In the face of looming threats to legal abortion in the United States, lawmakers and activists in left-leaning “blue” states are working to expand rights and access to the procedure.

State-level efforts to protect abortion rights and reduce the cost of obtaining the procedure in states such as California, Rhode Island and Vermont are, in large part, a response to a upcoming Supreme Court decision that could overturn nationwide abortion rights.

The landmark 1973 Supreme Court decision in Roe v Wade guaranteed pregnant women the constitutional right to obtain an abortion, invalidating dozens of state abortion bans that were in effect at the time. However, many states have never passed their own laws affirming the right to abortion.

Now, the newly conservative U.S. Supreme Court appears willing to strike down abortion rights as it prepares to rule on a new case, called Dobbs v Jackson Women’s Health Organization. A decision in this case is expected in June.

If the court overturns Roe v. Wade, it could send the abortion issue back to the states, many of which have not updated their laws in decades or are actively hostile to abortion and ready to enforce bans or severe restrictions.

In the event the US Supreme Court overturns Roe v Wade, 26 states would be certain or likely to ban abortion, while only 15 states and Washington DC have laws to protect the right to abortion.

“Conservative lawmakers clearly feel they have the legal backing to continue to pass abortion bans and restrictions,” said Elizabeth Nash, acting deputy director of state affairs at the Guttmacher Institute, a research center on reproductive rights. Nash said the researchers see “a real trend around abortion bans, including full and early bans.”

“Part of the problem is that we just have fewer progressive state legislatures than conservative ones,” Nash said. However, she is optimistic about efforts to affirm abortion rights and expand access in progressive states.

“Over the past few years, we’ve seen more action in state legislatures to protect abortion rights than ever before,” she said. “We’re looking at 2019 — you had states from Illinois to Maine to Vermont to Rhode Island all looking to add statutory protections,” for abortion rights, a momentum that continued then that the threats against Roe against Wade have multiplied.

Right-wing lawmakers have long used abortion to rally their base, while Roe’s protections against Wade meant abortion was often ranked as a low priority for left-leaning voters. As a result, abortion rights legislation languished for decades, even as right-wing politicians enacted hundreds of restrictions.

Recent congressional efforts to codify abortion rights into law have failed in the face of Republican opposition. Although the Democratic-led House of Representatives passed the Women’s Health Protection Act last year, which would have banned medically unnecessary restrictions on the procedure, the bill died in the Senate this week.

The bill required 60 votes to overcome a filibuster. Democrats hold 50 seats and Republicans have universally opposed the measure. They were joined by a Democrat, Senator Joe Manchin of West Virginia.

“We should have codified Roe into state law across the country,” said Liana Cassar, a Democratic state representative in Rhode Island. “But there was a belief that we weren’t at risk – we weren’t at risk of losing access to abortion.”

That has changed since Donald Trump was able to confirm three Supreme Court justices, swinging the nine-member bench firmly to the right.

Now, lawmakers on the left are seeking to push through more abortion protections. New Jersey became the first state in the country to pass an abortion law in 2022, affirming the right to terminate a pregnancy and ordering a study of the barriers low-income women face in obtaining the procedure.

In February, Vermont lawmakers voted in favor of a constitutional amendment guaranteeing the right to abortion and contraception. The measure — the first of its kind in the United States — will appear on the ballot in November and voters across the state are expected to approve it.

Rhode Island affirmed the right to abortion in state law in 2019, but left restrictions in place that barred state employee health insurance and Medicaid, an insurance program sickness for the poor and disabled, to pay for abortion. Lawmakers are now working to allow Medicaid to pay for abortions and other services.

“It’s a problem of racism and classism,” said Cassar, the sponsor of Rhode Island’s legislation. If passed, Rhode Island will join 15 other states that allow Medicaid to pay for abortions.

In California, Democratic Gov. Gavin Newsom commissioned a report on the future of abortion, in part to examine the impact of abortion bans in neighboring states.

If the U.S. Supreme Court allows states to ban or severely restrict abortion, a recent Guttmacher report found that the number of out-of-state people who could find the nearest clinic in California could grow from 46,000 to 1.4 million overnight, an increase of almost 3,000%.

“People can fall into the idea that advocacy, aggressive advocacy, to expand access to abortion is not necessary,” said Onyemma C Obiekea, policy analyst for the Black Women for Wellness Action Project, a reproductive justice group that helped lead the Future of Abortion committee. . However, potentially devastating Supreme Court rulings have “really changed that”.

One of the first recommendations lawmakers are addressing from the report would seek to further protect California residents from the high cost of abortion. California’s Medicaid program already pays for abortions. A new bill would end payouts for people who have abortions and have private insurance.

This could reduce the cost of pregnancy termination by hundreds of dollars for approximately 9,600 of the 23,000 Californian women who have abortions in the state each year, reducing the number of people facing high costs by 41%. according to the California Health Benefits Review. Program. The bill would only affect people whose private health insurance is regulated by the state. The health insurance plans of approximately 5.7 million Californians are federally regulated.

Perhaps the most ambitious efforts to protect abortion rights are taking place in so-called “purple states” such as Michigan, where – like Vermont – a coalition of reproductive rights groups is pushing a ballot initiative to provide a right to abortion in the state constitution. . Currently, if the United States Supreme Court reverses Roe against Wade, it could allow the reinstatement of a 1931 law banning abortion. To get a question on the 2022 ballot, Michigan groups need to collect more than 425,000 signatures, according to the Detroit News.

Michigan has a Democratic governor, but abortion rights legislation has no realistic chance of passing through the Republican-controlled state house, prompting voters to ask the question. The initiative’s chances of success are unclear. An initiative to legalize abortion in Michigan failed in 1972, just a year before the Roe v Wade decision.

In every state, powerful opposition to efforts to expand abortion rights and access has come from Christian anti-abortion organizations, the Catholic Church, and aligned Republicans. In just one example, the Catholic Church was among the most vocal opposition to Cassar’s bill in Rhode Island.

Even if more progressive states pass and expand abortion access, millions of people in abortion-unfriendly states would face insurmountable challenges in obtaining a legal abortion. This scenario is currently unfolding in Texas, where state lawmakers have successfully passed a law banning abortion before most women know they are pregnant.

States like California are simply “too remote” for many people living in conservative southern states that are most likely to enact tough abortion bans, said state justice organizer Michelle Anderson. for reproductive rights based in Texas and focused on black women. Afiya Center group.

“The bottom line is that abortion bans don’t stop abortions,” Anderson said. “They just make abortions less safe, and that’s especially true for black women.”