Michigan voters backed abortion rights. Now Democrats want to go further.

Nearly every day, Halley Crissman and her physician colleagues in Michigan must tell patients seeking abortions they're very sorry that they can't proceed with their scheduled appointments.

"Patients tell me, 'Doctor, why are you stopping me from getting the care that I need?'" said Crissman, an OB-GYN who provides abortions as part of her practice and is also an assistant professor at the University of Michigan. "The answer is that Prop 3 made access to abortion care a right in Michigan. But these [other] laws remain on the books."

Ever since the Supreme Court overturned Roe v. Wade, abortion patients have traveled to Michigan in record numbers for care. Voters passed what's known as Proposal 3 last November, enshrining abortion rights in the state's constitution. But it can still be difficult to get abortion care in Michigan, and even patients who have secured appointments are regularly turned away, doctors say.

That's because of remaining legal restrictions, including an informed consent form that must be printed and signed 24 hours before an appointment begins.

This fall, Democrats in Michigan pledged to change those older state laws. They introduced the Reproductive Health Act, which would repeal the state's 24-hour mandatory waiting period, get rid of the informed consent form, allow Medicaid to cover abortions for low-income patients, and make it easier for private insurance to cover abortions. The legislation would also lift regulations on abortion clinics that advocates say are unnecessary and burdensome.

The time is ripe, Democrats say. Since the 2022 election, the party controls both chambers of the legislature and the governorship, positioning them to pass what they consider a landmark victory for reproductive health.

But now that legislation is stalled — not because of opposition from the Republican minority, but because of dissension within the Democrats' ranks. Michigan is one of the few remaining Midwestern states where abortion remains legal, so Democrats' efforts to make the procedure more accessible in the state will have wide-ranging consequences.

Pre-visit paperwork requires Internet access, a printer, and exact timing

Crissman has a request for anyone who thinks Michigan's 24-hour mandatory waiting period and informed consent form laws are reasonable: See if you can figure them out.

"Try to figure out what you're supposed to print. See if you get it right," said Crissman, "because every day I see patients who've driven five hours for abortion care. And they haven't gotten it right."

A pamphlet distributed to patients relies heavily on a Q&A format that appears focused on helping them navigate potential difficulties during a pregnancy. One question reads: "How am I supposed to eat healthy food when it costs so much?" The answer: Try food stamps. Q: "What if my house or apartment is in an unsafe neighborhood?" A: Have a "safety plan in mind" and "lock your doors."

The pamphlet features pictures of smiling pregnant women cradling their bellies and beaming parents holding sleeping newborns. At a statehouse hearing last month, Sarah Wallett, chief medical operating officer of Planned Parenthood of Michigan, said state law mandates these materials be provided to all patients, regardless of their circumstances. One patient was ending a much-wanted pregnancy because of a fetal "anomaly incompatible with life," Wallett said. "She asked me with tears in her eyes why I had forced her to look at information that wasn’t relevant to her, that only made this harder for her and her family going through this heartbreak. I could only reply, 'Because Michigan law requires me to.'"

Once patients have reviewed the required materials, they need to click "finish." That automatically generates a signature form, with a date and time stamp of the exact moment they clicked "finish." That time stamp must be at least 24 hours, but no more than two weeks, before their appointment. Otherwise, under Michigan law, the appointment must be canceled.

Patients must then print and bring a copy of that signed, time-stamped page to the appointment.

Cancellations over paperwork can lead to increased risks

Planned Parenthood of Michigan reports turning away at least 150 patients a month because of mistakes with that form: The patient didn't sign it in the proper time window, or printed the wrong page, or didn't have a printer.

That delay in care can be medically risky, said OB-GYN Charita Roque, who testified at the hearing for the Reproductive Health Act. Roque explained that a patient had developed peripartum cardiomyopathy, a potentially life-threatening heart problem that can occur during pregnancy.

"Not wanting to risk her life, or leave the young child she already had without a mother, she decided to get an abortion," said Roque, who is also an assistant professor at Western Michigan University's medical school. "But by the time she finally got to me, she was 13 weeks pregnant, and the clock was ticking due to her high-risk health status."

The patient didn't have a printer, so when she arrived at her appointment, she hadn't brought a hard copy of the required form. Her appointment was postponed.

"During that time, her cardiac status became even higher risk, and it was evident that she would need a higher level of care in a hospital setting," Roque said. "This meant that the cost would be much, much higher: over $10,000. And since her insurance was legally prohibited from covering abortion care, she anticipated she would have to incur significant medical debt. In the end, she suffered a five-week delay from the first day I saw her [to] when her procedure was finally completed. The delay was entirely unnecessary."

A Democrat breaks with her party

Republicans and abortion opponents have called the Reproductive Health Act a political overreach, pointing out that the bills go far beyond Proposal 3's promise, which was to "#RestoreRoe."

"The so-called Reproductive Health Act, with its dangerous and unpopular changes, goes far beyond what Michigan voters approved in Proposal 3 of 2022," Republican state Rep. Ken Borton said in a statement. "While claiming to promote reproductive health, this plan ultimately risks hurting Michigan residents by undermining patients and decriminalizing the worst parts of abortion practices.”

Still, until a few weeks ago, Democrats appeared poised to pass the Reproductive Health Act through their majorities in the House and Senate. Gov. Gretchen Whitmer vowed to sign it.

Then, on Sept. 20, state Rep. Karen Whitsett stunned her party: She cast the lone Democratic "no" vote in the House of Representatives health policy committee. The bills still passed out of committee, but the Democrats' majority in the House is so slim, they can't afford to lose a single vote.

Whitsett said that she's not alone in her concerns, and that other Democrats in the state legislature have privately voiced similar doubts about the legislation.

At first, Whitsett said, she thought her discussions with Democratic leadership were productive, "that we were actually getting somewhere. But it was pushed through. And I was asked to either not come to work, or to pass on my vote. I’m not doing either of those."

It's not that Whitsett doesn't support abortion rights, she said. "I’ve been raped. I’ve gone through the process of trying to make the hard decision. I did the 24-hour pause. I did all these things that everyone else is currently going through."

And because she's had an abortion, she said, she is proof the current restrictions aren't so unreasonable. If the current online forms are confusing, she said, "let's bring this into 2023: How about you DocuSign? But I still do not think that 24 hours of a pause, to make sure you’re making the right decision, is too much to ask."

Most of all, Whitsett said, her constituents in Detroit and Dearborn do not want Medicaid — and, therefore, their tax dollars — funding elective abortions. Medicaid is jointly funded by state and federal dollars, and the long-standing federal "Hyde Amendment" prohibits federal funds from paying for abortions except in the case of rape or incest, or to save the life of the patient. But states have the option to use their own funding to cover abortion care for Medicaid recipients.

In Michigan, voters approved a ban in 1988 on state funding for abortion, but the new legislation would overturn that. The change would increase state Medicaid costs by an estimated $2 million-$6 million, according to a Michigan House Fiscal Agency analysis.

"People are saying, 'I agree to reproductive health. But I never agreed to pay for it,'" Whitsett said. "And I think that’s very fair. … I just do not think that that’s something that should be asked of anyone as a taxpayer."

As legislative clock ticks, political pressures ramp up

Whitsett is now the target of a public pressure campaign by advocacy groups such as the American Civil Liberties Union of Michigan and Planned Parenthood of Michigan. A virtual event targeted Detroit voters in Whitsett's district. Paula Thornton-Greer, president and CEO of Planned Parenthood of Michigan, issued a public statement claiming Whitsett would be "solely responsible for the continued enforcement of dozens of anti-abortion restrictions that disproportionately harm women of color and people who are struggling to make ends meet."

Crissman, the OB-GYN, said she's tired of not being able to give her patients the care they seek.

"I wish Rep. Whitsett could sit with me and tell a patient to their face: 'No, we can’t provide your abortion care today, because you printed the wrong page on this 24-hour consent,'" Crissman said. "Or 'No, mother of five trying to make ends meet and feed your kids, you can’t use your Medicaid to pay for abortion care.' Because I don't want to tell patients that anymore."

But abortion opponents say they're not surprised the legislation has stalled.

"These hastily crafted bills present a real danger to women and our broader communities," said Genevieve Marnon, legislative director of Right to Life of Michigan, in an email. "I have no doubt many people of good conscience are finding cause for hesitation, for a whole host of reasons.”

On Monday, Gov. Whitmer told reporters she still expects "the whole package" of legislation in the Reproductive Health Act to pass.

"Any and every bill of the RHA that hits my desk, I'm going to sign. I'd like to see them come as a package. It's important, and I think that the voters expect that. It was a result of an overwhelming effort to enshrine these rights into our constitution. But also with an expectation that additional barriers are going to be leveled. So I'm not going to pick and choose. I'm not going to say that I can live with this and not that. I want to see the whole package hit my desk."

This article is from a partnership that includes Michigan Radio, NPR, and KFF Health News.