High-risk abortion patients from other states head to Chicago hospitals

Emily found out when she was around 22 weeks pregnant that her unborn son didn’t have kidneys, and his lungs wouldn’t develop.

If her baby survived the pregnancy, he would be born unable to breathe, and would die a few hours later. 

Emily had a crushing decision to make: continue to carry a baby who would not survive, which could be a risk to her health and having children in the future, or have an abortion. 

“I don’t think I stopped crying for an entire two weeks,” said Emily, who asked WBEZ not to use her real name to protect her privacy and safety. “The whole world felt heavy. … It’s not something anybody should have to go through. It’s not easy losing somebody you love.”

Emily said doctors told her her life wasn’t in immediate danger, but they also pointed out the risks. Emily’s family has a history of hemorrhaging. If she started to bleed, doctors said she might lose her uterus, too. Emily said this was devastating. She’s a young mom who said she wants more children. 

“It was really scary,” Emily recalled. “The doctors told me the baby could die tomorrow. He could die next week. But it’s very unlikely that he’ll make it full term.” 

She chose to get an abortion. She said her doctors told her it was the safest option — but they wouldn’t provide one. 

She lives in Missouri, which has one of the strictest abortion bans in the nation. So Emily had to leave and found her way across the border to Illinois, a haven for abortion rights.

Since Roe v. Wade was overturned in June of last year, who can get an abortion and where has been complicated by vague laws and fear: fear among doctors who practice in states where abortion is banned or heavily restricted that they could lose their medical licenses or wind up in jail. There’s fear among abortion patients that they could be prosecuted for traveling across state lines.

All of this is what drives many physicians in Illinois to fill the void and treat as many patients as they can.

Data is hard to come by on how many abortion patients are coming from other states, and that data is only going to shrink. Illinois officials on Friday announced they would collect and release less information about abortion to protect both patients and providers.

‘Very difficult to get an exception’

Many states that ban abortions have exceptions to save the life of the mother, new research from the health policy non-profit KFF shows. But just when the mother’s life is at risk appears to be open to interpretation.

“It’s very, very difficult to get an exception,” said Alina Salganicoff, director of women’s health policy at KFF. “It’s like, how imminent is this threat. And in many cases, patients can’t wait until they’re about to die before they get an abortion.”

While in the past only 3% of abortions typically occurred in hospitals, OB-GYNs in regions across the U.S. that protect abortion rights, including Chicago, tell WBEZ more out-of-state patients are showing up. 

And along with more hospital stays comes more patients who need help covering the expensive price tag of the procedures, abortion funds and providers say. 

Emily made her way to Dr. Laura Laursen, an OB-GYN at Rush University Medical Center in Chicago, in May. The number of out-of-state abortions at Rush has quadrupled since Roe was overturned.

Laursen received Emily’s consent to discuss her case with WBEZ. She remembers Emily was frustrated about having to jump through so many hoops to get the abortion, and she was stressed about the cost of being in a hospital.

“The biggest thing was just making space for her to express those emotions,” Laursen said. “Making sure that she felt comfortable with all the decisions she was making. And trying to make her feel as empowered as possible.” 

Emily’s life wasn’t in immediate danger, but it was safer for her to have an abortion than remain pregnant, Laursen said. She added just what qualifies as an immediate danger is really hard for physicians to figure out.

“I’m constantly hearing stories from my partners across the country of trying to figure out what counts as imminent danger,” Laursen said. “We’re trying to prevent danger. We’re not trying to get to the point where someone’s an emergency.”

Across the border in Wisconsin, Dr. Jennifer McIntosh specializes in high-risk patients and is increasingly referring them out of state. Wisconsin’s abortion ban has essentially ground procedures to a halt, despite an exception to save the life of the mother.

“It’s really awful,” McIntosh said of having to send patients away. She recalled conversations she’s had with patients who wanted their pregnancies, but whose babies faced dire outcomes. 

And “now I’m going to tell you, ‘Yes, it’s very reasonable to get an abortion. But oh, by the way, it’s illegal in your own state.’ So now on top of this terrible news, I’m going to tell you that you have to figure out how to leave the state to get an abortion.’” 

McIntosh said in some cases she’s able to offer abortions if the risk is significant enough to satisfy the life of the mother exception. But even that carries possible legal risk. 

“Am I worried that someone might think that it doesn’t satisfy that?” McIntosh said. “Absolutely, that terrifies me.” 

‘What do I do now?’

Dr. Jonah Fleisher’s phone is often ringing and buzzing with texts. An OB-GYN who specializes in abortion and contraception at UI Health on the Near West Side near Rush, he’s frequently asked to see how quickly he can squeeze in another patient from another state.

Since Roe fell, Fleisher estimates the health system is treating at least three times more patients who are traveling from other states for abortion care. 

Sometimes he’s the third or fourth stop after a person was referred from clinic to clinic — each one uncomfortable providing the abortion — then wound up at the hospital because there was something worrisome about their pregnancy.

“They are often calling us from the parking lot [of a clinic] saying, ‘What do I do now?’ ” Fleisher said.

He worries, too, about the “invisible” patients, the ones who live in banned states and have a medical problem that complicates their pregnancy, yet aren’t showing up in his exam room. 

“I know that some number of those women are not going to make it through birth and postpartum,” Fleisher said. “More than the stress of somebody who’s actually making it to see me, that’s the thing that causes me more stress.”

‘This is really their last resort’

One of the biggest barriers for high-risk patients to get abortions at hospitals is the price tag. Emily’s hospital stay cost around $6,000, Laursen said, paid for by local and national abortion funds. Some hospital bills can reach into the tens of thousands of dollars for more complicated procedures.

Abortion funds, which help patients cover everything from meals to hotel stays to the abortion procedure, have largely been footing the bill. 

Meghan Daniel, director of services at Chicago Abortion Fund, known as CAF, says the organization pledged to cover at least $410,000 in hospital bills for about 220 patients in the year after Roe was thrown out, primarily for out-of-state patients. That compared to just over $11,000 for around 30 patients the prior year. 

In many cases, patients around the country are having a hard time accessing abortion care, and the delays push them into needing the procedure in a hospital, said Melissa Fowler, chief program officer at The National Abortion Federation. 

“We’re seeing more cases right now [of] people who are later in gestation,” Fowler said. “More adolescents who are later in gestation who are showing up at hospitals because this is really their last resort. They’ve been referred all over.” 

All of this raises questions about how long these funds can afford to help. 

“The current financial way in which people are paying for their abortions I fear is not sustainable,” Fleisher said.

Laursen argues out-of-state Medicaid plans and insurance companies should be picking up the tab.

“Whose responsibility is this?” Laursen questions. 

‘Not ready to let him go’

Back in Missouri, Emily has a special room dedicated to her unborn son. She brought home a recording of his heartbeat and keeps his remains in a heart-shaped casket. She talks to her son, tells him how much she loves him.

“I’m just not ready to let him go,” Emily said. “Even though they’re not here on Earth anymore, you still see them in your dreams.”

She’s healing emotionally and physically. She said she’s thankful she was able to travel to Illinois for care, but this experience has made her angry with her home state. 

“There’s a lot of good people out there who go through a lot of unfortunate situations like me who need abortion care and to have that taken away by the government … It just doesn’t feel right,” Emily said. “It feels scary and frightening and unsafe because you can’t choose that option for yourself.”

Kristen Schorsch covers public health and Cook County for WBEZ.