Val Arkoosh listened last week as an OB-GYN recounted the conversations she has had with women struggling with difficult pregnancies and the threats she has received as an advocate for abortion access in Pennsylvania.

Arkoosh, a doctor and Montgomery County commissioner running for U.S. Senate, noted her own experience with patients who were weighing an abortion, and the “horrific” consequences of taking away that choice.

“I have seen it firsthand,” she said. “I uniquely understand how consequential these laws are to the doctor-patient relationship.”

The virtual conversation was one of several on women’s reproductive rights that Arkoosh’s campaign has organized in the wake of Texas’ enactment of the nation’s strictest antiabortion law, and the U.S. Supreme Court’s refusal to intervene. With the future of Roe v. Wade suddenly as unclear as it has been in years, Democrats running for office in Pennsylvania have been sounding the alarm that women’s reproductive rights are under attack.

They’ve blasted out email alerts and fund-raising solicitations warning that abortion could emerge as a key issue in next year’s midterm elections.

Republican candidates have been less vocal on the Texas ban, quick to describe themselves as antiabortion but reserved about whether they would support a similar law here.

» READ MORE: Here’s where candidates for Pa. Senate and governor stand on Texas’ abortion ban

And as the nation’s high court reconvenes this week with a case from Mississippi on its docket that could allow it to revisit the 1973 legalization of abortion, interest groups are lining up on both sides.

“There are some things that will gain traction now and will likely not have traction in a year,” said Alison Dagnes, professor of political Science at Shippensburg University. “Abortion is not one of those things.”

The issue could impact races up and down the ballot. Pennsylvania’s next governor would have direct control over state laws (Gov. Tom Wolf recently vetoed three restrictive abortion bills in Pennsylvania). The U.S. Senate could attempt to codify abortion rights at the federal level via the Women’s Health Protection Act. And state judges — including some on the ballot this November — will soon hear a Pennsylvania abortion case over public funding.

“With Governor Wolf’s tenure coming to an end, we realize the only thing stopping us from becoming Texas is the power of the veto pen,” said Signe Espinoza, interim director of Planned Parenthood Pennsylvania.

» READ MORE: Who's running for Pa. governor in 2022?

The Susan B. Anthony List, an antiabortion organization, said it plans to canvas 500,000 homes across Pennsylvania ahead of the midterm elections. Mallory Quigley, its vice president of communications, called the Democrats running for Senate and governor “radical extremists” when it comes to abortion. “We believe [voters] can be persuaded to vote pro-life once they understand the stark contrast that exists,” she said.

Much of what could happen is speculation right now. If the Supreme Court were to overturn Roe in the Mississippi case, state legislatures and governors would be fully empowered again to legalize or ban abortion. Abortion is currently legal in Pennsylvania at up to 24 weeks. New Jersey, by contrast, has one of the least restrictive laws and allows abortion at all stages of pregnancy.

Abortion has traditionally not ranked high among voters’ issues. In the 2020 election, 40% ranked it a “very important issue,” according to the Pew Research Center. And while those voters turn out, they rarely shift.

But a new administration is also bringing the topic back into the news. This week, the Biden administration reversed a Trump administration ban on abortion referrals, restoring federal funding to clinics that refer people seeking abortions to a provider. Direct federal funding for abortions is still illegal, except for in the case of incest or rape.

Democratic organizer Kelly Dietrich said his party sees this as a time when candidates can be more vocal and build momentum. Late last month, four women in the U.S. House publicly shared their stories about their own abortions.

“The GOP continues to overplay its hand trying to feed this beast of a base that they have created that continues to alienate anything resembling a moderate voter, a woman voter,” Dietrich said. “Unfortunately for them, it provides us an opportunity to turn out moderate, pro-choice voters.”

The law that went into effect in Texas last month bans abortion after about six weeks — or as soon as cardiac activity is detected — and allows private citizens to sue abortion providers or anyone who helps someone obtain an illegal abortion.

When asked by The Inquirer, all the Democrats running for the U.S. Senate seat being vacated by retiring Republican Pat Toomey denounced the Texas law and said they support expanding abortion access in Pennsylvania and codifying Roe v. Wade into federal law. So it’s unclear how much of a factor abortion could be in their Democratic primary.

Still, the issue has helped elevate Arkoosh, the only woman in the crowded Democratic primary field.

» READ MORE: Val Arkoosh would be the first Pa. woman elected to the Senate. But she’s running as Dr. Arkoosh.

She called the Supreme Court’s inaction on the Texas law “a hair-raising preview of what could be next” and warned that birth control and in vitro fertilization could be targeted.

One Democratic candidate, U.S. Rep. Conor Lamb, has described his personal position as pro-life but has voted consistently for abortion rights.

“That’s as nuanced as it’s going to get,” Dagnes said, adding that the candidate who is most outspoken or who comes with a background in women’s health could have an advantage among voters closely following the issue. “Any distinction that can be made to say, ‘I am super-duper pro-choice, or super-duper pro-life’ is incredibly helpful in this debate.”

Eleven states have so far introduced legislation mirroring Texas’ law. Pennsylvania is not one of them, though Republican legislators here advanced three bills this year to restrict access to abortion — all of which Wolf has promised to veto.

Attorney General Josh Shapiro, who has not formally announced but is widely expected to be the Democrats’ nominee to replace Wolf, called the Texas ban “dangerous, extreme, and cruel” at a Planned Parenthood march Saturday.

There’s good reason for Republican candidates for Senate and governor to remain mostly quiet on the Texas ban, said David Dix, a strategist in Pennsylvania who has worked with both parties.

The Texas law is wildly unpopular even with Republicans in Texas, according to an NPR and Marist poll. That’s partly due to its provisions — allowing private citizens to enforce the law by suing neighbors, physicians, and clinics. Pennsylvania is also a more moderate state and Republicans here want to hold on to the reliably Republican antiabortion coalition without alienating potential voters like suburban women who often favor abortion rights, Dix said.

“Most sensible Republicans recognize to take a [Texas Gov. Greg] Abbott-like stance would be political demise,” Dix said.

He thinks the GOP primary will largely be about the economy, the pandemic, and how candidates define themselves relative to Donald Trump. When it comes to abortion, he’s not sure there are that many voters left to capture.

“People have been in those corners for 45 years,” Dix said. “There’s not a fluid middle.”

Where the GOP candidates stand

Despite being largely mum on the Texas ban, many Republican candidates said they would support a similar Pennsylvania proposal for a six-week ban on abortions.

“No person with a beating heart, no matter how small, should be deprived of the fundamental right to life,” said State Sen. Doug Mastriano of Franklin County, a likely gubernatorial candidate and sponsor of the measure.

Charlie Gerow, a longtime GOP strategist and candidate for governor, said that if elected he’d sign Mastriano’s six-week ban. “In my judgment most Pennsylvanians want fewer abortions, not more.”

Former ambassador to Denmark Carla Sands, who marched in last month’s Harrisburg March for Life, told The Inquirer she is “unapologetically pro-life” but didn’t give details on what changes she would or wouldn’t support. The same went for Senate candidates Sean Parnell and Jeff Bartos.

State Sen. Dan Laughlin, who represents Erie and is expected to run for governor, was the only Republican who said explicitly that he’d keep Pennsylvania’s current law intact. He doesn’t favor making it any more restrictive or permissive.

Laughlin said his stance was informed by his own experience. When a sonogram for his third child at 20 weeks of pregnancy came back inconclusive, doctors warned there might be a serious medical problem with the baby. He and his wife decided they were personally against abortion and wound up having a healthy girl. But Laughlin said he is grateful Pennsylvania laws gave his family the time — and the option.

“During that time period the last thing that I would have wanted was someone telling us what we had to do,” Laughlin said. “I don’t feel that it’s a legislator’s job to stick their nose into the private medical decisions of a couple.”

It wasn’t so long ago that the issue was less polarized across parties, particularly in Pennsylvania, where about 24% of residents are Catholic. Democratic Sen. Bob Casey — whose father’s staunch antiabortion stance became a focal point of the 1992 Supreme Court decision that upheld Roe — has described himself as personally pro-life but has voted for abortion rights. Former Pennsylvania Gov. Tom Ridge, a Republican, backed abortion rights.

Nationally, 59% of Americans think abortion should be legal in all or most cases. In Pennsylvania, 27% think it should be legal under any circumstances, 56% think it should be legal under certain circumstances, and 13% illegal in all circumstances.

“The battle has become ‘This person, or this candidate, wants no abortions ever vs. this candidate wants abortion to be legal up until day of delivery,’” Pennsylvania GOP strategist Christopher Nicholas said. “That is not where the vast majority of voters are. They’re much more in the middle.”

The spotlight on the issue will likely grow. The Supreme Court will hear oral arguments on Mississippi’s 15-week abortion ban Dec 1.

Staff writer Jonathan Tamari contributed to this article.