The last time Donald Trump was president, his health care policies chipped away at the Affordable Care Act and helped eliminate federal abortion rights, leaving states to fill the gaps. In his second term, experts predict Trump’s agenda to be similar and warn that health care will get more expensive and harder to access for millions of people. 

Congressional Republicans, newly empowered by Trump’s victory and the Senate moving to GOP control, have made it clear that they intend to try to implement long-standing conservative goals that include decreasing government spending on health care and further dismantling abortion rights, which are currently protected in about half of the country, including California.

Newly nominated Health Secretary Robert F. Kennedy Jr. has also pushed erroneous claims about vaccine hazards and exaggerated the risks of water fluoridation that could have ripple effects across state public health efforts. 

The Democratic supermajority in the California Capitol, however, has spent the past several years passing laws to stymie future conservative administrations on health care, said Mia Bonta, chairperson of the Assembly health committee and a Democrat from Oakland. 

Legislators have protected insurance coverage of abortion and transgender care. They have expanded health insurance programs to low-income undocumented immigrants and paid for it with state funds. They have taken pieces of the Affordable Care Act and written it into state law, expanding the enrollment period and banning lifetime limits on coverage. And they’ve invested millions of dollars into public health after the system languished for a decade.

“We were able to be very deliberate in the past several years to Trump-proof our health system moving forward,” Bonta said.

Not all state lawmakers have been happy with California’s health care expansions. Senate Republican Minority Leader Brian Jones, for instance, said public insurance for undocumented immigrants, which as of this year is available to all income-eligible immigrants, is too expensive and should be “delayed or repealed entirely.”

But Democratic lawmakers and health care advocates say they are better prepared than the first time Trump took office — though they expect the new administration to put California’s new laws to the test.

“We have their playbook from 2017, and almost everything they tried to do, California helped stop through our advocacy … or through court cases,” said Rachel Linn Gish, communications director for Health Access California. “In that way we are in a much stronger position than before.”

Affordable health care at risk

During his first term, Trump tried and failed to repeal the Affordable Care Act. He has said for his second term that he has “concepts of a plan” for the program that insures more than 21 million Americans. 

Republican lawmakers in general have shifted away from talking about eliminating the program entirely, but some leaders, including Vice President-elect J.D. Vance have suggested changes that would make insurance more expensive. Vance during the campaign said he wanted to increase choices for consumers and “make the health insurance marketplace function a little bit better.”

Eliminating the health insurance marketplace, which is also known as Obamacare, has grown deeply politically unpopular even among Republican constituents. Since Trump’s first term, the number of people enrolled has grown by more than 9 million nationally. That political leverage is something that California advocates believe will help protect the program. 

“More people are enrolled in (Affordable Care Act) marketplaces than ever before,” Linn Gish said.

But in many ways the state’s Achilles heel is federal funding. Federal spending on California health care programs is more than three times greater than the state’s share. That’s more than $117 billion from the federal government to support Medi-Cal and the Affordable Care Act compared to $35 billion from California’s general fund for all state health spending, which includes public health, state hospitals and social services.

And much of California’s policies can only be fully realized with sufficient money in the bank.

With the state grappling with a third consecutive deficit next year, the most immediate and likely federal health care cut will be difficult to prevent: financial assistance for middle-class families. 

Outgoing President Joe Biden approved two rounds of Affordable Care Act subsidies during his presidency, making assistance available to middle-class families for the first time. Those  subsidies will expire at the end of 2025, and Trump and congressional Republicans have signaled that they don’t want to renew them.

Without them, premiums will increase by an average of $1,000 annually for residents with insurance through Covered California, the state’s Affordable Care Act program. Premiums are already set to increase by about 8% next year, and without federal assistance other out-of-pocket costs such as deductibles and copays will most likely spike as well. 

Prior to Biden’s push to lower health care premiums, many Californians paid upwards of 18% of their income on health insurance, according to Covered California data. Federal assistance capped that expense at 8.5%.

“You’re talking about a world where we’re doubling how much people pay,” Linn Gish said.

In 2023, California lawmakers established a backstop of state funding to help more people afford health insurance, but those reserves can’t make up the gap if federal funding stops.

Health care for immigrants

Medi-Cal, the state Medicaid program, offers expansive benefits to all low-income individuals regardless of immigration status.  The program could face uncomfortable cuts with a less-than-friendly federal administration. 

Federal dollars cover about 70% of Medi-Cal’s program costs, while the state invests approximately $30 billion in general fund spending. 

“The largest concern many of us have who have worked with our state budget is the resources we will be receiving from the federal government this upcoming year,” said Assemblymember Joaquin Arambula, a Democrat from Fresno who has focused on expansions for undocumented workers. “There are many who are struggling who need their government to help.”

About 7 million more Californians qualified for Medi-Cal after Affordable Care Act rules allowed the state to bump up income limits in 2014, and about 1.8 million undocumented immigrants have gotten Medi-Cal coverage after the state began expanding eligibility for them  in 2015.

Some California Republicans have strayed from the party platform when it comes to health care for undocumented immigrants. The Central Valley relies heavily on immigrant labor, and a handful of state Republicans from those communities supported expanded access to health insurance for undocumented residents. 

The state GOP, however, still officially opposes coverage for undocumented immigrants and several Republican lawmakers want the state to undo that health care expansion.

Gov. Gavin “Newsom and Democrat lawmakers insist on expanding free health care for illegal immigrants to the tune of $5 billion per year. In the midst of a multi-billion dollar budget deficit, hospitals and maternity wards shutting down, and a massive influx of migrants illegally crossing our open border, we should not be expanding this costly government program,” Jones, a Republican from San Diego said.

Immigrants who came to the United States in their youth and who are protected by the Obama-era program known as Deferred Action for Childhood Arrivals (DACA) for the first time can enroll in Covered California thanks to expanded eligibility under the Biden administration.

Liberal lawmakers and policy advocates hailed the expansions as a long-sought-after victory, but they remain controversial among California Republicans. Many lawmakers and advocates expect these expansions to be challenged over the next four years. 

“Anything that has Biden’s fingerprints on it is going to be the first touched. The DACA expansion is going to be high on the list,” Linn Gish said.

This year a bill expanding Covered California to all undocumented immigrants, not just those who came to the U.S. as children, stalled in committee. That measure would have allowed immigrants who make too much money to qualify for Medi-Cal to purchase insurance.

Arambula, who authored the bill, said those populations are “unjustly excluded” from buying insurance at full price even if they want to. He plans on reintroducing the measure, which could be implemented without federal approval. 

Family planning and abortion cuts

On the campaign trail Trump took credit for appointing the Supreme Court justices who ended the national right to abortion by overturning Roe vs. Wade, but he said he would not support a national law banning abortion.  

Still, California Democrats aren’t taking any chances on abortion rights. They passed more than two dozen laws to protect access to abortion, contraceptives and gender-affirming services in the last three years.

In 2022, voters also protected abortion as a right in the state constitution. 

Democratic lawmakers say they have more work to do. 

Bonta said she plans on introducing bills to further protect reproductive rights on the first day of the legislative session. Those bills would require hospitals to provide emergency abortions, protect birth control for Medi-Cal recipients and ease the regulation of birth centers. Bonta said lawmakers are working quickly and she expects many of the bills introduced in December to have urgency clauses that allow immediate implementation.

“It’s going to be a huge change within the health care space,” she said.

The first time Trump was president, he also dismantled Title X regulations that fund the federal family planning network by instituting a “gag rule” prohibiting clinics from performing or referring for abortions. The clinics funded have historically provided contraceptives, abortion care, sexually transmitted infection testing and treatment, gynecology services and postpartum care. After the rule change, the number of people served by Title X clinics dropped 60% nationally as a result of clinics exiting the program, according to the Kaiser Family Foundation, an independent health policy research center..

In California the number of people served dropped from 1 million to fewer than 200,000, said Amy Moy, co-CEO of Essential Access Health, which administers the state’s Title X money. 

California dedicated $10 million to bridge the gap, but Moy said if there is another federal cut, clinics say to expect longer wait times and fewer providers.

“We will be having to test the bounds of our guardrails and see what we can do here, but we are committed to working with partners and state leaders to do everything possible,” Moy said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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President-elect Donald Trump is lashing out at California Gov. Gavin Newsom after he called a special session of the Legislature to beef up the state’s legal defenses against the incoming president.

“Governor Gavin Newscum is trying to KILL our Nation’s beautiful California,” Trump said Friday in a post on Truth Social, using his derisive nickname for the governor. “He is using the term ‘Trump-Proof’ as a way of stopping all of the GREAT things that can be done to ‘Make California Great Again.’”

Trump’s post came a day after Newsom said state lawmakers would convene to take immediate legislative action to counter Trump’s expected attacks on abortion, electric vehicles, immigration and federal disaster aid.

California is one of several blue states that have announced preemptive moves to defend against Trump’s policies. New York Gov. Kathy Hochul and Attorney General Letitia James have pledged to beef up coordination between their offices to “protect New Yorkers’ fundamental freedoms from any potential threats.” And state leaders in Illinois and Massachusetts have pledged to take action to protect undocumented immigrants, access to abortion and the rights of LGBTQ+ people.

But the Golden State has borne the brunt of Trump’s wrath. His rebuttal read like a greatest hits list of his gripes about California, hammering the state over its voting laws, water-conservation policies, vehicle-emissions standards, homelessness crisis and high cost of living.

“People are being forced to leave due to his, & other’s, INSANE POLICY DECISIONS,” Trump wrote.

Newsom and prominent Democrats in Sacramento have vowed the Golden State will once again lead the resistance to Trump’s policies — reviving its role from the first Trump era. During that time, state officials filed more than 120 lawsuits challenging the Republican administration’s actions and passed a sweeping law limiting local authorities’ cooperation with federal immigration officials.

“The freedoms we hold dear in California are under attack — and we won’t sit idle,” Newsom said Thursday, in a statement announcing the special session. The governor was a central surrogate for Vice President Kamala Harris and is considered a likely contender for president in 2028.

The special session will start in Sacramento on Dec. 2, when lawmakers were scheduled to return to the state Capitol to swear in new members and prepare for next year’s session.

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WAUKESHA, Wisc. (AP) — Vice President Kamala Harris blasted Republicans as extremists for trying to ban abortions as she rallied women in the key battleground state of Wisconsin on Monday, marking the 51st anniversary of Roe v. Wade by leading Democrats’ charge for restoring reproductive rights.

She singled out Donald Trump, who is tightening his grip on the Republican presidential nomination, for saying he was “proud” of helping to limit abortions. Trump nominated three conservative justices to the U.S. Supreme Court during his term in office, paving the way for the overturning of Roe v. Wade.

“Proud that women across our nation are suffering?” Harris said. “Proud that women have been robbed of a fundamental freedom? Proud that doctors could be thrown in prison for caring for their patients? That young women today have fewer rights than their mothers and grandmothers?”

“How dare he?” she added.

The barrage reflects the White House’s intense focus on abortion rights during this year’s presidential campaign. Back in Washington, Biden convened a meeting of his reproductive health care access task force to discuss threats to emergency care and new steps for implementing executive orders on the subject.

The Democratic president described Roe v. Wade as “a fundamental right” that had been “ripped away.”

Biden, Harris, first lady Jill Biden and second gentleman Doug Emhoff are holding another rally focused on abortion in Virginia on Tuesday. In addition, Harris’ trip to Wisconsin is the first stop in a nationwide tour to talk about reproductive rights.

In her speech on Monday, Harris described abortion as an integral part of the country’s tradition of personal liberty.

“In America, freedom is not to be given. It is not to be bestowed. It is ours by right,” she said. “And that includes the freedom to make decisions about one’s own body — not the government telling you what to do.”

Harris shared stories of women who have miscarried in toilets or developed sepsis because they were denied help by doctors concerned about violating abortion restrictions.

“This is, in fact, a healthcare crisis,” she said. “And there is nothing about this that is hypothetical.”

Wisconsin faces an ongoing legal battle over abortion. When Roe v. Wade was overturned, Republicans argued that an 1849 law that was still on the books would effectively ban the procedure except in situations where a mother’s life was at risk.

“These extremists want to roll back the clock to a time before women were treated as full citizens,” Harris said.

Clinics across the state stopped offering abortions until a court ruled the law did not apply to abortions. Republicans have appealed the decision, and the case will likely be decided by the state supreme court. They’re also pushing for a voter referendum that would ban abortions after 14 weeks, holding a hearing on the proposal on Monday.

The White House is pushing against the limits of its ability to ensure access to abortion without new legislation from Congress, where control is split between Democrats and Republicans.

On Monday, Biden administration announced it was creating a team dedicated to helping hospitals comply with the federal Emergency Medical Treatment and Labor Act, which requires hospitals receiving federal money to provide life-saving treatment when a patient is at risk of dying.

The Department of Health and Human Services said it would beef up training at hospitals around the law and publish new information on how to lodge a complaint against a hospital.

Some advocacy groups have criticized HHS as not responding aggressively enough to such complaints. Last week, the Associated Press reported that federal officials did not find any violation of the law when an Oklahoma hospital instructed a 26-year-old woman to wait in a parking lot until her condition worsened to qualify for an abortion of her nonviable pregnancy.

The White House has repeatedly turned to Harris, the first woman to serve as vice president, to make its case on abortion. Her outspokenness contrasts with Biden’s more reticent approach. Although he is a longtime supporter of abortion rights, he mentions less often and sometimes avoids using the word abortion even when he discusses the issue.

“I think the real star from a messaging standpoint is the vice president,” said Mini Timmaraju, head of Reproductive Freedom for All, the activist organization formerly known as the National Abortion Rights Action League. “Look, Joe Biden picked Kamala Harris. Joe Biden has asked Kamala Harris to lead on this issue. This is going to set us up for a great contrast with the other side.”

While Harris and Democrats have embraced abortion as a campaign issue, Republicans are shying away or calling for a truce, fearful of sparking more backlash from voters.

Nikki Haley, the former South Carolina governor who is running for the Republican presidential nomination, recently made a plea to “find consensus” on the divisive issue.

“As much as I’m pro-life, I don’t judge anyone for being pro-choice, and I don’t want them to judge me for being pro-life,” she said during a primary debate in November.

Trump has taken credit for helping to overturn Roe v. Wade, but he has balked at laws like Florida’s ban on abortions after six weeks, which was signed by Gov. Ron DeSantis, another Republican candidate who dropped out of the race over the weekend.

“You have to win elections,” Trump said during a recent Fox News town hall.

Vice presidents are rarely decisive figures in reelection campaigns. However, Harris has faced additional scrutiny because of Biden’s age — he would be 82 at the start of a second term — and her status as the first woman, Black person and person of South Asian descent to serve in her position.

Abortion has reshaped Harris’ tenure as vice president after earlier struggles when dealing with intractable issues like migration from Central America.

Jamal Simmons, a former communications director for Harris, said abortion “focused her attention and her office in a way that nothing had before.”

“Focusing on abortion rights tapped into the vice president’s legal background, her political values and her substantive knowledge in a way that I saw no other issue do while I was there,” he said.

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JEFFERSON CITY, Mo. (AP) — Reproductive rights activists in Missouri agree they want to get a ballot measure before voters this fall to roll back one of the strictest abortion bans in the country and ensure access. The sticking point is how far they should go.

The groups have been at odds over whether to include a provision that would allow the state to regulate abortions after the fetus is viable, a concession supporters of the language say will be needed to persuade voters in the conservative state.

It’s a divide that’s not limited to Missouri.

Advocates say the disagreements there and in other states where activists are planning abortion-rights measures this year have resurfaced long-brewing ruptures among reproductive rights advocates. The divisions are most acute in Republican-leaning or closely divided states, where some worry that failing to include limits related to viability will sink the measures.

The conflict has been especially sharp in Missouri, where dueling strategies have complicated efforts to push ahead with a ballot measure seeking to reinstate the right to abortion.

“The movement is grappling with its value system,” said Bonyen Lee-Gilmore, the Kansas City-based vice president of communications for the National Institute for Reproductive Health, which opposes viability clauses.

Viability is used by health care providers to describe whether a pregnancy is expected to continue developing normally or whether a fetus might survive outside the uterus. It’s generally considered to be around 23 or 24 weeks into pregnancy but has shifted downward with medical advances. The American College of Obstetricians and Gynecologists opposes viability language in legislation or regulations.

Some say it creates an arbitrary dividing line and stigmatizes abortions later in pregnancy, which are exceedingly rare and usually the result of serious complications, such as fetal anomalies, that put the life of the woman or fetus at risk.

The Supreme Court’s 1973 Roe v. Wade decision established a constitutional right to abortion but also created a framework that allowed states to regulate abortions at certain points during pregnancy. Since the current court overturned it in 2022, “Roe is the floor, not the ceiling” has become a rallying cry for activists who vowed to rebuild access, especially for marginalized communities, according to Pamela Merritt, executive director of Medical Students for Choice, a group that opposes viability clauses.

Yet measures proposed for this year’s ballot in Missouri, Florida and Arizona have been replicating Roe’s viability framework, as did an Ohio constitutional amendment guaranteeing the right to abortion that passed last year.

Shortly after that election, a Black Ohio woman who miscarried in her bathroom was charged with abuse of a corpse. The amendment’s viability clause was cited as justification for allowing the case to move forward, though a grand jury ultimately dismissed the case.

The charges are part of a larger effort by anti-abortion forces in Ohio to use the viability clause to limit the reach of the amendment, said Merritt. Many of these efforts will wind up in Ohio’s largely conservative court system, she added.

“When you hand them the scalpel, you can’t turn around and be surprised when they start cutting,” Merritt said.

In South Dakota, the local Planned Parenthood affiliate has pulled out of ballot measure efforts for a proposal that allows lawmakers to restrict abortion after the first trimester. In a statement, the group said the proposal fails to protect abortion rights.

In Oklahoma, viability has been central to conversations about a potential ballot measure to repeal the state’s abortion ban, said Rebecca Tong, co-executive director of Trust Women, which provides abortion care. Tong said viability is “not something we want written into the Constitution in Oklahoma.”

But Lauren Brenzel, campaign director for Floridians Protecting Freedom, said viability has not been a major focus in conversations around ballot measure language in a state that currently bans the procedure after six weeks of pregnancy. The campaign recently reached the necessary number of verified signatures to qualify an abortion-rights measure for this year’s ballot that includes a viability clause.

“Viability is the framework that Florida had used until the legislators started passing abortion bans,” Brenzel said. “What we know is that voters understand this, and we see it as clear and concise language that matches with what the standard was in Florida for a long time.”

Viability language in Florida’s proposed measure has already opened the door to a legal challenge from the state’s Republican attorney general, who has asked the state Supreme Court to keep the measure off the ballot because of vagueness over the meaning of the term.

A few states, including California and Vermont, have enshrined abortion rights in their constitutions without viability limits. Proposed amendments in Maryland and New York also don’t mention viability.

Missouri has found itself in the center of the national debate over the issue as abortion-rights groups have split over which of 11 versions of a measure to support for the ballot. The petitions have been tied up in court for months after being challenged by Republican Secretary of State Jay Ashcroft.

Complicating the effort is another initiative petition — one proposed by a Republican, strategist Jamie Corley. It would allow abortions up to 12 weeks into pregnancy and include exceptions for rape, incest or to protect the life of the mother until viability.

Corley said those restrictions are what’s feasible to pass in Missouri, where Republicans banned abortions except in medical emergencies.

“Pro-life, anti-abortion voters, a lot of them are still OK with legal but limited access,” Corley said.

Some reproductive rights groups advocating for versions of a more permissive ballot measure with a viability clause raised concerns that anti-abortion forces would attack proposals without one by saying it was an attempt to legalize abortion “up until birth” or “abortion on demand,” terms considered misleading by medical experts.

Sarah Standiford, national campaigns director of Planned Parenthood Action Fund, said reproductive rights groups must balance their desire for the most expansive access with proposals that can withstand legal challenges and qualify for the ballot.

She acknowledged that such an approach “may ultimately advance a policy that is far short of the ideal.”

Other activists say they’re increasingly frustrated by compromises they see as based on fear and repeating past mistakes in Roe v. Wade that prevented abortion access for the most vulnerable, including people with higher-risk pregnancies, those with lower incomes, people of color and people living in rural communities.

“It is a restriction under the guise of reproductive freedom,” said Jennifer Villavicencio, senior director of public affairs and advocacy at the Society of Family Planning.

In Missouri, it’s yet to be seen how and if activists divided over viability will come together. To many, there’s a sense of urgency to restore at least some rights.

“Real lives are on the line, and that has to be part of these political considerations,” said Mallory Schwarz, executive director of Abortion Action Missouri. “We have to consider both what is politically possible and also look at why that is possible in that moment.”

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Democratic governors in 20 states are launching a network intended to strengthen abortion access in the wake of the U.S. Supreme Court’s decision nixing a woman’s constitutional right to end a pregnancy and instead shifting regulatory powers over the procedure to state governments.

Organizers, led by California Gov. Gavin Newsom, described the Reproductive Freedom Alliance as a way for governors and their staffs to share best practices and affirm abortion rights for the approximately 170 million Americans who live in the consortium’s footprint — and even ensuring services for the remainder of U.S. residents who live in states with more restrictive laws.

“We can all coalesce,” New Mexico Gov. Michelle Lujan Grisham said in an interview ahead of a Tuesday announcement. She added that the court’s Dobbs decision that ended a national right to abortion “horrified” and put pressure on governors to act. “This is leveraging our strengths … to have more of a national voice.”

That includes, organizers said, sharing model statutory language and executive orders protecting abortion access, ways to protect abortion providers from prosecution, strategies to maximize federal financing for reproductive healthcare such as birth control, and support for manufacturers of abortion medication and contraceptives that face potential new restrictions from conservatives.

Lujan Grisham noted the launch comes as a federal court in Texas considers a challenge to the nationwide availability of medication abortion, which now accounts for the majority of abortions in the United States. In a statement, Newsom called the effort, which he and his aides spent months organizing, “a moral obligation” and a “firewall” to protect “fundamental rights.”

The group includes executives of heavily Democratic states such as California, where voters overwhelmingly approve of abortion rights, but also involves every presidential battleground state led by a Democrat, including Govs. Gretchen Whitmer of Michigan, Roy Cooper of North Carolina, Josh Shapiro of Pennsylvania and Tony Evers of Wisconsin. The alliance has secured its initial funding from the California Wellness Foundation and the Rosenberg Foundation, nonprofits that often steer money to public health efforts focused on disadvantaged communities.

While the organization is billed as national and nonpartisan, the makeup underscores that abortion access since Dobbs has settled essentially into two Americas that broadly track the platforms of the nation’s two major parties. That means greater access in states controlled by Democrats, tighter restrictions or practically outright bans in those controlled by Republicans. For example, 22 Democratic-run states have weighed in on the Texas challenge to medical abortions that was filed by many of the same litigant states that worked together to overturn the 1973 Roe vs. Wade ruling that legalized abortion nationwide.

A similar contingent of Republican-led states has filed briefs in the Texas case urging a judge to reverse a decades-old approval by the Food and Drug Administration of medical abortions. Still, Newsom aides said the group would welcome Republicans, though they declined to name any GOP executives that Newsom or other Democratic governors might be recruiting to the consortium. Indeed, a handful of Republican governors support abortion rights broadly.

Lujan Grisham mentioned New Hampshire Gov. Chris Sununu, who has sent mixed messages on the issue. Sununu signed a state budget in 2021 that included a ban on abortion after 24 weeks of pregnancy but also said after the Dobbs decision that abortion would remain legal in his state. He endorsed candidates in the November elections who favored further restrictions but also supports adding exemptions to the current law for victims of rape and incest.

Lujan Grisham acknowledged that the alliance cannot make national policy or even impose policy across state lines. But she said there’s practical value in having executives and their staffs have a formal framework to communicate. She noted that New Mexico lawmakers now are considering how to affirm abortion access with a statute, even though she and others believe the state’s constitution already establishes the right. “The problem is everyone keeps challenging those constitutional interpretations,” she said. “We’re going to codify equality on abortion rights, reproductive rights and care in as narrow as possible a way.”

New Mexico’s process, she said, could become a model for other similarly situated states. Governors’ offices in the alliance also have started working with advocacy groups that back abortion access. Jeanné Lewis, the interim chief executive of Faith in Public Life, a progressive multistate faith-based organization, said having states work together to ensure abortion access is essential as states and federal lawmakers continue to consider bans and deeper restrictions.

“It is important for governors to be in conversations now about shared solutions across state lines,” she said. Alexis McGill Johnson, president of Planned Parenthood Foundation of America, said states should be working together to protect abortion access, especially given the pending Texas case.

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Voters in battleground Michigan enshrined abortion rights in the state constitution, joining reliably Democratic California and Vermont in taking that step. An anti-abortion measure in Kentucky was too early to call. The Tuesday ballot measures came months after the Supreme Court overturned Roe v. Wade and the constitutional right to abortion it guaranteed to women nationwide. The decision in June has led to near-total bans in a dozen states.

Supporters of the push to protect abortion rights in Michigan collected more signatures than any other ballot initiative in state history to get it before the voters. It puts a definitive end to a 1931 ban on abortion that had been blocked in court but could have been revived. It also affirms the right to make pregnancy-related decisions about abortion and other reproductive services such as birth control without interference. On Michigan State University’s campus, junior Devin Roberts said that students seemed “fired up” and that he had seen lines of voters spilling out of the school’s polling places throughout the day.

The ballot measure was one of the main drivers of the high turnout, he said. “There’s a lot of energy for Prop 3 on campus right now, whether you agree with abortion or not,” Roberts said. “I think students want to have the same rights that their parents had when they were younger.” Nationally, about two-thirds of voters say abortion should be legal in most or all cases, according to AP VoteCast, an expansive survey of over 90,000 voters across the country. Only about 1 in 10 say abortion should be illegal in all cases.

About 6 in 10 also say the Supreme Court’s abortion decision made them dissatisfied or angry, compared with fewer who say they were happy or satisfied. James Miller, 66, of Flint, Michigan, said he thought of his daughters, granddaughters and great-granddaughters when he voted in favor of the measure. “I think we should do the right thing for women,” he said. “It’s her body; it’s her privacy.” Michelle Groesser, of Swartz Creek, Michigan, said she opposes abortion, even though she believes that any ban likely would have some narrow exceptions. “In a perfect world, I personally would want all life preserved,” she said.

Opponents have contended the Michigan measure could have far-reaching effects on other laws in the state, such as one requiring parental notification of an abortion for someone under age 18. Legal experts say changes to other laws would only happen if someone sued and won, a process that could take years and has no certainty of success.

Even so, the messaging appeared to resonate with some Michigan voters, including Brian Bauer, 64, of Mundy Township, who said the proposal was confusing and voted against it. Bauer is an abortion opponent who supports some limited exceptions, “but nobody’s willing to throw (in) any kind of compromise … it’s either a yes or no vote.” Montana voters, meanwhile, were also considering newborn resuscitative care requirements with possible criminal penalties, including the rare case of an attempted abortion. In deeply conservative Kentucky, the ballot measure would amend the state constitution to say there is no right to abortion.

The Republican-controlled Legislature has already passed a near-total ban on abortion. The measure would not change that, but the results could shadow the legal battle returning to a courtroom a week after Election Day. Lawmakers added the proposed amendment to the ballot last year, a move that some thought would drive more conservative voters to the polls. But after the Roe decision, abortion-rights supporters raised nearly $1.5 million to fight it. They were hoping to repeat the surprise outcome this summer in conservative Kansas, where voters overwhelmingly defeated a similar amendment that would have allowed new bans or restrictions.

Initial returns indicated that thousands of Kentucky voters who backed GOP Sen. Rand Paul for reelection opposed the abortion amendment. At a elementary school in Simpsonville, a small town outside of Louisville, 71-year-old voter Jim Stewart said he voted for Paul, calling him “the only one on TV making sense.” Stewart is a registered Republican and opposed to abortion, but still voted no on the amendment. “You got to have a little choice there.” Al Smith, 83, voted yes: “I don’t believe in abortion at all, not for any circumstance,” he said.

The reproductive-rights question in Vermont, came after Legislature passed a law in 2019 guaranteeing reproductive rights, including getting pregnant and having access to birth control. Supporters with the Reproductive Liberty Ballot Committee said the overturning of Roe meant “state-level protections are vital to safeguarding access to reproductive health care.” California already had passed several measures aimed at easing access to abortion and set aside millions of taxpayer dollars to help pay for some out-of-state abortion travel.

On Tuesday, voters approved language that would explicitly guarantee access to abortion and contraception in the state constitution. The question for Montana voters was whether to create criminal penalties for health care providers unless they do everything “medically appropriate and reasonable” to save the life of a baby after birth, including the rare possibility of birth after an attempted abortion.

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gov.ca.gov | Contributed

In November, California voters will have an opportunity to amend the state’s constitution to include the right to an abortion and Governor Gavin Newsom signed an executive order to further protect women coming to California from other states.

“California will not back down from the fight to protect abortion rights as more than half the states in this country, enabled by the Supreme Court, ban or severely restrict access,” said Governor Newsom. “We are ensuring Californians will have the opportunity this November to enshrine the right to choose in our state constitution. And we’re not waiting until November to take action, the executive order ensures that the state will not hand over patients who come here to receive care and will not extradite doctors who provide care to out-of-state patients here. In California, women will remain protected.”

The order signed prevents any information, including medical records and patient data, from being shared by state agencies or departments in response to inquiries or investigations brought by other states or individuals within those states looking to restrict access. The state is expanding efforts to protect women seeking abortions or reproductive care as well as anyone assisting those women.

SCA 10 was passed by the California State Assembly on June 27th and now heads to the November ballot.

Within hours of the U.S. Supreme Court’s decision to overturn Roe v. Wade last Friday, Governor Newsom signed legislation to help protect patients and providers in California from civil liability for providing, aiding, or receiving abortion care in the state. In addition, Governor Newsom and the governors of Oregon and Washington launched a new Multi-State Commitment to defend access to reproductive health care and protect patients and providers.

The budget agreement announced yesterday includes more than $200 million in additional funding for reproductive health care services. Governor Newsom recently signed legislation eliminating copays for abortion care services and has signed into law a legislative package to further strengthen access and protect patients and providers.

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MONTPELIER, Vt. (AP) — Early in the new year, the Vermont House of Representatives is due to begin debate on an amendment that would enshrine the right to abortion in the state constitution and send the question to voters in the fall.

Because the process began two years ago, it’s a coincidence that Vermont lawmakers will be considering the Reproductive Liberty Amendment while the U.S. Supreme Court is considering a case that could severely erode a right that has stood for half a century.

The pending decision in that case, expected in mid-2022, means it’s not just Vermont with abortion on the legislative agenda. State legislatures across the country will be responding to the possibility of seismic change to the 1973 Roe v. Wade ruling that legalized abortion across the U.S. Republican-led legislatures are ready to further restrict or ban abortions outright while Democratic-led ones are seeking to ensure access to abortion in their state law.

Supporters of the proposed Vermont amendment had the possible loss of Roe in mind when they began the process in 2019 to enshrine “reproductive autonomy,” including abortion, in the constitution.

“In my mind, there should be no question where Vermont stands with regard to its core values and fundamental rights,” said Democratic state Rep. Ann Pugh, who chairs the committee that will hold hearings on the proposal as early as January. “And for those rights and responsibilities and values to be protected more definitively, they need to be enshrined in our state constitution.”

A far different approach is being considered in Kansas. Republican state lawmakers have placed on the state’s August 2022 primary ballot a proposed constitutional amendment that would overturn a 2019 state Supreme Court decision. That ruling declared abortion access a “fundamental right” and part of a woman’s inherent right to bodily autonomy.

The amendment would say that the state constitution provides no right to abortion and that the Legislature can regulate it however lawmakers see fit — which means if Roe v. Wade is overturned, Kansas lawmakers could ban abortion completely.

In California, lawmakers are expected to consider a plan in the coming year to make the state a “sanctuary” for those seeking reproductive care. That could include paying for travel, lodging and procedures for people from other states where abortions have been restricted or perhaps outlawed.

“Abortion has always been contentious,” said Mary Hahn Beerworth, of the Vermont Right to Life Committee, which is opposing Vermont’s abortion-rights amendment. “In every state legislature across the country, in every political election, abortion rises to the top. It’s one of the most identifying issues of our time.”

At least 20 states, mostly across the South and Midwest, already have laws that would severely restrict or ban abortion if the high court overturns Roe and leaves the issue up to the states, according to the Guttmacher Institute, a reproductive rights think tank.

Earlier this year, Republican lawmakers in at least half a dozen states said they planned to introduce legislation modeled after a new Texas law that effectively bans abortion about six weeks after conception. The law is written in a way that is intended to circumvent the federal courts by leaving enforcement up to individuals rather than the state. They hope it provides a pathway to enacting the kind of abortion crackdown they have sought for years.

In Mississippi, Republican state Sen. Chris McDaniel said earlier this year he would “absolutely” consider filing legislation to match the Texas law after a sharply divided U.S. Supreme Court let that law stand, at least for now.

“I think most conservative states in the South will look at this inaction by the court and will see that as perhaps a chance to move on that issue,” he said.

More than a dozen states, plus the District of Columbia, have statutory protections in place for abortion rights, said Elizabeth Nash, a state policy analyst with the Guttmacher Institute. That includes Massachusetts, where the Democrats who control the legislature earlier this year approved a bill over the veto of Republican Gov. Charlie Baker codifying abortion rights into state law.

Yet even in California, which already has adopted several measures to protect abortion access, a pro-choice group laid out 45 steps that could be taken to further protect those rights.

“There is a lot of work to be done in order to shore up abortion rights and access,” Nash said.

Efforts to further restrict access are not just coming from more traditionally conservative parts of the country. The state budget New Hampshire Gov. Chris Sununu, a Republican, signed in June contains a provision prohibiting abortion after 24 weeks of gestation, with exceptions for the mother’s life or physical health. It takes effect Jan. 1, just before the start of the new legislation session.

And Republican lawmakers, who control New Hampshire’s legislature, are drafting several abortion-related bills, including one that would prohibit the procedure after the detection of a fetal heartbeat. Another would allow the biological father of an unborn child to seek a court order prohibiting a woman from having an abortion. A third would repeal the prohibition against remaining on a sidewalk adjacent to an abortion clinic.

Nash said a handful of states have interpreted their state constitutions as protecting abortion rights, but Democrats in Vermont want to be certain.

The proposed amendment does not contain the word “abortion.” Proponents say that’s because it is not meant to authorize only abortion, but also would guarantee other reproductive rights such as someone’s right to get pregnant or have access to birth control.

“There’s a lot of support for this in the legislature,” said Lucy Leriche of Planned Parenthood of Northern New England. “I think the reason seems pretty clear to me at the moment. We’ve had this right for almost a half a century to reproductive liberty, and people don’t want to see us go backwards.”

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