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For the Future of Anti-Abortion Laws, Look to Missouri

Health policy experts say other conservative states often follow Missouri's lead on abortion measures. This year, the state passed several never-before-seen regulations.

Activists dressed as characters from "The Handmaid's Tale" outside the Texas Capitol.
Activists dressed as characters from "The Handmaid's Tale" leaving the Texas Capitol as they protest proposed abortion restrictions.
(AP/Eric Gay)
As legislative sessions across the country wrap up this year, several states are left with new abortion laws -- some that restrict access to the procedure and others that ease it. 

Most recently, Oregon passed a law this week that requires health insurers to provide birth control and abortion services without a co-pay. Texas, on the other hand, passed a law this week that requires women to buy a supplemental insurance plan for abortion services -- with no exception for rape and incest. Critics are calling the legislation the "rape insurance" bill. 

But for the future of the anti-abortion movement, Missouri just might be ground zero.

“Missouri never met a restriction it didn’t like. It’s just always been a part of their culture. They’re a state that other states look to when looking for new restrictions,” says Elizabeth Nash, a state policy expert at the Guttmacher Institute, an organization that tracks reproductive rights around the world.

During a special session that ended late last month, Missouri -- which is led by a Republican governor and legislature -- passed a sweeping abortion bill that introduced several regulations that are firsts of their kind in the country. While several of the provisions were enacted to preempt specific ordinances in St. Louis, the state's liberal enclave, others have the potential to pop up again in conservative states.

The ACLU of Missouri isn't planning to challenge the law right now, but the group expressed disappointment when it passed, calling it an “attack on Missouri’s women” that’s “in direct conflict with the will of the people.”

Both the Missouri Hospital Association and the Missouri State Medical Association declined to comment on the new law, saying they avoid discussing abortion because of the issue's controversial nature.

Here are four new abortion provisions in Missouri law.


'Abortion Sanctuary City'

The reason Missouri Gov. Eric Greitens called the second special session was to address a new abortion discrimination ordinance passed by the city council in St. Louis. That measure was meant to prevent potential employers and landlords from discriminating against someone based on her reproductive health decisions and beliefs. In other words, it made it illegal to ask job and housing applicants whether they've had an abortion.

The governor condemned the ordinance, saying he didn’t want St. Louis to turn into an “abortion sanctuary city.” He then signed off on a bill that essentially overturned the city’s ordinance.

“I have not read anything like this, ever. It’s unusual,” says Nash, referring to both the St. Louis measure and the state's law to override it. 

Refusing a lease or a job to someone based on her reproductive history or beliefs might sound legally dubious to some, but Nash points out that the law around businesses' "right to refuse" has grown murky in recent years. 

After the U.S. Supreme Court legalized same-sex marriage in 2015, it wasn’t uncommon to hear about wedding vendors refusing to do business with gay couples. That same year, Indiana found itself in a PR nightmare when then-Gov. Mike Pence signed the Religious Freedom Restoration Act. Once businesses started turning away same-sex couples, boycotts and a national uproar led Pence to amend the law to protect LGBT customers, employees and tenants. 

On the other side of the spectrum, the U.S. Supreme Court ruled in 2014 that companies could refuse to offer contraceptive coverage to their employees if that violated their religious beliefs. 

But for Andrew Koenig, the Missouri state senator who sponsored the bill overriding St. Louis' measure, it’s pretty cut and dry.

"If you're a part of a pro-life organization, but if you’re forced to hire someone who is pro-choice, then you’re no longer a pro-life organization," he says. 



New Requirement for Doctors

Missouri is now the only state that requires doctors -- as opposed to nurses, physicians assistants and other providers -- to counsel women seeking abortions. 

The bill's sponsor says it's a common-sense idea.

“It just seems reasonable. I had a surgery recently, and the doctor did the counseling -- not a nurse or social worker or anything like that,” says Koenig. 

Nash, however, says the new mandate will stretch doctors' resources thinner than they already are and make it harder for women to obtain abortions in a timely manner. The state already has a 72-waiting period to get an abortion, so a doctor must now be available for the counseling and again 72 hours after that. There's only one clinic that performs abortions in the state, Planned Parenthood of St. Louis, so the few doctors who work there will have to counsel every woman in Missouri who's considering abortion.

Last summer, the U.S. Supreme Court ruled that requiring abortion clinics to meet hospital-like standards, and requiring doctors who perform abortions at clinics to have admitting privileges at nearby hospitals, places an "undue burden on abortion access and thus violate the Constitution." It remains to be seen if this latest wave of restrictions will be challenged in court. 


More Power for the Attorney General

Missouri's new legislation also gives power to the state’s attorney general to prosecute people and organizations not following the state’s abortion laws. State lawmakers feared that local prosecutors, some of whom are more progressive than Missouri AG Josh Hawley, might not be upholding abortion laws. 

“The prosecuting attorney in St. Louis is a pro-choice Democrat, so we just wanted another set of eyes there,” Koenig says.


'Complication Plan'

Going foward, abortion clinics in the state must create a "complication plan" for medication-induced abortions and get it approved by the state’s health department. Medication-induced abortions account for one in four abortions in the U.S. 

"It just makes medical sense," says Koenig.

But Nash says there was talk that Planned Parenthood might start allowing abortions in another clinic in the state, and this provision is an attempt to stop that. 

“They’re trying to make it very hard to get medication abortions and in turn hard to open a new clinic since so many abortions are medication-induced,” she says.

Mattie covers all things health for Governing.

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