SALT LAKE CITY — Republican Utah Gov. Spencer Cox signed legislation Wednesday that will ban clinics from providing abortions until next year, prompting a rush of confusion among clinics, hospitals and prospective patients in the deeply Republican state.
Hospital and clinic administrators have not made public their plans to adapt to the new law, adding a layer of uncertainty on top of fears that if the clinics are closed, patients may not be able to access the hospitals due to staffing diversity and cost concerns .
With the law set to take effect May 3, both the Utah Planned Parenthood Association and the Utah Hospital Association declined to elaborate on how the increasingly crowded legal landscape for providers in Utah will affect abortion access.
The upheaval mirrors developments in Republican strongholds across the United States since the U.S. Supreme Court overturned Roe v. Wade, changing the legal landscape and sparking a spate of lawsuits in at least 21 states.
Utah lawmakers have previously said the law would protect the “innocent” and the “unborn,” adding that they don’t believe the state needs abortion clinics after the high court overturned the constitutional right to abortion.
Although Planned Parenthood has previously warned that the law could dramatically hamper its ability to provide abortions, Jason Stevenson, the association’s lobbyist, said Wednesday that it will now further examine the wording of other provisions of the law that would could allow clinics to apply for new licenses for nursing – equivalent services.
Based on Planned Parenthood’s interpretation, he said in an interview, the clinics would no longer be able to provide abortions with their current licenses. They plan to continue, however, to provide the majority of their services, such as sexually transmitted diseases and pregnancy tests and cancer screenings. Stevenson said they were “carefully considering” the licensing options in the law, but did not say whether the clinics would apply at that point.
Jill Vicory, spokeswoman for the Utah Hospital Association, said in an email that it is “too early to comment” on whether hospitals could soon be the only abortion providers in Utah, noting that each “will have to decide on the how will he choose to move.”
If the clinics stop providing abortions, experts worry that the comparatively higher cost of care and hospital staffing shortages will make it harder to obtain legal abortions in Utah, even though the law does not specifically limit those seeking them in the state, where it remains legal until 18 weeks.
Dr. Carole Joffe, a professor at the University of California, San Francisco who has written about the social impact of reproductive health, said removing licenses from clinics would upend the way abortions have been provided for decades. Historically, patients with low-complication pregnancies have mostly received abortions at outpatient clinics, which on average are able to provide them at a lower cost.
“Everything in a hospital is more expensive than in a clinic. Doing an abortion in a hospital, you need more staff,” he said, noting that hospitals, with teams of anesthesiologists, doctors and surgeons, have historically provided them in emergency scenarios.
Another challenge facing already overburdened hospitals is staffing, Joffe said, both in recruiting and staffing abortion providers. Especially in states where anti-abortion sentiment is strong, many doctors or hospital nurses may be reluctant to provide them, he added.
“You have to draw from a reservoir that may or may not be sympathetic to abortion, as opposed to a clinic where you don’t go to work unless you have a commitment that abortion is part of health care,” Joffe said.
Abortion advocates say the confusion stems from vague language about the license removal process. The law bars clinics from obtaining new licenses after May 2 and sets up a full ban on Jan. 1, 2024. But advocates are concerned about a separate provision in the 1,446-line bill that specifies under state law that abortions can only be performed in hospitals.
Clinic-focused legislation has also raised questions about what kinds of facilities are best equipped to provide specialized care to patients regardless of socioeconomic status or location.
If clinics stop providing abortions — as early as May or until the end of next year — it could reroute thousands of patients to hospitals and force administrators to devise new policies on elective abortions. To do so would require them to expand their services beyond the emergency procedures they previously provided, prompting questions about the shift’s impact on capacity, staffing, waiting lists and costs. About 2,800 abortions were performed in Utah last year.
The Utah Hospital Association said no hospitals provided elective abortions in the state last year.
The new restrictions are more likely to affect those seeking to terminate pregnancies through medication, which accounts for the majority of abortions in Utah and the United States. Abortion medication is approved up to 10 weeks of pregnancy, mostly prescribed in clinics, and after the FDA’s pandemic-era rule change, increasingly offered via telemedicine.
The new law takes on added significance amid a legal vacuum surrounding other abortion laws signed into law in Utah.
Last year’s Supreme Court decision led to two previously approved pieces of legislation – a ban on abortion in 2019 after 18 weeks and a ban on abortion in 2020 regardless of trimester, with several exceptions such as cases of risk to maternal health as well as rape or incest reported to the police. Planned Parenthood of Utah sued over the 2020 ban, and in July, a state court delayed its implementation until legal challenges were resolved. The 18-week ban has since been de facto law.
Abortion access advocates decried this year’s clinic ban as a back door used by anti-abortion lawmakers to limit access while the courts deliberate. If abortions were restricted regardless of trimester to exceptional circumstances, the closure would have a less wide-ranging impact on patients seeking elective abortions between zero and 18 weeks of pregnancy.
The law also clarifies the definition of abortion to address legal liability concerns providers have raised about how the exemptions are worded in state law — a provision the governor and Republican lawmakers called a compromise.