As a candidate, President Donald Trump promised abortion opponents four specific actions to “advance the rights of unborn children and their mothers.”
One year into his presidency, three of those items remain undone. Nevertheless, abortion opponents have made significant progress changing the direction of federal and state policies on the issue.
Indeed, last week, as anti-abortion protesters gathered in Washington for the 45th annual March for Life, the Trump administration announced two new policies. One is a letter to states aimed at making it easier for them to exclude Planned Parenthood facilities from their Medicaid programs; the other is a proposed regulation to allow health care providers to refuse to perform services that conflict with their “religious or moral beliefs.”
“In my administration, we will always defend the very first right in the Declaration of Independence, and that is the right to life,” Trump said in a video address from the Rose Garden to the marchers.
That line is a hard sell in California, which has a long history of protecting abortion rights.
California law requires Medi-Cal and fully funded private insurance plans to cover abortion services without requiring proof of medical necessity. Medi-Cal — along with the other 16 state Medicaid programs that cover abortion — uses no federal dollars to pay for those services.
Last year, state Sen. Connie Leyva (D-Chino), introduced a controversial bill that would require California’s public universities to provide abortion pills to female students who are less than 10 weeks pregnant. The legislation stalled last year, but it is being picked up again this year and has already moved through some key committees.
Numerous university health centers in California provide some level of reproductive health services, but none offers abortions, according to the text of Leyva’s bill. The proposal would require that abortion pills be paid for by private funds and grants — not via state funding or student fees.
Despite its political disadvantage, California’s anti-abortion movement is still striving to make its voice heard.
“We know we’re outnumbered … but it’s part of our role to get the information out there,” said Wynette Sills, director of Californians for Life, an anti-abortion coalition. Even in California, there seems to be some pushback against abortions, she said, citing a significant drop in the number of abortions in recent years.
Opponents of abortion have faced some political challenges at the federal level as well.
A vendor sells buttons during the “March for Life” on Jan. 19, 2018 in Washington, D.C. (Julie Rovner/KHN)
During the 2016 presidential campaign, then-candidate Trump said he was committed to “nominating pro-life justices to the U.S. Supreme Court,” which he did with the nomination and confirmation of Justice Neil Gorsuch in April.
But despite many attempts, Congress did not pass a federal ban on abortions occurring after 20 weeks, did not cut off Planned Parenthood’s federal funding and did not write into permanent law the “Hyde Amendment,” which bans most federal abortion funding but needs annual renewal.
Still, there was progress on scaling back abortion and, in some cases, access to contraception at the federal level.
The administration made myriad changes. It reinstituted and expanded the “Mexico City Policy,” which forbids funding of international aid programs that “perform or promote” abortion. It issued rules aimed at allowing religious-affiliated and other employers to not offer contraceptive services if they have a “religious belief” or “moral conviction” against them, although federal courts have blocked the new rules from being implemented. And just last week it created a new “conscience and religious freedom” division in the Department of Health and Human Services’ Office of Civil Rights. That new division is designed to enforce both existing laws protecting the rights of conscience for medical personnel as well as the new regulations.
Most important, according to many in the anti-abortion movement, the president nominated and the Senate confirmed a dozen and a half federal district court and appeals court judges who are considered likely to rule in their favor.
Abortion rights supporters concede that while the priorities on their opponents’ wish list were not accomplished, plenty still happened.
“This administration is the worst we’ve ever seen for women and families,” said Kaylie Hanson Long of NARAL Pro-Choice America in a statement. “Its attacks on reproductive freedom are relentless, under the radar, and aren’t supported by the majority of Americans who believe abortion should remain legal.”
Marjorie Dannenfelser, president of the anti-abortion group the Susan B. Anthony List, who led the Trump campaign’s Pro-Life Coalition, said one of the biggest changes is the number of anti-abortion advocates now working in the Department of Health and Human Services in key roles. “I can say there is more unity in this administration than there has been in any presidency on this,” she said.
Abortion opponents know their biggest obstacle is the U.S. Senate, where they don’t have the 60 votes required for most legislation. “Without making advances in the Senate, it’s going to be really tough,” said Dannenfelser.
Meanwhile, outside Washington, states continued their efforts to restrict access to abortion and family planning. States have passed 401 separate measures since Republicans took over most state legislatures in 2011, according to the Guttmacher Institute, a reproductive rights research and advocacy group.
During 2017, 19 states enacted 63 separate restrictions, said Elizabeth Nash, who tracks state legislation for Guttmacher. Among the notable laws was one in Ohio to outlaw abortions of fetuses diagnosed with Down syndrome. Arkansas and Texas passed laws to ban “dilation and evacuation” abortions, a procedure that uses suction and medical instruments to remove the fetus and is the most common procedure for abortion after the first trimester of pregnancy. Both bans have been blocked by federal courts.
Some of the new restrictions came from states that have not been active on the issue in recent years. A Wyoming law requiring ultrasounds to be offered to pregnant women seeking an abortion was that state’s first in 30 years, Nash said.
But 2017 was also notable for states seeking to widen or ensure access to abortion and other reproductive services, including several beyond California. For example, Delaware passed a law enshrining abortion rights, while Oregon and New York require private health plans to cover abortion without patients’ cost sharing.
As a result, said Nash, “we are really living in a bifurcated country. The states that are progressive are looking to protect access” to abortion and contraception. “The states that are conservative are looking to restrict it.”
In other words, a nation that looks a lot like it did 45 years ago, when the Supreme Court legalized abortion nationwide in Roe v Wade.
California Healthline Reporter Ana B. Ibarra in Sacramento, Calif., contributed to this article.
This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.