With Roe v. Wade overturned, telehealth providers brace for impact

The Supreme Court’s reversal of Roe v. Wade has telehealth providers of abortions—regardless of how they interact with patients—bracing for widespread changes in how care is delivered. 

The high court’s opinion, written by Justice Samuel Alito, reads in part, “We hold that Roe and Casey must be overruled. The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision.” The court overturned the law by a 6-3 decision.

“If that patient is looking to go to a brick-and-mortar clinic, or they’re looking to have pills mailed to them from somewhere else, that is still an abortion,” said Jenny Sheehan, the telehealth program director of the National Abortion Federation. “[The procedure] is going to be restricted in the same way by the same laws.” 

The federation, a professional organization for abortion providers, said it will do what it can to help providers understand and adapt, even though it is limited by the decision. 

Regardless, the not-for-profit organization is set to launch a software platform in the coming months that will make it easier for abortion providers to offer virtual services, she said. Along with the face-to-face video capability, it will include access to consent forms and questionnaires in English and Spanish. 

“These systems are time-intensive and resource heavy.” Sheehan said. “So, we got the idea that NAF could maybe devise our own telehealth platform that could work for a lot of our members, and take the burden off of members for vetting, customizing and paying for the platform.”  

Sheehan said providers will be responsible for legal analysis pertaining to their own situations.   

“Abortion care via telehealth is abortion care”  

As state telehealth restrictions loosened significantly during the pandemic, experts say the flexibility won’t fill the void for women seeking abortion care now that the landmark case is overturned.  

“Restrictions affect us all,” said Cindy Adam, co-founder and CEO of Choix, a California-based digital provider of sexual reproductive healthcare services, including abortions. 

Overturning Roe v. Wade adds further complexity to the current patchwork of state laws. According to Kaiser Family Foundation, 23 states have no requirement for the number of in-person visits one needs for an abortion, while 19 require more than two. Another 19 have banned the use of telehealth for abortions. 

Choix currently operates in California, Colorado and Illinois, with plans to expand into two other states by the end of July. 

“Abortion care via telehealth is [still] abortion care. So, at least in the way that Choix operates, we would not be able to provide care in states where specific trigger bans go into place or where states outright [ban] abortion care.” 

Demand for abortion services in states with less burdensome restrictions will increase. Telehealth providers are expecting an increase in patients if the law is overturned.  

“Telehealth does not work for every person,” Sheehan said. “It's restricted in the same way abortion care is restricted, and as with all essential health services, the landscape of abortion act that needs both telehealth options and access to in person care at brick-and-mortar clinics.” 

 Adam said Choix will assist abortion-seekers through partnerships. 

“People have always found ways to seek care,” Adam said. “We do hope and expect to serve those patients [in states restricting abortion care], and to work with our partners and practical support groups who can help those people travel and coordinate care.”  

Currently telehealth providers ask patients to report where they are receiving care. Providers are not required to check IP addresses or authenticate where a patient says they’re calling from. In some states, providers could be held responsible if a patient is from a state that restricts abortions, experts say. 

Adam said such laws are “designed to make abortion providers and people like myself afraid to provide care and to make people afraid to seek care.”  

State telehealth policies vary widely 

As more states allow the public health emergencies that loosened state licensing requirements around telehealth to expire, virtual abortion providers using those temporary policies are left with few options. 

Adam said there are challenges with obtaining medical licenses in multiple states because of varying requirements. “It is a very bureaucratic and timely process,” she said. 

Dr. Julie Amaon, medical director at Just The Pill, an in-person and virtual provider of medication and procedural abortions said if Roe falls, patients will have to travel to ‘safe states’ to have telehealth appointments. Just The Pill will dispatch mobile clinics or mail medication in the four states they serve. 

The ruling’s influence could go beyond those seeking abortion care, experts said.  

Dr. Mary Jacobson, chief medical officer at Alpha Telehealth, is worried women will be hesitant to seek other, non-abortion services, such as the morning-after pill. 

“I think it’s a huge violation of the patient-provider relationship,” Jacobson said. “I think [the ruling] adversely impacts women’s health. I’m concerned that women may be afraid just to seek any form of women’s reproductive healthcare.” 

That’s one of the reasons Sheehan and other experts believe Roe’s reversal will exacerbate existing inequities in women’s health.