Telehealth activists, providers face challenges with Trump assuming office

Jurisdictional questions, whether medical sector completely supports them among the questions that Telehealth abortion providers face.

Abortion providers are anxiously waiting to see what will happen during the incoming Trump Administration. 

The first thing that most people will watch for will be whether the Food and Drug Administration will rescind approval for mifepristone and misoprostol, which work in tandem to cause abortion. Secondly, there is an antiquated law known as the Comstock Act that forbids the mailing of contraceptives and abortifacients. It could be used to prevent the dispensing of modern-day medication. Elisa Wells, co-director of Plan C, a national campaign for abortion pill access, spoke to me over the phone. 

“It's hard to know what we're going to be able to accomplish under a Trump administration,” Wells said. “I think our best hope is with liberal states, such as the ones that have enacted protections for providers under these shield laws and in those same states to protect access to in-person services. 

“But even that has the potential to be overridden by federal federal legislation or decision-making.” 

A study from the Journal of the American Medical Association shows no marked difference between the effectiveness and safety of abortion medication distributed through telehealth versus in-person dispensing. The paper, Comparison of No-Test Telehealth and In-Person Medication Abortion, was co-authored by Dr. Lauren J. Ralph, Dr. C. Finley Baba, and Dr. M Antonia Biggs. The study found that medication abortion obtained following no-test telehealth screening and mailing of medications was associated with similar rates of complete abortion compared with in-person care with ultrasonography (94.4% vs. 93.3%, respectively) with a low prevalence of adverse events.

Some organizations and doctors have dragged their feet supporting telehealth because it removes operating revenue from their businesses. The San Francisco Chronicle reported in June that Planned Parenthood privately lobbied officials in California, New York, and Massachusetts against shield laws allowing doctors to provide abortion medication via telehealth, sources told the Chronicle. They aren’t alone. I’ve also spoken to some abortion providers who don’t support it at all. 

One thing to remember with all this is that even though most abortions now are done through medication, it doesn’t diminish the need for the surgical option because there are often complications, and some patients still prefer that method. We should fight for various services, including expanded telehealth and medication access. 

As I reported before, there also remain many challenges at lower levels of government as there are jurisdictional disputes between different states over where the location of an abortion should be designated. That matters because pills can be prescribed from elsewhere and taken in an abortion-restrictive or banned state. If the abortion is deemed to have happened in a place like Alabama, then it would be considered a violation of state law. 

That’s something that pioneering abortion rights scholars Greer Donley, David Cohen (no relation to Glenn), and Rachel Rebouche wrote about in a Stanford Law Review article published in February. They pointed out that the location of an abortion could be at several places. 

It could be where the patient interacts with the medical professional and receives the pills. It could be when the patient ingests the mifepristone, which could be in the medical office or later when the patient returns home. It could be where the patient ingests the misoprostol, which usually occurs twenty-four hours after the mifepristone is taken. Or it could be where the patient expels the products of conception, which could happen within hours of taking the misoprostol or a few days later. With each step, a patient could be in a different location. And the laws may differ. 

Wells’ organization has sought to lobby for more shield laws protecting telehealth providers. The progress they’ve made has encouraged her. 

“We've made amazing strides in access to abortion in our country despite the draconian bans that have been put in place,” Wells said. “There is now more abortion happening this year than there was prior to Roe being decimated by the Supreme Court.”