On Friday, U.S. District Judge Myron Thompson temporarily blocked a portion of Alabama's TRAP (Targeted Regulation of Abortion Providers) bill from taking effect until July 12. Regularly scheduled to take effect on July 1, the provision covered by the judge's ruling would require that physicians performing abortions in the state have admitting privileges to local hospitals. While it is likely that this provision will be overturned, other provisions of HB 57 have the potential to close clinics and increase the cost of abortion procedures for patients.
The lawsuit, filed on June 11 by Planned Parenthood Southeast and Reproductive Health Services (a privately-owned clinic in Montgomery), claims that the provision of HB 57 that requires physicians who perform abortions to have hospital admitting privileges would create an undue burden on people seeking legal abortion services. Because many abortion providers do not live in the communities (or even the states) in which they work, it can be difficult for them to receive admitting privileges from hospitals in those communities. Furthermore, the stigma of providing abortions would also prevent many local physicians from being granted admitting privileges.
Though many state lawmakers have said that HB 57 is intended to increase the safety of abortion services, there is no evidence to suggest that legal abortions performed in Alabama require additional regulation. Nationwide, only 0.3% of all abortions result in complications that require hospitalization. Alabama's rates are lower.
"We're an extremely low-risk facility," Dalton Johnson, the owner and operator of Huntsville’s Alabama Women’s Center for Reproductive Alternatives, said of his own clinic. "Our safety record shows that. Fifteen thousand procedures in 12 years and only six complications and no fatalities. There are procedures with higher risks they need to look into."
While Judge Thompson believes that the admitting privileges requirement of the law will likely be overturned, HB 57's requirement that clinics make the necessary upgrades to meet the state's regulatory standards for ambulatory surgical centers could still close clinics and, at the very least, decrease or eliminate abortion access for those with little or no income.
"It requires clinics to be like a miniature hospital. It's going to pretty much probably close us down," Johnson said. "I'm letting my staff know that it's a possibility."
The financial burden to transition into an ambulatory surgical center will disproportionately affect privately owned clinics. Gloria Gray, the operator and part-owner of Tuscaloosa's West Alabama Women's Center, said, "It is much more difficult for an independent clinic to meet the requirements of the law or to challenge the law due to limited financial resources." While nonprofit organizations like Planned Parenthood have "their own attorneys on staff who are able to challenge the law and numerous resources available in donations and federal funds," privately owned clinics have a much more difficult time fundraising to pay legal fees to challenge the law or become compliant with newly imposed regulations.
Because of the stigma attached to providing abortion services, some privately owned clinics are also having difficulty finding architects and contractors that will agree to work with them on making the mandated upgrades, and, even when people can be hired, privately owned clinics must be able to pay for these services using their own financial resources.
Coming up with the money to meet Alabama’s regulatory standards for ambulatory surgical centers will ultimately come out of the pockets of patients, but it’s not clear as to whether patients will be able to afford the high cost of procedures in these “safer” clinics.
Currently, the average cost of a medical abortion (RU 486, Mifepristone, Mifeprex) is $450 in Alabama and is effective for terminating pregnancies up to eight weeks. The cheapest surgical abortions can be performed from about 5-11 weeks into the pregnancy and cost, on average, $400. However, surgical abortion patients can expect to add at least $100 to the cost of the procedure for every additional week after 11 weeks.
While service fees at the West Alabama Women’s Center will not increase as a result of the mandated upgrades, patients at the Alabama Women’s Center for Reproductive Alternatives will most definitely face fee increases if the clinic can remain open. Rightly, Johnson worries that the patients affected most by HB 57 will be those low-income and no-income patients who come from outside Alabama to obtain abortion services.
“We have people who ride the bus to get here,” Johnson said. “They come from places like Mississippi, where there’s only one clinic, and they take the bus to Huntsville and get a cab from the bus station to the clinic. Then they have to get a hotel room, because they have to wait at least 24 hours to have the procedure done.”
In addition to overturning the requirement that abortion providers have local hospital admitting privileges, the federal court should recognize that the increased cost of abortion services that results from TRAP legislation places an undue financial burden on those who seek to exercise their right to terminate a pregnancy.