State Rep. Kelly Cassidy, D-Chicago, speaks on the House floor in favor of a broad bill that requires insurance coverage of abortion and gender-affirming care medications, along with elements aimed at growing Illinois’ reproductive health care work force. (Blueroomstream.com)

SPRINGFIELD – Six months after the U.S. Supreme Court overturned nearly 50 years of precedent providing for legal abortion, Democrats in the Illinois General Assembly have their eye on once again expanding access to reproductive health care as the state solidifies its position as a “haven” for abortion in the largely red Midwest.

But some advocates in Illinois are looking beyond strengthening the health care system around reproductive rights in Illinois and are also seeking to establish protections for those seeking and performing gender-affirming care — a practice some Republican-led states have already begun clamping down on in addition to restricting abortion access.

“Make no mistake that the attacks on gender-affirming care come from the same place as the attacks on reproductive health care,” Planned Parenthood of Illinois vice president Brigid Leahy told a panel of lawmakers this week. “They simply do not trust people to make their own health care decisions.”

Under legislation passed in the Illinois House late Thursday, insurance plans regulated by the state would be required to cover — at no cost to the patient — abortion medications typically used up to about 10 weeks of pregnancy, in addition to gender-affirming medications like hormones. The measure also requires the same coverage of medications aimed at preventing HIV infections like PrEP and PEP.

However, the state doesn’t have the power to regulate most employer-provided insurance plans in the private sector, exempting those plans from the required coverage.

Still, the bill would apply to thousands of individuals who buy their own health insurance or are public employees in Illinois, although bill sponsor Kelly Cassidy, D-Chicago, maintained the extra cost to taxpayers would be negligible, as many insurers already cover those medications at no cost.

Republicans balked at the idea that insurance companies would be required to pay for abortion medication even if there is no proof of pregnancy, meaning that people could hold onto the shelf-stable pills until a need arises.

“Your insurance provider may not be required to cover insulin, but would be required to cover an abortion (medication)?” State. Rep. Avery Bourne, R-Morrisonville, asked Cassidy during a hearing this week.

“If you would like to sponsor a bill requiring coverage of insulin, I would be the chief co-sponsor, representative,” Cassidy responded.

Pressure for Senate action

After the bill’s passage in the House late Thursday night Jan. 5, the Senate briefly convened on Friday, Jan. 6 before leaving for the weekend. Democratic leadership in that chamber has been non-committal on taking up the House’s proposal, instead introducing its own more stripped-down version that doesn’t include references to gender-affirming care.

The legislation shares center stage with a measure that would ban the manufacture and sale of assault weapons in Illinois during lawmakers’ “lame duck” session in Springfield ahead of a new General Assembly term that begins Wednesday.

In a short statement Friday, Senate President Don Harmon, D-Oak Park, said only that the assault weapons legislation and abortion expansion bill are “critically important issues” and that his chamber is “giving these proposals an extensive review and careful evaluation” in order to enact “the most effective legislation possible.”

Advocates spent Friday pressuring Senate leadership to pass Cassidy’s bill. During debate Thursday evening, Cassidy called certain Republicans “bullies” as they debated her, using rhetoric she said was offensive and harmful to the trans community.

Outgoing State Rep. Tom Morrison, R-Palatine, said he was worried about current trans youth someday regretting their decision to seek gender-affirming care, particularly if they choose to go through surgery, which Morrison decried as even more readily available in Illinois “because now it’s being subsidized by everyone.”

“What we’ve also seen over the years is an enormous uptick in attacks and abuse — some of it led by you — against trans youth,” Cassidy told Morrison. “And I’m very proud to say that I stand with trans youth. I protect trans youth against bullies like you, sir.”

The bill doesn’t include any minimum age for youth seeking gender-affirming care, but Cassidy said the general “standard of care” includes parents in health care decisions. Bourne, however, balked at the reliance on an industry’s self-guidance, and pointed out that Democrats had repealed Illinois’ Parental Notice of Abortion Act in late 2021, meaning teens could seek an abortion without their parent or guardian’s involvement or even knowing.

Expanding abortion access through shield laws, tweaks to licensure

Other provisions in the bill would offer both legal protections and licensure opportunities to health care professionals from other states that have banned or restricted abortions and gender-affirming care.

For example, the legislation establishes “shield laws” similar to ones in Massachusetts, California and a handful of other East Coast states, protecting information about abortions and gender-affirming care from being subject to subpoenas and orders for witness testimony issued from courts in other states.

And if a medical professional — anyone from a physician to a genetic counselor to a therapist — had his or her license revoked in another state solely for performing abortions or trans-related care, he or she would be able to practice in Illinois, pending an investigation by Illinois’ professional licensure oversight authority.

Illinois would also grant temporary two-year licenses to doctors, physician assistants and nurse practitioners in order to meet the growing need for abortion-related services in the state. The action is similar to one the state took in 2020 to address COVID-19-related hospital staff shortages.

Illinois had already been seeing steady increases from out-of-state abortion-seekers even prior to Roe v. Wade’s reversal in June, but reproductive health advocates have been planning a build-out of services for years, anticipating the need for more providers. In order to help grow that workforce, the legislation would allow for nurse practitioners and physician assistants to perform non-surgical “vacuum aspiration” abortions – the most common type of in-clinic abortion procedure, which typically doesn’t require general anesthesia.

Another move designed to expand the capacity of Illinois’ reproductive health care system would allow birth centers to provide reproductive health services beyond childbirth and caring for newborns.

Plan B vending machines, birth control-dispensing pharmacists

Also included in the legislation is a requirement that both public and private universities in Illinois, in addition to community colleges, maintain at least one vending machine on each of its campuses that sells emergency contraception, also known as the Plan B pill, for no more than $40.

The bill would also expand a 2021 state law that allows pharmacists to dispense birth control under what’s known as a “standing order,” rather than monthly prescriptions from a doctor. Along with Arizona, New Hampshire, Utah and West Virginia, Illinois already allows for these standing orders from either physicians or a state health authority to govern birth control dispensary from specially trained pharmacists, but under the legislation passed by the House, the state’s Department of Public Health could issue that standing order, rather than local health departments.

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