Thousands of people from neighboring states may come to Pennsylvania to terminate their pregnancies if a forthcoming U.S. Supreme Court decision ends a national right to an abortion.

Pennsylvania abortion providers have spent months preparing for a surge of up to 8,500 more out-of-state patients from places that could lose abortion access — hiring more staff, creating patient navigator programs, and pushing fund-raising efforts into overdrive.

Any week now, the court is expected to release a decision that could overturn the landmark abortion rights cases Roe v. Wade and Planned Parenthood v. Casey that have guaranteed the right to abortion access for nearly 50 years. In a leaked draft of the majority opinion, Justice Samuel A. Alito Jr. wrote that “Roe was egregiously wrong from the start.”

Overturning Roe would mean every state decides whether and under what conditions people can obtain an abortion. Neighboring Ohio and West Virginia are among the 26 states that are likely to swiftly ban or severely restrict abortion. This could leave their residents, along with people across large swaths of the South and Midwest, to seek abortions elsewhere.

For many, Pennsylvania would be the closest option. Abortion is legal in Pennsylvania through the 24th week of pregnancy, even though access is limited — only 14 of 67 counties have an abortion provider.

A projected 25% increase in cases here could strain the limited number of clinics, lead to longer wait times for appointments, and tap out financial resources available to help people pay for care, reproductive health organizations warned.

It also could disproportionately hurt people of color, low-income individuals, and those who aren’t able to travel long distances for care.

“Not everyone will receive the care they need,” said Sara Dixon, a spokesperson for Planned Parenthood of Western Pennsylvania.

Abortion remains legal in Pennsylvania

For those who can’t afford to travel any further than necessary, Pennsylvania is a promising option — especially compared to states expected to ban most procedures, like Ohio or West Virginia, or in Texas where abortion is already banned once a heartbeat can be detected. But the commonwealth still places many limitations on abortion.

New Jersey is also expecting an increase in patients because its abortion laws are among the least restrictive and best protected. Earlier this year, Gov. Phil Murphy codified the right to abortion. The state does not require a 24-hour wait, extra lab work, or parental notification like Pennsylvania.

Those seeking abortion here face a mandatory consultation with a doctor to hear alternatives, then must wait 24 hours before having the procedure. People under 18 must have parental consent, and everyone must complete lab tests that doctors say are unnecessary for most patients.

“It’s certainly better than some other states,” said Kelly Davis, executive director of New Voices for Reproductive Justice, which advocates for health rights for Black women and girls, and people of all gender expressions in Pennsylvania and Ohio. “But Pennsylvania is not a utopia for reproductive health.”

There are just 22 abortion providers in Pennsylvania, and 19 of them are east of Harrisburg. The others are clustered in or near Pittsburgh, leaving a large swath in the middle of the state without an abortion provider.

Pittsburgh has just two providers and is expected to see the most significant surge of out-of-state patients.

“Just because of our location, we already see people from Ohio and West Virginia,” said Dixon, of Planned Parenthood’s western Pennsylvania chapter.

Pennsylvania could see an additional 8,500 out-of-state patients, based on an analysis of abortions in Ohio and West Virginia, ZIP codes, and travel patterns of potential patients, said Melissa Reed, CEO of the Philadelphia-area Planned Parenthood Keystone.

In 2020, 2,144 out-of-state patients sought abortions in Pennsylvania — representing about 7% of the 32,123 cases that year.

Longer waits, farther drives

As more people turn to Pennsylvania for abortion care, patients may experience longer wait times for appointments and have to travel farther for an opening. This risks pushing some later into pregnancy, when medical options can be more complicated.

“Pregnancy care, including abortion, is time sensitive care. Any delay patients might face could result in them being pushed past the time that care is available,” said Roxanne Sutocky, director of community engagement at The Women’s Centers, which operates abortion clinics in Philadelphia; Cherry Hill, N.J.; Connecticut; and Georgia.

An increase in patients seeking care here would also strain Pennsylvania’s limited private funding for abortion aid, which helps people cover the cost of abortion, regardless of whether they are Pennsylvania residents. Health insurance plans are not required to cover the cost of abortion, and most Medicaid programs — including in Ohio, West Virginia, and Pennsylvania — are banned from covering abortion.

The out-of-pocket cost of the procedure, an average of $400, comes on top of transportation and lodging expenses, plus the cost of childcare while away — all expenses that will increase if people must travel farther, said Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University.

“The majority of people who need abortions don’t have that level of money,” he said. “People who have the economic means will always be able to access abortion, regardless of whether it’s legal in their state or even in their country.”

Independent abortion funds typically give money on a first-come, first-served basis to people who meet financial qualifications. This can leave out people who aren’t aware that help is available or who can’t complete the needed paperwork because of language or literacy challenges, said Davis, of New Voices for Reproductive Justice, which has been working with midwives, doulas, and community providers to better reach people in need.

Abortion providers hire for a surge

Reproductive rights groups are staffing up to treat more patients and help them navigate a complex health-care landscape.

Both Planned Parenthood chapters hope to expand operating hours by hiring more medical staff. They’re also training teams of “patient navigators,” who help people book appointments, apply for financial aid, and find lodging.

“We know when patients are traveling to us from out of state their need for support is greater. We’re talking about people who are facing more time off work, increased costs for travel, childcare, and lodging,” said Sutocky, of The Women’s Centers.

Earlier this year, The Women’s Centers launched a telehealth platform to relieve some of the pressure. Medication abortion, when a person takes a pill to stop a pregnancy, now accounts for over half of abortions in the U.S., and can be done without traveling to a clinic.

But Pennsylvania law requires that patients be physically in Pennsylvania during the initial consultation with a doctor and 24 hours later, when they go online for another virtual visit for the doctor to watch them swallow the first of two pills. The medication can only be mailed to a Pennsylvania address.

Pennsylvania Gov. Tom Wolf has vowed to veto any bills passed by a Republican-controlled state legislature. But with a tight governor’s race to be decided this fall, abortion access in Pennsylvania could change.

Regardless, Republican lawmakers are expected to approve legislation calling for a constitutional amendment stating there is no right to abortion in Pennsylvania. If approved in two consecutive sessions, the constitutional amendment would become a ballot question for voters to decide, potentially as early as May 2023.

“It’s precarious,” said Dixon, of the Pittsburgh-area Planned Parenthood chapter. “We will be safe. But we will not always be safe unless we really push back.”