Decompiling Oppression #115
Sam McVeety
Two years after Dobbs, threats to reproductive care are spiraling into consequences that affect entire health systems. In Idaho, an exodus of health care workers is reducing overall standards of care (particularly for those already on the margins). Here in Washington, potential hospital mergers and acquisitions threaten the number of abortion providers in Washington. Claiming religious exemptions, merged hospitals might discontinue care, cutting off entire areas of the state from accessible reproductive care.
Despite efforts from leaders like Senator Emily Randall, the proposed Keep Our Care Act died in the state senate. In places like Washington, it can be easy to miss how tenuous care is, in part because of an implicit tendency to sort states into "good" and "bad" places for reproductive care. Washington is better, certainly, than neighboring Idaho, but also a place where constant vigilance is needed, particularly when powerful interests (like multibillion dollar hospitals) are involved.
In response to the national crisis, Washington did pass a shield law, aimed at protecting travelers from other states who are accessing care in Washington. (It's worth repeating here that this is not an accessible solution for the vast majority of birthing people, for whom out of state travel is infeasible for a variety of reasons.) It's a small step (along with storing location history on-device in a legal landscape with sweeping geofence warrants), but by no means a comprehensive solution.
Lest our strategy focus entirely on defense, states like Washington are also an opportunity to push forward on what a true vision of reproductive justice would look like. Through extensive organizing efforts from groups like Surge Reproductive Justice, the state passed a Doulas for All bill that paves the way for Medicaid reimbursement for doula care, providing better compensation and structural support for culturally responsive reproductive care.
Over in Idaho, the situation is dire. After passing a pre-Dobbs trigger law in 2020, Idaho is now enforcing one of the strongest abortion bans in the country. There are now both criminal and civil penalties in Idaho law, which combine to make the situation particularly hostile to health care workers. The criminal penalties are perhaps more obvious in their effect: providers risk fines and jail time based on whether the state decides to pursue a case.
The civil penalties are more pernicious and subtle, though. In a revision modeled after Texas's SB 8, Idaho law allows relatives of a couple that has conceived to pursue a private right of action against health care workers. The upshot of this is that it is very difficult to establish a sort of medical "safe harbor" that allows for providers to unambiguously do their jobs, absent ironclad contracts with an entire extended family that they won't sue. This means that health care workers (already facing life-or-death choices) must also weigh whether they might be sued into poverty and/or sent to jail.
Meanwhile, a couple of cases are winding through the courts. In FDA v. Alliance for Hippocratic Medicine (the mifepristone case), lest we be tempted to read any kind of moderation into the unanimous ruling, the critical detail here is that the Court ruled on standing, rather than the merits of the case. In other words, the ruling says nothing about the Court's opinion on access to mifepristone with respect to Dobbs, it only says that there isn't a cognizable harm to the set of anti-abortion doctors who were claiming that providing access to the drug was harmful to their interests.
For Idaho specifically, we have both Idaho v. United States (with a decision due out any day) and Adkins v. Idaho, which is still in the lower courts. The first case deals with a federal law about emergency care, with the federal government asserting that Idaho's ban on reproductive care violates that law. The second case has actual plaintiffs who have been affected by the law. Even if the Court ends up limiting the Idaho law, the slow speed at which these cases are moving through the courts underscores the tremendous amount of harm that can happen when laws like these are allowed to take effect.
Here are this week's invitations:
Personal: What aspects of health care do you take for granted? Which do you express gratitude for?
Communal: How can we reduce barriers and make care accessible to everyone?
Solidarity: Support Surge Reproductive Justice and their work to build a world where all people can make powerful, self-determined choices for their bodies and the future of their families and communities.
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