Celal Gunes / Anadolu Agency via Getty Images
In their first full legislative sessions after the Supreme Court overruled Roe v. Wade, Republican state legislators are being pressed on what “pro-life” really means. There are plenty of bills focusing on abortion restrictions — particularly in the Republican-controlled states where abortion is still largely legal — but GOP lawmakers are also being pushed to consider new protections for pregnant women and new mothers.
These new proposals — which usually involve strengthening social safety net protections for low-income women — fly in the face of Republican orthodoxy about limited government. Of the 14 states with near-total bans or where abortion is unavailable, at least six have passed or are considering some type of law that would create additional support for pregnant women, new mothers or young children, and seven additional Republican-controlled states with less restrictive abortion laws are considering similar legislation.
In Mississippi, for example, the Republican governor and House speaker initially opposed a new program that would expand postpartum Medicaid coverage from 60 days to 12 months. Last spring, as other red and blue states were adopting the proposal, Mississippi House Speaker Philip Gunn said he wasn’t in support. Less than a year later, with an abortion ban in place, Gunn changed his tune — albeit reluctantly. A postpartum Medicaid expansion bill passed the Mississippi Legislature, with the governor’s blessing and a promise from Gunn not to stand in the way, and several other lingering Republican-controlled holdouts are considering adopting the measure as well — although the proposal hasn’t had legs everywhere. A Republican-sponsored version died in the Utah legislature earlier this month.
Postpartum Medicaid expansion is just one example. “We’re seeing a lot of activity at the state level this year that I’d call ‘post-Dobbs guilt bills,’” said Joan Alker, executive director of the Georgetown University Center for Children and Families. Some of these proposals don’t push the envelope — three Republican-controlled legislatures in states where abortion isn’t banned are considering direct funding or tax credits for donating to crisis pregnancy centers, which was a common legislative response to the idea that anti-abortion lawmakers don’t care about pregnant women or new moms, even before the Dobbs decision. Others are less traditional. In North Dakota, lawmakers are considering raising income limits for food stamps; in Idaho, a Republican lawmaker proposed expanding eligibility for the Children’s Health Insurance Program, to bring the state in line with national averages.
“It’s a new era, one that conservatives aren’t used to,” said Patrick Brown, a fellow at the right-leaning Ethics and Public Policy Center. “At this point it’s insufficient to focus on a purely legal action to defend life in the womb. We need to be doing more to support low-income moms and parents of all kinds, and that’s pro-life too.”
It’s well documented that states with abortion bans have among the country’s highest rates of maternal and infant mortality and some of the weakest social safety net protections for parents and children. And until recently, lawmakers in those states didn’t seem especially motivated to do anything about it. Many states seized the chance to expand postpartum Medicaid to 12 months when Democrats included it as a new option in the 2021 pandemic relief bill, but some Republican-controlled states were uninterested — even though the federal government would pick up most of the tab, and the proposal would only expand the length of access, without adding anyone new to the Medicaid rolls. Alker chalked their reluctance up to political opposition to social safety net expansions. “Most states really jumped at the opportunity to pick up this new option,” she said. “The ones that didn’t — well, there are some politicians who are just very opposed to putting anyone on Medicaid.”
But as abortion bans rippled across the country, this opposition has become harder for Republicans to justify. The women who obtain abortions are overwhelmingly poor, and the ones who are unable to travel out of state for an abortion are especially likely to be low-income. Most states with abortion bans have not expanded Medicaid, which puts women in an even more precarious position once they’ve given birth. Many simply lose the Medicaid coverage they got while they were pregnant — which is easier to obtain than regular Medicaid, thanks to higher income cutoffs — and become uninsured, which can be dangerous, since about one-third of pregnancy-related deaths happen in the year after birth. That’s why many researchers predicted that overturning Roe could make the U.S.’s already-high levels of maternal mortality even worse.
By the end of states’ legislative sessions, as many as four additional Republican-controlled states may have adopted a postpartum Medicaid expansion — although some lawmakers are fighting over the details. In Missouri, for example, anti-abortion lawmakers added an amendment that would prohibit women who have received abortions in violation of state law from qualifying for the coverage — which could keep the federal agency that administers Medicare and Medicaid from accepting the legislation if it passes.
Some of this year’s proposals to help families serve more traditional anti-abortion goals, like the tax credits for donations to crisis pregnancy centers. These organizations historically focused on convincing women not to have abortions — a goal that’s still very much front and center in states where abortion remains legal. And other lawmakers are focusing on beefing up protections for unborn children — like in Arkansas, where the legislature is considering a bill that would allow parents to claim fetuses as dependents on their tax returns.
In general, Republicans are not on the same page about what additional support should be available to families in a post-Roe era — nor are anti-abortion advocates outside of legislatures. “We need to be working to make the Republican Party into a truly pro-life party, but we were just not ready at all to make that pivot when Dobbs happened,” said Charles Camosy, a bioethics professor at the Creighton University School of Medicine and the co-author of a statement signed by a number of prominent anti-abortion advocates calling for “bold, new pro-family policies,” including expanded child tax credits and paid parental leave.
There are a handful of examples of GOP lawmakers who have bucked the party line by pushing for new benefits for parents and families, but so far results have been mixed. South Dakota Gov. Kristi Noem championed a new paid family leave program for state employees, with an option for private employers to buy into, but it failed in the legislature. A child tax credit for low-income families proposed by Montana Gov. Greg Gianforte might still have a shot, though. And the jury’s still out on the fate of a proposal introduced by Tennessee Gov. Bill Lee in his annual address to the state, where he suggested adding a diaper benefit for the first two years of a child’s life to the state’s Medicaid program.
Advocates like Brown and Camosy, though, are hopeful that Republicans will become less allergic to social safety net spending for families as time goes on. Brown pointed out that, according to polling by his organization, support for policies like paid family leave is pretty high among Republicans — and 60 percent of Republicans think that families today have it harder than families 50 years ago.
But Republican voters — like politicians — aren’t overwhelmingly sold on the idea of spending more money to support families, even when aid is targeted to low-income people. In the survey Brown cited, 46 percent of Republicans said they’d support a plan that would “increase state spending on low-income pregnant and new mothers, including expanded Medicaid coverage of prenatal and postnatal health care,” while 33 percent said they opposed it, and 21 percent were unsure.
“I think the boat is slowly turning,” Brown said. “But it’s an ocean liner, and we’re talking about reorienting society to be more pro-parent and pro-family, which will take some time.”