Massachusetts Beyond Roe
An Agenda for Abortion Access and Reproductive Equity
In June 2022, the United States Supreme Court confirmed our worst fears and completely overturned Roe v. Wade, the landmark case that once enshrined federal constitutional abortion protections. With this decision, more than half of states across the country quickly acted to ban or severely restrict abortion care, preventing millions of people from accessing critical, life-saving health care.
In response to the Supreme Court’s decision, policymakers in Massachusetts immediately took meaningful action to promote true reproductive freedom by passing An Act expanding protections for reproductive and gender-affirming care. This historic legislation advanced many critical reforms, safeguarding and improving abortion access in Massachusetts.
The 2022 law was a significant milestone; it was not the end of the important journey toward full reproductive justice. Barriers to reproductive health care still exist in Massachusetts, especially for low-income communities, communities of color, and immigrant communities, and our work continues to ensure access to the full spectrum of reproductive health care for every person.
Below are recommendations for future legislative action, budget investments, and regulatory solutions to achieve the short-term and long-term goals of the Beyond Roe Agenda:
1. Expand abortion and other reproductive health care access
THE PROBLEM
The ROE Act codifies the right to abortion into state law, ensuring it will remain legal in Massachusetts. But with the U.S. Supreme Court’s decision to overturn Roe v. Wade, Massachusetts must be prepared to handle the cascading impacts of hostile abortion bans across the nation, go further to remove barriers to abortion that still exist in our state, and ensure meaningful access for anyone who wants it.
THE SOLUTIONS
There are critical steps lawmakers can take to identify and break down barriers to abortion and other reproductive care:
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$2 million was invested in the FY2023 budget to support abortion access and funds in Massachusetts.
No person in Massachusetts should be turned away from care because they cannot afford it; policymakers must fill that gap by devoting state dollars to local abortion funds—the grassroots, community-based organizations with decades of experience making abortion care more affordable. Abortion funds provide financial and logistical support to people seeking reproductive care, including funding the cost of care itself, and the travel, child care, and accommodations necessary to access that care.
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The reproductive health care bill includes a provision to end cost-sharing for abortion care.
High out-of-pocket costs for reproductive health care put people in an impossible position: scrape together money, go into medical debt, or forgo basic health care. We must enact legislation that would require health insurance plans to cover all pregnancy care—including abortion, miscarriage management, prenatal care, childbirth, and postpartum care—without any kind of cost-sharing.
To learn more about this legislation, click here: (H.1196/S.673)
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While most insurers in Massachusetts cover abortion, it is difficult to assess the extent of coverage across the multitude of plans available in the marketplace. Currently, there is no law mandating insurance coverage of abortion or mandating that data be collected annually about the prevalence of abortion coverage. A blanket mandate on insurance coverage for all policies regulated by Massachusetts law, with appropriate religious exemptions, will offer clarity to patients in our state.
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Progress: Adopted as amendment to Senate Budget; must be negotiated in conference
Decisions about emergency contraception are time sensitive. Currently, people often pay out-of-pocket for over-the-counter emergency contraception, like Plan B One Step, regardless of its efficacy for them, to avoid the lengthy process of acquiring a prescription. Massachusetts lawmakers must implement a statewide standing order for both prescription and over-the-counter emergency contraception, making insurance coverage—without cost-sharing—possible for all forms of emergency contraception at the point of sale. Ultimately, lawmakers must ensure that every person can access the emergency contraception that’s right for them without delay.
To learn more about this legislation, click here: (H.2264)
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Thousands of college students in Massachusetts currently live in “access deserts” where the nearest abortion provider is multiple hours away via public transit. Massachusetts must enact legislation ensuring that public college and university students have access to medication abortion at their campus health centers.
For more information on this legislation, click here: (H.2399/S.1470)
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The ROE Act removed a major parental consent barrier for 16- and 17-year-olds seeking abortion care. But there’s more work to do: We must pass legislation to improve access to abortion care for all young people. Every person—regardless of age—must be able to access the timely reproductive health care they need without interference or delays from parental consent or judicial bypass.
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Though lack of transparency in hospital pricing is not unique to abortion care, there is a specific need to incentivize a discount cash price for later abortion procedures provided by hospitals and clinics. Wide variability in pricing makes it a challenge for patients, and the abortion funds that help them, to pay for later abortion care if they do not know the total cost of services up front.
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No pregnant person should be forced to travel out of state for later abortion care. Yet even after passage of the ROE Act, that has been the case for some people and families who receive a devastating diagnosis later in pregnancy. Massachusetts must ensure more comprehensive access to abortion later in pregnancy and full compliance with the ROE Act.
2. Support our providers and patients
THE PROBLEM
Some states are already considering laws that prohibit residents from traveling out of state for abortion care; other states are seeking to impose criminal, civil, and administrative liability on patients, providers, and those coordinating care. As anti-abortion states legislatures force pregnancy within their borders and attempt to chill access beyond their borders, Massachusetts must protect Bay State providers, patients, and helpers.
THE SOLUTIONS
We can't rely on other states to protect our providers; Massachusetts must do what we can to strengthen legal protections for abortion providers in our state. We need to do all we can to try to insulate Massachusetts providers from harmful consequences for providing care that is legal in Massachusetts. Protecting our providers also means equipping them with the tools to increase capacity and meet patient demand. Here are some of the steps that Massachusetts should take to support providers and patients:
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No one should be harassed, intimidated, or harmed for providing health care. But too often, abortion providers face threats and violence. Massachusetts should enact legislation to protect providers’ private information to the maximum extent possible.
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No one should be harassed, intimidated, or harmed for seeking health care. More and more of our lives are online: internet searches, visits to clinics, and apps leave digital traces. If care is outlawed in one state and a person travels to another state to obtain the care they need, their digital location trail can make them vulnerable to harassment and targeted litigation. Stronger digital privacy laws are needed to keep patients safe. As a first step, Massachusetts should prohibit the sale and trade of location data generated by cell phones and personal devices to help prevent their use to track or monitor patients.
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Massachusetts must take steps to protect providers’ professional licenses from any negative impacts of being sued by a resident of a state where abortion is illegal for providing legal abortion care in the Commonwealth.
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Malpractice insurance is critical to the practice of medicine. Massachusetts must take steps to keep malpractice insurance within reach for providers when they face out-of-state civil lawsuits for providing lawful abortion care in Massachusetts.
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As Roe falls, our clinics will need financial assistance to ensure they have the proper infrastructure and capacity to meet increased demand. State funds must be allocated to invest in security enhancements, boost staffing, and acquire the technology needed to facilitate telehealth services.
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MassHealth reimbursement rates are low—often far below the cost of care—for both abortion care and for family planning and preventative care offered at sexual and reproductive health care clinics. These rates must be increased to ensure providers are properly reimbursed for critical care provided to low-income patients. Furthermore, telehealth services for abortion care are increasingly popular, and we must ensure that future regulations do not disincentivize telehealth by reimbursing at a lower rate than in-person care.
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Massachusetts providers should not be forcibly sent to another state based on the lawful practice of medicine in Massachusetts. To take steps against this outcome, we must modify our extradition statutes to prohibit the extradition of Massachusetts providers who lawfully provide abortion care in Massachusetts to a resident of a different state where the procedure is illegal.
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We need to deter people from bringing lawsuits in hostile states seeking to impose civil liability on Massachusetts providers for the lawful practice of medicine in the Commonwealth. To that end, Massachusetts providers who could be subject to civil lawsuits by people in other states for providing lawful abortion care in Massachusetts should have a civil remedy to recover the damages assessed in these harmful lawsuits.
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The right to access reproductive health services is core to the public policy of the Commonwealth. We must pass legislation that prevents Massachusetts courts from being used as a venue for hostile-state claims seeking liability for the provision of lawful abortion care in the Commonwealth.
3. Increase research and education efforts
THE PROBLEM
With nearly half of U.S. states working to ban or restrict abortion, our country is facing an unprecedented health care crisis. In order to respond comprehensively and effectively, we need to understand the size and scope of the problem we are facing.
We must also ensure that pregnant people in Massachusetts have clear, comprehensive, and up-to-date information on where to access legitimate reproductive health care. Crisis pregnancy centers, or CPCs, pose as legitimate health care facilities, but in fact are unlicensed centers that do not provide abortion care and have an anti-abortion agenda. They often pop up near legitimate clinics to deceive pregnant people seeking to access real abortion care. In Massachusetts, CPCs outnumber legitimate abortion clinics three to one.
THE SOLUTIONS
This is the moment to launch a massive research and education effort in the Commonwealth and ensure our state has the resources to respond to existing and growing health care needs. Here are steps Massachusetts can take to increase and improve care across the state:
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Research and data collection are needed to determine the state of abortion access in Massachusetts and identify remaining barriers to care. In particular, understanding the demand for abortion care by geographic location, income, age, and insurance status can help us better address existing gaps in services and access. Investing in the capacity of the Department of Public Health to understand the contours of abortion access, barriers to care, and provider needs is critical to securing access.
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In order to address unmet health needs, Massachusetts must expand and diversify its abortion provider workforce, including through incentives to train new providers and streamline the integration of medication abortion into primary care.
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While ensuring equitable access to reproductive health care, Massachusetts should require medically accurate, inclusive, and comprehensive sexual health education in our public schools to help young people make healthy decisions about their futures. Comprehensive sex education gives young people the tools to build healthy relationships, learn the benefits of delaying sex, as well as how to prevent STIs and pregnancy when they become sexually active.
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Abortion will be legal in Massachusetts even if Roe is overturned, and it is critical that people in all our communities understand the status of abortion access in our state, the availability of local abortion funds, how to navigate care, and how to avoid CPCs. We must increase our public education efforts on the danger of CPCs and highlight where they exist in our communities. For example, tools like Reproductive Equity Now’s New England Abortion Care Guide allow users to search by zip code for the nearest legitimate abortion provider, and flags dangerous CPCs in their area.
Is your organization interested in joining the Beyond Roe Coalition?
The Beyond Roe Coalition is in the process of building an advocacy structure. We are open to and invite all organizations who agree to support the full Beyond Roe Agenda as presented above to join. Please sign up to become part of this movement and receive information and updates as we continue to discuss and build the advocacy campaign.