For abortion advocates in Colorado, confronting a situation in which the U.S. Supreme Court shuts down access to abortion in conservative states, requiring Colorado to take in huge waves of patients, has been a matter of when, not if.

So when the court ghosted an emergency petition to stop Texas’ Senate Bill 8 from taking effect last week, banning nearly all abortions there, they’d been long preparing.

From increasing abortion clinic capacity to paying for appointments and travel to offering emotional support, Colorado providers and advocates are geared up to take on an influx of Texas patients seeking abortion care.

They also know that this is just the beginning, given Colorado’s status as an abortion care safe haven and the many abortion-hostile states in the region that are poised to follow Texas’ lead.

On Sept. 1, a ban on abortion at six weeks gestation took effect in Texas after stalled court challenges that culminated in the U.S. Supreme Court missing the deadline for temporarily blocking the law. The next day, it issued a 5-4 ruling in favor of letting the law stand for now despite the fact that the 1973 Roe v. Wade ruling holds that bans on abortion prior to viability, which usually occurs around 24 weeks gestation, are unconstitutional. The majority claimed that its ruling had less to do with the constitutionality of the ban than the procedural questions raised by the law and its unique enforcement scheme, which allows private citizens from anywhere to sue anyone who provides or aids or abets an abortion and rewards them with a minimum of $10,000 for winning their suit.

For people on the ground in Texas, however, the constitutional right to an abortion enshrined in Roe was rendered null and void overnight, regardless of the “procedural questions” at hand, and they must now figure out how to get care elsewhere.

Luckily for them, providers and practical support networks have long been helping people get abortion care when it is otherwise inaccessible due to the financial and logistical barriers that are exacerbated by abortion regulations that are already in place across the country. In that, they’ve been preparing for this post-Roe future, when the already-patchy map of abortion access across the U.S. becomes more and more sparse.

Across the board, the Texas law — as with any major restriction on abortion -– will present a huge inconvenience for people seeking abortion care. They’ll have to get a plane ticket to a state like Colorado where abortion is legal and relatively accessible, get an appointment at a time when clinics are seeing an influx of patients, and arrange a hotel stay. They might need to take time off of work, find childcare for their kids (most abortion-seekers are already parents). On top of it all, they’ll have to explain to their boss, friends, family, coworkers, neighbors, kids, teachers, and whoever else why they’re leaving town for a procedure during a time when the government has encouraged suspicion.

But for people with low incomes and members of marginalized communities, who already face disproportionate barriers to care and systemic challenges in every corner of their lives, those hurdles are more than an inconvenience to overcome–they push abortion care completely out of reach.

“Women of means in this country access abortion and always have. They’re going to figure out how to get to an airplane and they’re going to fly wherever they need to go. This is a devastating crush to communities of color,” said Adrienne Mansanares, Chief Experience Officer for Planned Parenthood of the Rocky Mountains (PPRM). “It’s another generation of racism that perpetuates poverty, and that is why I’m so angry and so saddened.”

There’s data to back up the notion that denying abortion care often leads to serious financial distress. In The Turnaway Study, Diana Greene Foster studied a group of women who were denied abortion care due to gestational age and found that they were 78% more likely to have outstanding debt and had an 81% higher chance of being evicted or declared bankrupt compared with those who were able to receive an abortion.

“I think about how thankful I am to be able to provide care for the patients who get to us, but for every patient that gets to us, I don’t know how many there are that just are not able to,” said Dr. Kristina Tocce, vice president and medical director of PPRM. “And then they’re being forced to pursue a path in life that they did not choose. That is unacceptable medically and in every other way.”

One of the great conundrums of gestational limits on abortion care is that in forcing an earlier cutoff for legal abortion, the result is that many people who would have had abortions earlier are now forced to have them later in pregnancy due to a lack of available appointments and the added burden of travel, getting time off, securing childcare, and scraping together the funds for what just became a significantly more costly endeavor. 

Tocce said that delays in abortion care caused by such restrictions can have serious medical impacts on patients, particularly those with underlying medical conditions that make pregnancy more dangerous.

“If they can’t access abortion care or there is a huge wait for an appointment, we are subjecting them to a possible medical complication during that waiting period,” she said. “Pregnancy is one of the greatest stress tests in medicine.”

She added that while abortion is very safe, it’s “always safest the earliest you can have the procedure done,” and that medication abortion, which is only available up to 11 weeks gestation, is preferable for certain patients in lieu of an abortion procedure. What’s more, the cost of abortion care increases later in pregnancy.

Colorado abortion providers had practice preparing for Sept. 1 during the beginning of the COVID pandemic in March of 2020, when Texas Gov. Greg Abbott issued an executive order that deemed abortion non-essential and temporarily closed clinics along with other businesses. Advocates say that period of time, when clinic doors shuttered overnight and Colorado saw a huge influx of patients from Texas, was the canary in the coal mine for a post-Roe future.

“We have some muscle memory of gearing up for that,” Mansanares said.

PPRM’s health centers saw a 12-fold increase in Texas patients after the governor’s order took effect, and Mansanares said when they arrived, they were often terrified, exhausted, and confused, having just had the rug pulled out from under them–mirroring what Texas patients are once again experiencing due to SB8. Mansanares said that the situation in Texas now, however, is terrorizing for patients.

“The country has never seen anything as hateful as what’s going on in Texas right now. I can’t overstate the uniqueness of the harm that that’s causing and just how acute the stigma and the fear and the terror the patients coming from those states are experiencing.” Mansanares said. “Patients seeking this care are feeling threatened and confused and scared of their neighbors and that is just so horrific.”

For Planned Parenthood, dealing with an influx of patients raises logistical concerns about capacity that they’ve long been trying to address in order to prepare for an abortion rights fallout.

“The demand for our services is already incredibly high with our neighbors and our own community members seeking care, especially during a pandemic,” Mansanares said. “So there’s a tremendous pressure in our health care system, even in the states that have very pro-reproductive health care legislatures.”

One way PPRM has been preparing is by expanding telehealth services, meaning that patients can have a video visit with a health provider and have abortion medication delivered to them by mail if they live within PPRM’s service area of Colorado, New Mexico, and Nevada.

Mansanares said that by offering more virtual care to patients in the Rocky Mountain region, they’ve been able to free up more in-person appointments for those who may be traveling long distances or need a last-minute appointment.

She also said caring for PPRM’s employees – and hiring more – has also been part of the strategy to ensure they’re ready for whatever comes their way.

“It’s been a long 18 months providing care in a pandemic. No one signed up for that. And then to have September 1st on the calendar, this looming date where we know we’re going to be seeing more Texas patients when we can barely see the patients from our own communities, it’s been very overwhelming for folks,” Mansanares said.

She said they’re investing in mental health resources, offering competitive wages and benefits, encouraging workers to take time off, and offering more telehealth jobs for those who want to work from home.

But if patients can’t make it to a clinic in the first place, none of it matters. That’s where abortion funds and practical support networks come in.

Various organizations in Colorado, Texas, and all over the country offer not only funding for abortion procedures themselves, but for the costs associated with travel. Some specifically fund hotel stays, others plane tickets. And some, like the Colorado Doula Project (CDP), do a little bit of everything, including offering emotional support.

“Rarely is there just one source of support for a person, there is kind of a web of care of different organizations and different people who are making sure that one person gets from point A to point B with as many of the services that they need,” said Gina Martinez Valentín, co-founder of CDP. “It’s a really beautiful model of care.”

Valentín said that in addition to serving as a “steady and knowledgeable presence” for clients who are navigating a system they might know nothing about, CDP offers rides from the airport to the clinic, grocery shops for their favorite foods, provides abortion care packages with teas and heating pads, and gives them a hand to hold through it all.

“These are things that if we lived in a world where this care was accessible for everyone, really accessible and didn’t have the stigma on it that it does, you could turn to your friends and family for this kind of support,” Valentín said. “You would be at home, comfortable in your own bed, with somebody to drive you, somebody to chill with you when you get home, make your favorite meal, and all of those things. That’s exactly the kind of care that our clients should be getting. And we do the best approximation of that that we can.”

Other organizations like Cobalt (formerly NARAL Pro-Choice Colorado) and its abortion fund offer more in the way of financial support. The fund was originally focused on paying for procedures themselves, but over the past few years has begun helping to offset the costs of travel, as well.

Cobalt Abortion Fund Director Amanda Carlson said that of the 22 clients they’ve had since SB8 took effect, nearly half have been from Texas.

“Most are facing unexpected travel, unable to afford the cost of gas, plane tickets, and meals, let alone their procedure,” Carlson said. “Unless SB8 is blocked, we are bracing for this to be the new normal.”

It’s exactly these kinds of groups – abortion funds and practical support organizations that serve as lifelines for low-income patients – that the Texas law targets in allowing those aiding or abetting abortion to be sued. Lawmakers in other conservative states, like Florida, have already said they’d copy it. Meanwhile, the U.S. Supreme Court prepares to hear a case next term that could deal another blow to Roe v. Wade.

“I can only imagine how infuriating and frightening this is for people who are doing this work on the ground in Texas,” Valentín said.

Valentín said that given this new reality, it’s never been more important to donate to abortion funds and practical support networks.

“The work they’re doing is really incredible, and they always need everything they can get,” she said.