Sometime in June, America is likely to shift.
The U.S. Supreme Court, shoved right by a focused Republican party, will almost assuredly issue a decision overturning or limiting Roe v. Wade, its 49-year-old decision to protect a pregnant woman's freedom to have an abortion.
Maryland will become, more than it already is, a sanctuary for women seeking to terminate a pregnancy. Today, they stream in from places like Georgia and the Carolinas, where laws restricting abortion exist.
Women in Maryland still will be able to end a pregnancy up to 20 weeks, or after that if the mother's life is at risk or if the fetus has severe health problems. And the state will continue to be one of 16 states that provide Medicare funding for those who cannot afford the procedure.
Thursday, thousands will return to be in Annapolis for the annual Maryland Right to Life March. Periodic picket lines will continue to show up outside the Planned Parenthood clinic on West Street.
This will all remain the same. So, what is going to change?
The case awaiting a ruling pits Jackson Women’s Health Organization against Mississippi, which wants to ban abortion after 15 weeks and asked the highest court to overturn Roe.
If the court rules as many predict it will, that stream of women seeking abortions at Maryland clinics will likely turn into a flood. People will flee the restrictions of 26 states expected to ban abortion outright.
Abortion in Maryland has not been much of a political issue for 20 years, since a 1992 referendum on a law protecting abortion access won approval by 60 percent of the vote.
A poll last fall by Goucher College found that 88% of Marylanders want to keep abortion legal though they are divided on whether that means legal in all or only some circumstances.
But in a post-Roe America, candidates for elected office will begin talking about how Maryland should respond. Advocates for both sides will seek changes.
There is little room for compromise on abortion. But if both sides can agree on one thing, it's that change is coming.
“We’re already seeing an influx in out-of-state patients coming in as a result of restrictions in other states,” said Lily M. Bolourian, executive director of Pro-Choice Maryland.
And although Maryland law offers some of the strongest abortion access protections, Bolourian expects that increase in demand to put more pressure on providers.
“Clinics here are stretched, stressed, and their resources are limited,” she said.
Bolourian predicted a crisis of access because of a dramatic increase in the number of people seeking it. Maryland will become an abortion sanctuary.
That's what's happening in California, another state where access is written into the law. Gov. Gavin Newsom has said he wants to be ready.
In a report he launched, abortion providers and advocacy groups have developed a list of 45 recommendations for the state to adopt in a post-Roe America.
According to the Associated Press, the report recommends funding — including public spending — to support patients seeking abortion for travel expenses such as gas, lodging, transportation, and child care. It asks lawmakers to reimburse abortion providers for services to those who can’t afford to pay — including those who travel to California from other states whose income is low enough that they would qualify for state-funded abortions under Medicaid if they lived there.
“I’m really impressed what Gov. Newsom has talked about doing in California,” Bolourian said.
Pro-Choice Maryland, which recently dropped its affiliation with the NARAL Pro-Choice America after a reorganization at the national level, will be looking for funding in the form of direct grants approved by the General Assembly.
“I would really love to see just direct funding in the form of unrestricted grants to groups like the Baltimore Abortion Fund,” Bolourian said.
The nonprofit fund offers small grants to both Maryland residents and anyone traveling from out of state to Maryland clinics or the DuPont clinic in Washington, D.C., who cannot afford the cost of their abortion care.
Additional funding should also go to clinics, which often struggle for funding because, Bolourian said, Medicaid undervalues abortion and makes it difficult to operate.
To push for this, Bolourian said providers and advocacy groups like hers are working to change the culture around abortion, reducing the stigma. They’re currently working with individual women who want to share their personal history.
“We have been speaking out about our abortion stories. One in three people have had an abortion,” Bolourian said.
She said there are many reasons to get an abortion, including some sad and ugly. Sometimes, though, women get an abortion just because they don’t want to be pregnant. Allowing that decision to be politicized plays into the conservative narrative by anti-abortion groups.
In addition to seeking funding and a climate change in the General Assembly, Bolourian said Pro-Choice Maryland will be looking at individual counties with deep support for abortion access, including Anne Arundel, Montgomery and Howard.
They plan to push individual elected officials to support abortion access publicly and with funding for nonprofit agencies. She knows it has been an issue many politicians want to avoid but sees that changing after the Supreme Court decision is announced.
If a reversal of Roe is announced in June, it will coincide with the primary elections in Maryland. She thinks that will increase the number of elected officials and candidates talking about the need for action.
“We really can’t trust the Supreme Court to do anything positive for our rights anymore,” she said.
Laura Bogley is a second-generation advocate of ending abortion rights in Maryland.
Sam Bogley, her father, was Gov. Harry Hughes’ first lieutenant governor. His promise to set aside his personal beliefs and remain silent on Hughes’ plans to expand abortion services to poor women put him in an awkward position.
His wife, Rita, was a leader of public opposition to the idea as it worked through the General Assembly.
Laura Bogley, a lobbyist for Maryland Life to Right, believes her father's legacy is remembered in the pro-life community.
“I still have people who come up to me who say I wouldn’t have my son or my daughter if not because of my father,” Bogley said.
It’s no surprise then that she'll be in Annapolis on Thursday, working to reverse abortion access. She says Maryland is a victim of “abortion radicalization.”
She sees it in state Medicaid policy and the women come to Maryland seeking a third-trimester abortion. She sees it in Democrats' focus on abortion rights as a part of their fundamental beliefs.
She’s realistic about the possibilities of changing that, saying that despite her family’s views, growing up in Maryland included some basic ideas on abortion.
“My generation, we were raised being told that it wasn’t a baby. That’s what we were told it was a lump of clay,” Bogley said.
“The only way we’re ever going to change this is if the state divests itself from this abortion indoctrination in schools.”
She sees "indoctrination" in sex education and how families are defined.
Bogley said a Supreme Court decision overturning Roe would return power to regulate abortion to the individual state legislatures, where she believes it belongs.
Before the Roe decision in 1973 decision, 46 states had bans on abortion. The remainder restricted it to instances where the mother's life was a risk.
“Abortion was listed as a crime against the person,” she said.
Bogley said a state legislature is the right forum, even as she rails against Maryland's lawmakers' support for abortion rights.
She is working on several pieces of legislation for this year that it calls “commonsense health and safety regulation for women and children.” She said most proposals deal with the ability of fetuses to feel pain, and viability outside the womb.
But she's realistic about the prospects. She said legislative leaders usually send bills that would restrict abortion to quiet deaths in committee, where they get a hearing but not a vote.
“They simply deny Maryland voters due process because they don’t allow a vote in committee or on the floor,” Bogley said. ““They’re suppressing pro-life speech.”
Bogley predicts that the issue of abortion will be part of the 2022 election campaign for governor and the General Assembly. She said there's a parallel in the success of Glenn Younkin in the Virginia campaign for governor last year, which focused on parents’ concern about schools.
And, she accuses Democrats of using “fear-mongering” over the possibility of change in Maryland because of a Roe reversal to help raise funds.
“They were fear-mongering over the Texas and Mississippi laws. They are aware that the right to abortion does not exist in the state or U.S. Constitution."
Protesters show up outside the Planned Parenthood of Maryland clinic in Annapolis like clockwork.
Up in Baltimore, the picket line forms daily. But in Annapolis, it’s more of a weekly affair. The signs go up, and the protestors walk back and forth on the sidewalk. They’ll be there on the day the Supreme Court announces its decision.
“I think we’re worried,” said Karen Nelson, president and CEO of Planned Parenthood of Maryland. “I think we’re worried about what’s going to happen, and we’re trying to prepare. And when you prepare, you prepare for worst-case scenario.”
Planned Parenthood is the largest provider of Title 10 services in Maryland, family planning programs. It also provides education on healthcare and human sexuality.
Its leaders saw the post-Roe scenario as far back as 2016 when the court struck down a Texas law that many observers thought might be the moment when a conservative majority would strike down the precedent.
“If Roe is overturned, if we lose … if the SCOTUS case goes the way we don’t want it to go … there are 26 states that have, where abortion access will be jeopardized,” Nelson said. “That covers 36 million women of reproductive health age. These 26 states could move to abandon abortion, and that puts these 36 million people at risk.”
In Maryland, that means preparing to be strong enough to serve the demand for abortion services in Maryland and people coming to Maryland. It means expanding the number of providers to nurse practitioners, ensuring there is training and that providers can get the financing they need.
“It’s important in a state like Maryland, we’re going to continue to provide abortion care after the Supreme Court decision,” Nelson said.
The demand already comes from across Maryland, where abortion services are concentrated in just a few counties.
“Two-thirds of our counties in our state of Maryland do not have an abortion provider,” Nelson said. “People in those counties are already having to travel for health care.”
But it also meeans being prepared to accept an influx of patients from other states.
“That’s something as providers we’ve been trying to do. We’ve been doing that by looking at our own operations, renovating and expanding our own locations in the last couple of years."
In Annapolis, that expansion was completed in early 2020. The $2 million project was designed to accommodate a 66% jump in the number of patients seeking treatment by this year.
During the first year of the covid pandemic, the effort to prepare included keeping the doors open.
“If every single thing we did was to ensure that we could keep our seven health centers going, our staff on board so we would not have to rebuild, we’re proud to say we’ve been able to do that,” Nelson said.
Nelson is a bit ambivalent about the idea of a Maryland constitutional amendment, something that's been proposed in the last few years. Instead, it might be more important to provide equitable access. That means not only making insurance coverage of abortion clear and free of co-pays but also making it more available to people without insurance.
“We have to be very practical about it.”
And, Nelson said, they're ready for increased activism from protestors and public figures who oppose abortion rights.
“Look, we know we are a target of people who want to see abortion banned. And we also have seen... that there are people who will do anything," Nelson said.
“We take every precaution to protect our patients and our staff.”
State Sen. Ed Reilly proudly says he's not afraid to talk about abortion.
“I’m the pro-life voice on the floor of the Senate.”
Although the Republican from Anne Arundel isn't sure which states have the strongest protections of abortion access, he doubts any have fewer restrictions than Maryland.
“I can tell you that Maryland has the most liberal abortion laws in the nation,” he said.
Reilly sees Maryland’s relatively liberal laws on abortion as making it a destination for abortion, particularly late-term abortions. He's right about that. Several Maryland clinics offer third-trimester abortions.
Reilly wants people to know more about Dr. Leroy Carhart, a Nebraska physician who commutes to his clinic in Bethesda to perform late-term abortions outlawed in his home state. He thinks if more members of the public knew about the procedures, public opinion would change.
While he calls Democratic leadership in Maryland as the driving force behind abortion laws and Medicaid funding, he admits that even the two post-Roe Republican governors have supported the $12 million to $14 million a year budgeted for abortions through Medicaid policies in Maryland.
“Twenty-three hundred abortions in Maryland a year are paid for by taxpayers,” he said.
Over the years, Reilly has supported legislation that would have restricted access based on the capability of fetuses to feel pain or on the age of the fetus. A bill by state Senate Minority Leader Bryan Simonaire would have required women seeking an abortion to see a sonogram image of the fetus.
None got a vote, only a hearing.
Reilly predicted that if the Supreme Court makes a ruling, it will be an election issue in Maryland, just not a real one. He expects pro-abortion rights legislators and candidates to rally around the issue.
“It won’t be a real issue because we’re abortion liberal. But the pro-abortion advocates will rally around that issue,” he said.
He admits work on changing the debate in Maryland has failed, even in the language used: "anti-abortion" and "abortion rights."
“The Democrats aren’t going to move off this issue,” he said.
He also said many Maryland Republicans won’t campaign on the issue, or as Reilly advises “don’t lead with their chins,” because of those overwhelming poll numbers. He's OK if they leave it to him.
“I’m not afraid to talk about it.”
A first-trimester abortion costs about $400. A second-trimester procedure averages $3,500, and the cost climbs into the tens of thousands for third-trimester abortions.
The Baltimore Abortion Fund is an all-volunteer, nonprofit organization that provides financial help to people who live in or travel to Maryland for abortion care. Working primarily through a confidential hotline, the fund offers small grants that cover the cost of the procedures and logistical needs such as travel and lodging. It also works to reduce community stigma for abortions.
Abortion funds have been around for decades, and the Baltimore Abortion Fund was started in 2014. It was supported by grassroots fundraising, gathering small donations from people, mainly in Maryland.
Today, the fund gets about 1,500 calls a year for help with abortion services but only has the funds to help about half those calls. Funding budgeted to last through the year often runs out by mid-week.
Abortion bans fundamentally target people of color and other people working to make ends meet. That’s reflected in who calls the fund for help.
“We do see a large number of people of color, people who are uninsured or on a state form of health insurance,” said Lynn McCann, director of development and communication at the Baltimore Abortion Fund
And, as other states have extended abortion restrictions or use of publicly funded insurance for abortions, that has been reflected in who is seeking help.
“We have seen a growth in out-of-state callers,” McCann said. “Right now, it’s just under half… the rest are Maryland residents … sometimes people in D.C. There are a lot of people from nearby states that have more restrictive abortion laws or abortion bans. That’s Pennsylvania, North Carolina, Georgia.
“We haven’t seen up until this point seen a huge influx of people from Texas and Mississippi, primarily because it’s logically difficult for them to come here.”
Many of those people head to California or Mexico for the procedures.
“We know there are ... states that are likely to ban or further restrict abortion. A lot of them are nearby. It will likely cause us to create a need for out-of-state travel for people … We probably will see an influx,” McCann said.
How much is unclear. “It’s hard to predict how much abortion funding will be needed.”
That could change in 2022 as Operation Scale Up comes into operation. The collaboration is a pilot project by the National Network of Abortion Funds that will combine resources of several different funds from Maryland to South Carolina, including the Baltimore Abortion Fund and the D.C. Abortion Fund.
The goal is to create a single point of contact for someone seeking abortion services, and through that, find access to funding, help with travel and the abortion itself.
“Right now, we’ve created a system where people need to call multiple sources of support ... It’s eliminating the need for that,” McCann said.
That is something she hopes Maryland can help with. Even with state Medicaid funding, there's a gap for people who aren’t enrolled in Medicare or don’t have insurance.
“We should have grant funding to fully meet the need for every procedure.”
The fund also works to destigmatize abortions. Various studies show that three or four out of every ten women have abortions before reach 45.
That includes having conversations about abortion rather than focusing on just the legality.
“I think something that’s not really common in this work is that we try to bring joy to how we talk about abortion and the work of the funding that we do,” McCann said. “There’s nothing that’s more joyful than being able to make the decision that is right for you, right for your body and your family.”