Abortion bans have shaken up the U.S. healthcare system, influencing how pregnant people receive maternity care, how providers are allowed to practice in the emergency room and how professionals are allowed to practice medicine.

A report published today by the office of Sen. Maria Cantwell, Majority Leader Charles E. Schumer and 14 women Democratic senators sought to expand the scope of Cantwell’s report of the impact of Dobbs on Washington state. Taking a national approach, researchers and interviewers dug deeper into the nationwide impact of abortion bans in the two years after the Dobbs decision, finding that abortion restrictions have hindered medical care, the future of health providers, and the U.S. reproductive health care system, even in states where abortion is legal.

Since Roe was overturned, abortion had remained a topic of debate at the local and national level. According to KFF, there are currently five states confirmed to have abortion measures on the ballot in November, with many voters expected to be mobilized by the issue as they cast their vote in the 2024 election.

In a bid for reelection, the Biden-Harris administration is running heavily on a promise to restore the protections lost when Roe was overturned, but has been critiqued by abortion advocates of a lackluster campaign missing important elements, such as refraining from using the word “abortion.”

Nonetheless, Democrats are banking on abortion to win against Trump who says he will not support a federal abortion ban, and will continue to leave the issue up to individual states if he is elected.

“It is now clear that this decision has strained our healthcare system and forced women to travel across state lines to get essential care, putting them in heart-breaking and devastating situations,” Leader Schumer said in a press release. “Senate Republicans have shown that they are beholden to the extremists in their party – even as the American people continue to voice support for reproductive freedoms. Senate Democrats will fight as long as it takes to restore this most vital of protections.”

According to the report, some pregnant women are opting to travel to protective states even when they don’t need care, to ensure they can receive the full range of medical options in the event that they do.

“There are families with highly desired pregnancies and who have resources and say hey, at 20 weeks of pregnancy, because I can’t get the care I need in my own state if I face an emergency, I’m going to go and live somewhere else for a few months so that I may stay safe,” Dr. Sara Kennedy at Planned Parenthood Columbia Willamette told Sen. Cantwell’s staff.

The reality is that most Americans could not afford this option if they wanted to. According to a 2024 report by financial services company Empower, 37% of Americans can’t afford an unexpected expense over $400 and a similar poll by Bankrate found that 44% would not be able to afford an unexpected $1,000 expense. Most families and people who need abortions are left to navigate the U.S. abortion landscape and face the impacts of abortion restrictions head on, including traveling and finding care where there are limited resources available.

Abortion travel causing long wait times

The report sheds light on the reality of navigating abortion travel. Abortion seekers fleeing to neighboring states where abortion is legal has become a norm, with Guttmacher estimating that 171,000 individuals traveled out-of-state for abortion last year. This has driven the wait time to receive care in protective states up.

Illinois, which has become a hub in the Midwest for out-of-state abortion seekers, experienced a 49% spike in out-of-state patients, 17,000 people, the year Roe fell, reported the Chicago Tribune.

“Prior to Dobbs, you could get an abortion appointment within 24 hours. And that is still the case in some regions. But now in places like Kansas and Illinois, those clinics are booking three weeks out, and that can really play havoc with people’s lives,” Alison Dreith, director of strategic partnerships at the Midwest Access Fund.

Because of longer wait times due to an influx of patients from the South, people who live in protective states now have to travel too, Alisha Dingus, DC Abortion Fund’s director of development told researchers.

“Now our people in DC are having to go up for their appointments. We’re having to send people to other clinics in Maryland, sometimes all the way to Pennsylvania,” said Dingus.

According to the report, traveling to the nearest state isn’t always the best option for abortion patients. Appointments are booked weeks in advance but some patients, specifically those who find out they are pregnant later in term or who are facing urgent medical situations do not have the ability to wait, causing more and more patients to fly further rather than drive to a nearby state.

This causes cities with more flight options to fill up more quickly. In Ohio, Jubilee Fund reported that because Cincinnati and Cleveland are easiest to reach by air, appointments in those cities are in higher demand, especially after Florida’s six week ban went into effect in May. In Nevada, Las Vegas has received a large number of Texas abortion seekers even though it is an 11-hour drive away.

This is placing an additional burden on low-income patients who cannot afford flight costs and causing confusion or those who have never flown before.

“Part of this impact that’s not talked about enough is the individuals who don’t have the resources to make a call, buy a plane ticket, get to a safe state, and potentially pay out-of-pocket for care. We don’t talk enough about the ones who are left behind; those desperate individuals who don’t have gas money, resources, and the ability to pay in another state to get the services that they need,” said Nicole Barnett at Planned Parenthood Northern California.

Restrictive states are losing healthcare workers

Doctors and providers, including emergency room personnel, anesthesiologists and medical students are fleeing states with abortion bans for fear of the repercussions of performing abortions, even when it’s a life-saving procedure.

Idaho was one of the first states to ban abortion when a 2020 “trigger” law was enacted once Roe fell.  A report by the Idaho Coalition for Safe Healthcare found that the state lost 22% of its practicing obstetricians in the 15 months following the decision.

“I know how to manage the stress of managing a high-stakes medical emergency. I don’t know how to manage the stress of legal ambiguity that has massive implications in terms of my medical license, felony charges, the potential for every family member to sue me for a minimum of $20,000,” said Dr. Amelia Huntsberger, an Idaho OB-GYN who left the state in 2023 to practice in Oregon, abortion is not restricted by gestational limit and shield laws protect practitioners from investigations by other states.

The loss of staff has also caused the loss of maternity wards due to an inability to recruit. Four have closed in Idaho, including Steele Memorial Medical Center, which paused labor and delivery services after their longtime doctor retired, forcing many expectant mothers to travel 168 miles away to Idaho Falls to give birth, the Idaho Capital Sun reported in April.

“You can’t have your baby there, you can’t get a hysterectomy, you can’t get hormone replacement therapy for hot flashes, you can’t get surgery for incontinence, you can’t get treatment for abnormal uterine bleeding or fibroids … nobody’s there to provide those services anymore,” Hunstberger said.

Doctors in Oklahoma, where abortion is illegal, shared a similar sentiment. A poll by Oklahoma’s American College of Obstetricians and Gynecologists local chapter found that 76% of practitioners thought about leaving the state to practice elsewhere or wanted to leave but couldn’t, and 75% felt that fear of the consequences of following best-practice protocol prevented them from doing so.

Practitioners face further repercussions in states like Texas which require them to provide patient data and report conditions their patients have that could be linked to a past abortion, even if the past abortion is not relevant to the treatment or condition the patient is currently facing.

“If you violate Texas reporting requirements more than a few times, you can get your medical license taken away. And that is – if it gets taken away in one state, you have to report that to other states and that could be the end of your career,” said Dr. Alison Haddock,American College of Emergency Physicians president-elect.

Medical institutions are also finding it extremely difficult to recruit new OB-GYNS and fill positions of those who’ve left restrictive states. As medical providers flee, aspiring doctors and medical students are opting to study and establish residency elsewhere.

A 2023 survey of OB-GYN residents found that over 17% changed their mind about where they wanted to practice due to the Dobbs decision. A March 2023 Texas Observer report illustrated the difficulty in studying in Texas, where residents must travel out of state to learn abortion procedures because of the ban.

Many med students are choosing instead to pursue opportunities in states which allow them to practice their full scope of medicine. Washington State University College of Medicine graduate Carmen Abbe told Sen. Cantwell’s staff that she seriously considered completing her residency in Idaho but decided otherwise due to the educational barriers she would face.

“They told me: We want you to learn abortion care because we think it’s medically important. But you can’t do that in our state,” she said.