With a Republican trifecta going forward, the right to an abortion and the ability to obtain one will be at high risk even in states, such as New Mexico, where the right is currently protected by state law.

At least for the next few months, there will be no change to New Mexico’s status as a safe-haven state for abortion. President-elect Donald Trump does not take office until his inauguration on January 20.

But with Trump assuming office in late January, abortion clinic providers and policy researchers say the right to an abortion, or the ability to obtain one legally, will likely come under grave threat. Amy Hagstrom Miller, chief executive officer of Whole Women’s Health, told NM Political Report that abortion clinic providers are working to prepare for the worst. 

She said it was “pretty sobering” to see the majority of voters chose to elect an anti-abortion president even when polls show that 70 percent of the U.S. population supports the right to abortion care.

“What I do know is the same amount of people [as before] will need an abortion, no matter how many bans we have. There were more abortions in this country post Dobbs. How can we get people access to safe and high-quality abortion care?” She said that is the question abortion providers are facing now to prepare for what may come after January.

Republicans now have a majority in both houses of the U.S. Congress, which puts them in position to pass a law to ban abortion. If they do so and Trump signs it, that would negate the need for Trump to follow the plans of the authoritarian blueprint Project 2025 to ban it through a series of maneuvers that involve remaking the federal government. But he could also do both.

Trump, in an apparent effort to soft-pedal his rhetoric on abortion during the campaign, claimed, late in the campaign, that he did not support a national ban on abortion. Earlier in his campaign, Trump said he supported a 15-week gestation ban on abortion that would be nationwide, according to KFF, a nonprofit health policy, research and news organization. 

But there are some in Congress, such as current Speaker of the House Mike Johnson, a Republican from Louisiana, who support harsher measures. Johnson co-sponsored legislation in the past that would have placed a six-week national gestation ban on abortion, according to Politico.

Trump also tried to distance himself from Project 2025 during his campaign. But he is already encouraging Republicans in Congress not to hold Senate hearings to confirm his cabinet picks and to rubber stamp his choices for the federal bench. He has also named Tom Homan, a contributor to Project 2025, to be his “border czar.” Trump picked Robert F. Kennedy Jr. to lead the Health and Human Services Department. Kennedy promotes conspiracy theories and opposes vaccinations that have ended diseases like polio. Trump named U.S. House of Rep. Matt Gaetz, R-Florida, to be U.S. Attorney General despite investigations into illicit and unethical behavior. Such picks point to Trump’s plan to follow Project 2025’s call to remake the federal government by requiring fealty to Trump the primary, or in some cases, the only requirement for a position in federal government.

What to expect

Larry Levitt, executive vice president for health policy for KFF, said during a conversation with journalists shortly after the election that Trump did not lay out many policy plans during the election. Levitt said predicting what the future Trump administration will do is a bit of “tea leaf reading” at this point.

But, Levitt said, what we do have to rely on is Trump’s previous record, as well as proposals from Congress and conservative groups. 

Support for abortion access remains popular. Ballot initiatives to expand access or protect it won the majority of votes in almost every state where it was on the ballot on November 5. Hagstrom Miller said Trump won’t be trying to get elected again, so how he pivots on abortion care, once he becomes president, is “just a matter of where he cares to wield his power.”

She said that whether the likely impending fights over abortion care under Trump will have a chilling effect leading to abortion clinic closures is something that has happened before in states such as Texas or Louisiana even before the U.S. Supreme Court overturned Roe v. Wade through its Dobbs decision. In those instances, lawsuits against providers that were appealed all the way to the Supreme Court, and consequently took years to conclude, led to abortion clinic closures even before the high court decided the cases.

Jack Teter, regional director of governmental affairs for Planned Parenthood of the Rocky Mountains, said PPRM was “devastated” by the election and what it can mean for patients and their families. He said immediately after the election that “people are scared.”

“Donald Trump and his version of the Republican Party said they were coming for sexual and reproductive healthcare and we should believe them,” Teter said.

He said that if Republicans in power in Congress pass a national abortion ban and Trump signs it, “we will have to grapple with that as a nation.”

Brittni Frederiksen, associate director of women’s health policy at KFF, said that if a national ban is enacted by Congress and Trump, it would supersede New Mexico state laws that currently protect abortion care without gestational limits.

Mifepristone

Frederiksen said as far as what happens to abortion medication, a lot could depend on who Trump appoints to lead the U.S. Food and Drug Administration.

Since mifepristone, the first of the two-step regime for abortion medication, became more widely available in recent years, the number of abortions obtained through abortion medication has increased to more than 50 percent. Since the Dobbs decision, abortion medication prescribed through telehealth has been on the rise as a preference for patients. That fact has lessened the strain on abortion clinics, providers and patients alike as abortion medication through telehealth has enabled clinics to better meet the need for abortion care since it became banned in some states.

The U.S. FDA approved mifepristone to be used for abortion medication in 2000. Since the Biden administration rolled back some of the more severe restrictions on mifepristone, right-wing groups have challenged the FDA’s original approval. The U.S. Supreme Court said the conservative group suing the FDA lacked standing for its suit last summer.

But Project 2025 calls for the FDA to roll back its approval. Frederiksen said that, without mifepristone, abortion providers could still prescribe the second step of the current two-step regime, misoprostol alone, to terminate an unintended pregnancy. 

Misoprostol used alone to terminate an unintended pregnancy is slightly less effective and can cause more side effects but it is still a highly effective way to terminate a pregnancy up to the first 11 weeks of gestation, Frederiksen said. 

Comstock Act

Another worry for abortion clinics is how Trump may try to enforce an 1873 law, the Comstock Act. To do so would require a U.S. Department of Justice prepared to enforce it.  

The Comstock Act has not been enforced as a means of stopping material traveling through the mail considered an “abortifacient” since at least 1965. But conservatives have been arguing, since the Dobbs decision, that the Comstock Act, which was never repealed, is still enforceable. 

Teter called the Comstock Act “insane” and said the fact that Trump and his Republican followers “want to take us back to the 1800s is not surprising to me.”

“We should all be concerned at the reincarnation of an 1800s obscenity law. And that is one vehicle among many to threaten a national abortion ban,” Teter said.

If a future U.S. DOJ enforced the Comstock Act, it wouldn’t just mean the end of abortion medication telehealth. It could be a means to shut down abortion clinics everywhere because even items such as medical gowns and other generic medical supplies, are generally mailed to clinics from medical supply companies. 

Hagstrom Miller said that if the federal government takes that view, it would be “a radical reinterpretation of Comstock.” She said, historically, Comstock was enforced because abortion itself was not legal in the U.S. until 1973.

She said Whole Women’s Health, however, is already preparing for that possible eventuality through acquisition and storage and consideration of how else supplies and medication might be transported outside of the U.S. carrier system.

“Don’t underestimate the resilience of abortion providers. I’ve got over 20 years under my belt of running clinics in Texas,” Hagstrom Miller said.

But Frederiksen said that if the impending administration enforces the Comstock Act, it could have implications for the second part of the abortion medication, misoprostol, which is also used in labor and delivery.

“A lot of people are talking about that. It’s such an old law, it’s hard to know how it will play out,” Frederiksen said. 

Medicaid

Project 2025 also calls for cuts in federal funding as a way to try to eliminate, specifically, Planned Parenthood but also all abortion clinics in the U.S. Teter said what that really means are cuts to federal Medicaid. And while federal Medicaid dollars do not pay for abortion, they can be used to pay for other family planning services which Planned Parenthood clinics provide.

Levitt said that in order to pay for Trump’s promised tax cuts to top earners, Medicaid cuts “are absolutely on the table.” He said that the biggest federal government expenditures are Medicare, Social Security and the military but cuts in any of those areas are “off the table.” He said Medicaid is “the next biggest chunk of money after those other programs.”

“If there is pressure to cut spending to finance his tax cuts, Medicaid will have a big target on its back,” Levitt said.

Medicaid covers the cost for close to 80 percent of births in New Mexico and nearly 50 percent of individuals’ healthcare in New Mexico, so cuts to the federal Medicaid program could have many consequences within the state beyond abortion care.

Teter said the services Planned Parenthood clinics provide to patients excluding abortion care receive a considerable federal Medicaid match if the patient is on Medicaid. He said safe-haven states, like New Mexico, may try to make up those lost federal dollars through state funds but, he cautioned, a state like New Mexico could struggle with doing so. He said the consequences to patients could be, for instance, that a patient reliant on Medicaid might not be able to receive a timely cancer screening.

Although Teter pointed out that Planned Parenthood has been around for over a 100 years and that the clinics still exist and provide family planning services in hostile states like Texas, he said that if Trump should be successful in closing Planned Parenthood it would “remove one of the nation’s most trusted healthcare providers.” He said one in three Americans have received care at a Planned Parenthood clinic.

“When Donald Trump says he wants to get rid of Planned Parenthood, we should believe him,” Teter said.