After the Supreme Court’s decision to overturn Roe v. Wade last Friday, Massachusetts legislators and health care leaders promised to protect reproductive rights in the state and expand services to meet out-of-state patients’ needs.
Organizations like the Planned Parenthood League of Massachusetts (PPLM) have pledged to grow capacity for in-clinic and telehealth services and are expecting an increase in patients.
“All told, we expect it’s going to be about 26 states and millions of people effected,” said Dr. Jennifer Childs-Roshak, PPLM’s president and CEO. “Those folks are going to have to go somewhere, if they can.”
Telehealth abortion care is a relatively new service offered by Planned Parenthood and a few other providers in Massachusetts. While telehealth from these providers expands access to abortion services for Bay Staters, the protections around providing out-of-state telehealth abortion care, particularly in states with restrictions on these rights, remains untested. Legislators on Beacon Hill are moving to expand protections to providers serving out-of-state patients, with the House passing sweeping legislation on Wednesday and the Senate expected to follow before the session ends a month from now.
“If legal, I would serve patients anywhere,” said Kristina Shepherd, a certified nurse midwife and telehealth abortion care provider in Massachusetts and Rhode Island. “If I could be protected legally, absolutely.”
Telehealth abortion-care rules still being defined
Late last year, the FDA permanently lifted a ban on receiving abortion pills by mail. Abortion pills were previously only available via certain health providers and needed to be picked up in person. This decision opened the door for people to have telehealth appointments with a certified provider and receive their pills in the mail.
The Planned Parenthood League of Massachusetts opened up general telehealth appoints in the spring of 2020 and began offering abortion medication via telehealth about a year ago, Childs-Roshak said.
“For the patients who are early enough in their pregnancy and are eligible for a medication abortion, and medication abortion without needing to have an ultrasound or lab work done, those are the folks that more recently we’ve been doing the entire visit through telehealth and then mailing them their medication,” Childs-Roshak said.
These telehealth appointments are a benefit to people who live far from abortion clinics, like residents on the Cape and Islands who are 100 or more miles away from providers, according to PPLM. Childs-Roshak said these virtual appointments also reduce the costs and logistics of traveling to a clinic, as well as providing more privacy for patients.
Services available in Massachusetts
While the term "telehealth" might lead some to believe anyone can access these virtual appointments, Childs-Roshak said this is not the case. Similar to how out-of-state patients would need to travel here for in-person services, Childs-Roshak said patients would also need to be in Massachusetts to access their telehealth services.
“We provide care in Massachusetts to Massachusetts patients,” Childs-Roshak said. “If someone is able to make it to Massachusetts that’s great, but currently that’s how we’re doing it.”
Shepherd offers telehealth abortion care through her company, Lilith Care. In addition to serving patients in Massachusetts and Rhode Island, she is also pursuing licenses in Hawaii and New York. She can legally only serve patients in states where she is a licensed provider.
“If you knowingly provide a prescription for abortion pills to a patient who lives in a state where it’s illegal…you’re violating the law as it stands currently,” Shepherd said.
Twenty-two states already have laws or constitutional amendments in place that will attempt to ban abortions, according to the Guttmacher Institute, and four additional states have political leanings that indicate they might follow the same path.
Shepherd said she would love to serve people in these states if she were protected in doing so.
“There may in future be some states where they’ve changed that regulation and restriction, and that enables a provider from New York, say, to prescribe abortion pills for someone living anywhere, and the state of New York may make a regulation that protects that provider from being extradited and prosecuted in another states,” Shepherd said.
Beacon Hill moves to protect providers
On the same day the Supreme Court released its decision to overturn Roe v. Wade, Gov. Charlie Baker signed an executive order to protect access to reproductive health care services in Massachusetts.
Elected officials are moving to secure those protections into law, with the House approving a wide-ranging reproductive rights bill Wednesday evening. The bill would codify access to reproductive health care and gender-affirming services as legally protected health care in Massachusetts.
It would also protect providers and out-of-state patients in Massachusetts through several provisions, like preventing state law enforcement from providing information related to an investigation into reproductive health care activities and prohibiting boards of registration of different health professions from disciplining a registration application of a person who engages in reproductive health care.
“Now, more than ever, it is the responsibility of leaders in Massachusetts to ensure that the commonwealth can serve as a sanctuary for women seeking reproductive health care, and for providers whose licenses could be at risk because of this recent Supreme Court decision,” House Speaker Ronald Mariano said in a statement.
A spokesperson for Mariano’s office said the protections in this bill for providers could also be relevant for telehealth care.
“A provider has to be licensed in the state where the patient is located at the time of the visit,” the spokesperson said in an email. “The intent is to cover telehealth visits and some providers may do this whether or not they are licensed in the patient’s state. That’s where the pieces on protecting Mass. licenses from professional discipline outside of Mass. is especially relevant.”
This bill will now move on to the Senate and then to Gov. Baker before its protections can be tested out in the world. While it moves through the state government, the evolving abortion care landscape also underscores the importance of traveling across state lines for abortion care and receiving support to do so.
Companies such as Fidelity Investments and Biogen have announced that their benefits will now include covering travel expenses to receive abortions. A slew of other companies have done the same.
“We are proud to live and work in a state where reproductive freedom remains protected by law, but also recognize that there are states where the fight for reproductive justice has just begun in earnest,” Biogen CEO Joe Boncore and chief operating officer and president Kendalle Burlin O'Connor said in a joint statement. “Reproductive justice and rights are fundamental for the life sciences workforce, our patients, and our loved ones.”
