The State of Healthcare and Abortion in a Post-Dobbs World
On June 24, 2022, the landscape of healthcare and the lives of millions across the country were forever changed with the passing of Dobbs v. Jackson Women’s Health Organization and the official death of Roe v. Wade (1973). The controversial opinion was preceded by political unrest, including the appointment of Justice Amy Coney Barrett to the Supreme Court and the leak of the Dobbs draft decision just one month before its official publication. The opinion’s effects have rippled outwards in the past four years, with stories of abortion laws changing across the nation. With the arrival of Justice Barrett on Grounds this past week, the National Lawyers Guild—along with student organization partners VLPP, Lambda, ACS, VELF, AGAPE, PLAVA, and PILA—held counterprogramming to discuss the Dobbs decision with the Law School’s own Professor Coughlin and UVA Health OBGYN Dr. Danielle Johnson.
The program invited Professor Coughlin, Dr. Johnson, and students to engage in a meaningful discussion not only about what Dobbs said about abortion rights, but also how the effects have trickled into our healthcare system. Professor Coughlin began the evening with an overview of the Dobbs decision. The majority opinion concluded that “liberty” under the 14th Amendment due process clause does not include a woman’s right to an abortion, with Coughlin noting that this meant “women lost a constitutional right they had for fifty years.” In coming to this conclusion, the majority adopted a public meaning originalist view of what the word “liberty” should mean. They concluded that the public at the ratification of the 14th Amendment in 1868 would not have perceived “liberty” as encompassing the right to an abortion. Professor Coughlin points out the pitfalls of this type of reasoning: this was long before the modern understanding of reproductive health and before the inclusion of women as part of the public conversation. Professor Coughlin emphasized: “If the meaning of liberty is determined by 1858 by reference to texts of the time, women are not part of the people.”
Professor Coughlin continued her overview of Dobbs with an analysis of the impact of the decision on the modern world. She states that in her opinion, the Justices, by oral argument, had already decided that “Roe was dead or wrongly decided.” Still, in order to overview Supreme Court precedent, the Court must not trample over the rules of stare decisis if many are detrimentally relying on Roe. When reviewing the reliance on Roe, the Justices allude that Roe is no longer needed to protect women. They state that there is no longer a stigma with having children out of wedlock, nor is there a stigma with putting your children up for adoption should you not be in the position to be a parent. To this point, the audience chuckled with a sarcastic air. Professor Coughlin explained that the Court ultimately concludes that abortion is an unplanned activity and thus there is no detrimental reliance on Roe. In adopting this opinion, the Court failed to consider that abortion is not only meant for those who become pregnant unexpectedly but also for those who want to continue their pregnancy but experience complications. To this point, Professor Coughlin lingered, “[Abortion] is a routine part of healthcare, and the Court mentions not one word on this point.”
The audience silently soaked in these words as Dr. Johnson transitioned into speaking about the effects of Dobbs on healthcare and the healthcare system. Dr. Johnson began with her experience within the state of Virginia, which still allows abortion up until a certain gestational age. However, the access story is different for every individual. For those on private insurance, abortion and related care may be fully covered, partially covered, or not covered at all. Specifically, for those on Medicaid or federal insurance, these routine parts of healthcare are no longer covered. To emphasize how detrimental this can be to individuals, Dr. Johnson estimated that a routine hospital-based abortion in Virginia would cost between $17,000 and $20,000. This is non-inclusive of any additional care or travel expenses that may be incurred.
Dr. Johnson continued with the reality of what it is like to practice medicine under the current landscape. For the practitioners working out of states with outright abortion bans, Dr. Johnson noted that the choice to assist in an abortion means “making the decision between a medical malpractice suit or spending up to a century in prison for homicide.” Even in states like Virginia with more liberal abortion laws, the reality for those without insurance or coverage is that the state will only cover the procedure if there is a “lethal fetal anomaly.” However, what that means is dependent on each practitioner and reviewer. The inconsistency of reviewers and what they determine to be “lethal” results in many being forced to wait for their condition to worsen before getting access to the care they deserve. Johnson ended her portion of the discussion with two fruits for thought: (1) “Abortion is an inherent part of pregnancy, but it is the only part of medicine that is pulled out of medicine.” And (2) “Adoption is NOT an alternative to abortion; it is an alternative to parenthood.”
Author: Kelly Wu ’27, gcu2vn@virginia.edu
