriately and safely provide a medication abortion,” Kelly said. “It’s going to be obviously a much longer and more complicated training for surgical procedures or for more complex hospital-based procedures.”

In 2020, so-called “abortion pills” accounted for 54% of abortions nationally, according to the Guttmacher Institute, which says it is “committed to advancing sexual and reproductive health and rights worldwide.”

Sarah L. Szanton, dean of the Johns Hopkins School of Nursing, said Maryland’s bill is a “tremendous step,” especially because “there is so much pressure on current providers,” many of whom already assist with more dangerous procedures.

“Think about the excellent work midwives do in delivering babies, which is much more dangerous than an abortion,” Szanton said. “It makes sense they’d be able to provide this service. And there is money for training.”

Jenkins agreed that providing abortion services would not expand the scope of responsibilities for eligible clinicians.

“Nurse practitioners have been doing things like inserting IUDs and all kinds of other things related to reproductive health for a long time,” she said. “It’s well within our scope.”

Some of the newly eligible providers also may be able to prescribe abortion medication to non-Maryland residents remotely via telehealth appointments, which have become increasingly accepted by the medical community during the coronavirus pandemic, although the legal requirements for such appointments aren’t always clear.

“We need to be ready to provide both kinds of care,” Szanton said.

The law also requires private insurance providers to cover abortions without requiring co-payments or other cost-sharing measures, unless they qualify for certain religious or legal exemptions. It also would solidify abortion coverage under Medicaid in the state.

“I’m so excited about the insurance-related provisions,” Kelly said. “Most of our insurance plans in Maryland were already covering abortion care, but many of them were doing so with significant cost-sharing.”

Baltimore Sun reporters Jeff Barker and Ngan Ho contributed to this article.