Since the leaked draft of the U.S. Supreme Court abortion decision came out in May, people have been weighing the consequences for Washington, as well as for the rest of the country. Now, the decision is here: Roe v. Wade is overturned.

Where abortion protests are planned in Seattle and Washington

The Supreme Court, the decision by its conservative majority, ended constitutional protections for abortion that had stood for nearly a half century.

The outcome is expected to lead to abortion bans in roughly half the states in the U.S.

You might think there will be few ramifications in Washington, given state law ensuring abortion rights. But that’s not the case.

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State leaders seek constitutional amendment

Washington was the first state in the country to vote to legalize abortion, in 1970, although the protections were limited to the first few months of pregnancy and conditional upon a husband’s approval. A 1991 voter initiative went further, guaranteeing the right to abortion until the point of a fetus’s viability.

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That law will remain in effect, regardless of Friday’s ruling.

Still, political winds can change, and lawmakers or voters could conceivably pass a new state law restricting abortion. That’s why Gov. Jay Inslee and abortion-rights activists have called for a state constitutional amendment protecting abortion access in the absence of Roe. That’s a big lift, requiring a two-thirds majority in the state House and Senate and a popular vote.

“We are going to fight like hell,” Inslee said at a May rally.

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Influx of patients and providers expected

The Guttmacher Institute, a research organization focusing on reproductive rights, estimates Washington could see a 385% increase in abortion patients coming from states banning or severely restricting abortion in the wake of Roe.

Most notably, an Idaho law triggered by an end to Roe would make it a crime to perform an abortion. Another Idaho law, temporarily blocked in a case due to be argued before the Idaho Supreme Court in early August, would allow civil lawsuits against abortion providers.

Abortion patients from Texas, which has an even broader law allowing civil lawsuits, are already coming to Washington clinics, and an influx of out-of-state patients could strain clinic capacity.

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Abortion providers no longer able to practice in their home states could come to Washington, too. State Attorney General Bob Ferguson sent a letter in May to medical licensing organizations asking them to refrain from disqualifying providers who have been penalized in states that criminalize abortion.

The Washington Medical Commission and other regulatory bodies subsequently released a joint FAQ on abortion that remains vague on how they would handle such cases. “Washington does not discipline or refuse licensure based solely on the status of licensure or discipline in another state,” it reads.

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Backlash from out of state

As Washington joins the ranks of states offering a safe haven for abortion care, some are predicting a backlash involving lawsuits and attempted prosecutions by other states.

An Idaho prosecutor might accuse a woman who comes to Washington seeking an abortion, or the provider, of murder based on an Idaho law making the procedure illegal if Roe falls, according to Drexel University law professor David Cohen. Or, he said, someone could sue for wrongful death for helping a person get an abortion.

There are a lot of unknowns how this might play out. But Ferguson is worried enough that he has a team of more than 20 staffers looking at potential scenarios.

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“We’re not waiting around to start thinking about what a case might look like. We’re doing it right now,” Ferguson said.

Abortion providers are weighing the risks as well.

“We may be buried in legal action, both civil and from the hostile states themselves,” said Mercedes Sanchez, a spokesperson for Cedar River Clinics, which has several facilities in the Seattle area and a newly reopened one in Yakima.

“These lawsuits may result in financial burdens that could force clinics to close,” said Sanchez, who is also on the board of the Abortion Care Network of independent providers.

Providers and abortion-rights activists are pushing for new state laws that would obstruct or prevent such legal action. Some point to recently passed laws in Connecticut, Massachusetts and New York that enact a variety of safeguards, including preventing residents from having to cooperate with subpoenas and extraditions, and allowing them to countersue.

Washington’s anti-abortion activists step up activity

Local anti-abortion activists are hopeful they can capitalize on the Supreme Court decision to make headway in a state where they previously have had little traction.

Mark Miloscia, who recently stepped down from heading the Family Policy Institute of Washington to run for secretary of state, has expressed confidence that even Washington could ban abortion.

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“We have to change hearts and minds,” he said in May.

To mark the end of Roe, the national organization Students for Life is planning rallies at state capitols across the country, including in Washington, where the organization has 34 chapters. The rallies aim to highlight “an even more concentrated pro-life effort at the state level,” according to a media advisory.

Increasing use of abortion pills

In a post-Roe landscape, many patients are expected to turn to abortion pills, which can be discreetly mailed to their homes. Washington doctors may help.

One, Dr. Suzanne Poppema, is already working with an offshore online service that’s out of reach of American authorities. Patients hail from Texas and other states with abortion restrictions.

They have also come from Washington, where mergers have left an estimated 40% of hospital beds in religiously affiliated institutions. Many such hospitals will not perform abortions and have restrictions on care for spontaneous miscarriages as well, according to reports by the ACLU of Washington and the Rewire News Group.

In Eastern Washington, the relatively few providers have wait times as long as four weeks, according to Sanchez, of Cedar River Clinics. That and the expected surge in demand due to the Supreme Court decision led the organization in June to reopen its Yakima clinic, which it had closed for financial reasons in 2010.

Correction: A previous version of this story reported that Washington was the first state to legalize abortion in 1970, but now clarifies Washington was the first state to vote to legalize abortion. Hawaii legalized abortion months earlier in 1970.

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