The swing state could soon lose all abortion access if Roe is overturned. It could also become a destination for patients across the midwest.

Abortion-rights advocates rally outside the State House floor in Lansing, Mich. | Matthew Dae Smith/Lansing State Journal via AP

WESTLAND, Mich. — In 1966, 15-year-old Renee Chelian lay down, blindfolded, in the back seat of a stranger’s car and rode to a Detroit warehouse packed with other patients for a pre-Roe, illegal abortion. Her parents arranged it on the phone, using code words because they shared the line with neighboring houses and feared prosecution. It cost $3,000 — nearly $27,000 today — and she had to return home to pass the pregnancy, painfully, over many hours, into the toilet.

She was admonished by her parents never to speak of it and told no one would marry her if they knew. For two decades, she didn’t say a word.

Yet Chelian described her abortion as feeling like a second chance from God — a rescue from having to drop out of school, marry her 16-year-old boyfriend and abandon her career dreams. Today, she runs Northland Family Planning Center — a group of clinics in the Detroit and Ann Arbor suburbs — with her two daughters, and, like hundreds of abortion providers across the country, is waiting to learn whether a Supreme Court decision, expected in the coming weeks, will force her to close her doors.

“The idea that we’re going back to where we were when I started my career makes me sick to my stomach,” she told POLITICO in the conference room of one of her clinics.

Chelian now is among the tens of thousands of providers, lawmakers and volunteers fighting to keep the state law that necessitated her covert abortion decades ago from once again taking effect should federal protections fall.

The uncertainty over Michigan’s 1931 law, which has no exceptions for rape or incest, has providers like her preparing for two scenarios: a near-total ban that could make them close their practices, or, if one of their strategies to block the 90-year-old law succeeds, and abortion is protected, a surge of patients from Indiana, Ohio, Wisconsin and other nearby states that could overwhelm their resources.

At the same time, conservative officials, candidates and advocates who are fighting to preserve the state’s abortion ban in court, in the capitol in Lansing, and on the campaign trail are grappling with a different set of questions: should they enforce the 1931 ban if the Supreme Court gives a green light or pass an updated and possibly more moderate version? And how harshly should the state punish violators?

“I don’t know where we will land on that,” said Rep. Pam Hornberger, the Republican speaker pro-tempore of the Michigan state legislature. “None of us are thinking we’re going to let this 1931 law go back into effect and people are going to start getting arrested. Instead, we are fully prepared to have those difficult conversations with our colleagues.”

Republicans, many of whom are hesitant to discuss the potential ban, are also split over whether the state needs to boost health care or child care funding or make other preparations for either a ban or a surge in demand — even as health care workers across the state warn that patients could be in serious risk in just a matter of weeks.

“I’m worried we’re going to start seeing more patients from out of state, sicker patients, and patients who are further along in their pregnancies because they’ve had to figure out how to afford the trip,” Sarah Wallett, the chief medical officer of Planned Parenthood of Michigan, told POLITICO. “I’m also afraid that if there’s a surge, something will have to give. Will that be birth control? STD screenings?”

Sitting in the lobby of the group’s Ann Arbor clinic in navy blue scrubs and a silver necklace reading “1973” — the year Roe was decided — Wallett explained that the clinic doubled its capacity at the end of last year. The group also has tried to recruit more doctors, nurses and medical assistants, but have struggled to do so as pandemic burnout plagues the health care workforce.

But Wallett, who is also the lead plaintiff in Planned Parenthood’s lawsuit against the state’s 1931 abortion ban, said despite a preliminary injunction the group recently won in that case, they’re also preparing for the ban taking effect.

“I get teary-eyed just thinking about it, but we have been developing a plan for if the Supreme Court decision comes down in the middle of the day when patients are here, and we have to look them in the eye and tell them: ‘I have the ability to help you, but I won’t because I’d be committing a felony,’” she said.

In Michigan, providers could face up to 15 years in prison for violating the state’s ban if the Supreme Court allows it to be enforced. And as Texas — which last September banned most abortions — demonstrated, few, if any, providers are willing to violate the bans given the threat of prosecution and lengthy prison sentences.

A decision overturning Roe v. Wade would almost immediately outlaw abortion in nearly half of states, leaving millions to choose among terminating their pregnancy with pills ordered online, carrying an unwanted pregnancy to term or employing the same underground and risky methods as Chelian turned to nearly 60 years ago.

“While my heart does break for what’s going to happen everywhere else, I’m not letting myself go there right now,” Chelian said. “I’m putting every bit of energy I have into keeping Michigan a safe state not just for the people who are from Michigan but for those people who are going to have to travel from other states.”

Chelian is preparing for Michigan’s ban to potentially take effect by putting away funds so her clinics can keep paying rent and for around-the-clock security guards even if they have to temporarily shut down while waiting for either the lawsuits or ballot initiative to restore abortion rights.

She’s also preparing for a potential patient surge, weighing the possibility of opening a new clinic that just provides abortion pills so that her existing clinics can handle more patients who need a surgical procedure. She’s also in touch with Ohio clinics that are less than an hour away, and may be forced to close if Roe falls, to discuss whether they can do an ultrasound and blood test on patients before sending them to Chelian’s clinic for the abortion itself.

“Everything is up in the air,” she said.

The scramble isn’t only affecting abortion clinics. Lisa Harris, an OB-GYN and researcher at the University of Michigan, said hospitals like the one where she works are also forming contingency plans.

“Ban-wise, we’re trying to figure out which patients we can still care for, when a pregnancy is a threat to their life, and when we’ll need to make a referral out of state or out of the country,” she said, noting that for many Michigan patients, the nearest option may be in Canada. “We also need to train people in how to care for people who are self-managing their abortions and prepare for a potential birth surge, and we only have so many operating rooms. We’re already at or above capacity most of the time in terms of maternity care.”

Among the factors that could decide which way the state tips in a post-Roe world are two lawsuits filed by Gov. Gretchen Whitmer and Planned Parenthood that ask the state supreme court to decide whether the Michigan constitution protects abortion. There is also a possibility that new district maps, drawn by an independent panel, help Democrats take control of the state legislature for the first time since the early 1980s and pass pro-abortion rights legislation. Meanwhile, volunteers are gathering signatures to put an abortion rights constitutional amendment on the ballot this fall, and Whitmer and Attorney General Dana Nessel — two Democrats who support abortion rights — are up for reelection.

Nessel is vowing not to bring charges against doctors or patients, while her GOP opponent has said he will enforce the state’s ban.

“It’s prosecutorial discretion. I don’t have to enforce those laws. There’s all kinds of laws in the books. Adultery is still a crime here in Michigan, and you know, I haven’t enforced that,” Nessel told POLITICO.

Nessel, though, can’t stop the state’s 83 locally-elected county prosecutors from charging people who provide abortions, and she fears the threat of prosecution will cause doctors to turn patients away even in life-threatening situations that are supposed to be exempt from the ban.

“What type of doctor is going perform an abortion, even under emergency circumstances, if he or she thinks they are going to be criminally charged, and are going to have to defend themselves?” Nessel said. “I worry they’re just going to let the person die on the table. You’re looking at doctors losing their license, you’re looking at insurance carriers dropping that physician. Nobody would risk that.”

Nessel has also refused to defend the state’s 1931 abortion ban in court, prompting the Republican majority in the state legislature to do so themselves earlier this week.

“I wish we weren’t in this position but we are — we had to have a defendant,” Hornberger said. “But if Roe is overturned, we need to have civil conversations about what abortion looks like in the state of Michigan. It would be foolish of us, Republicans or Democrats, as polarizing as this is, to think we can just ignore that 1931 law.”

Other conservative officials, candidates and activists are divided on what the state needs to do, if anything, to prepare for the potential elimination of abortion rights.

Asked whether Michigan should offer more resources to parents if the ban takes effect, Kristina Karamo, the Republican running for secretary of state, argued that wasn’t the government’s place.

“I think a lot of institutions within our community, like religious organizations, are great tools to help identify and alleviate those issues,” she said. “I think oftentimes when we look for government to fix stuff, we cause more harm than good.”

Some advocacy groups disagree. Students for Life of America, a national anti-abortion rights group with a Michigan chapter, is pushing lawmakers in Lansing to reintroduce legislation that would provide $16 million in funding for pregnancy resource centers — often faith-based facilities that discourage people from having abortions and help arrange adoptions. Whitmer vetoed that funding last year.

And Tudor Dixon, who is running in the GOP primary to challenge Whitmer this fall and who recently won the endorsement of Right to Life of Michigan, said more funding and law changes are needed, but declined to specify.

“This state is not providing what it needs to families to make sure young women and young families feel supported enough that they can afford to have a baby,” she said.

Harris at the University of Michigan and other health care providers in the state argue these discussions are inadequate and that the state is nowhere near ready to handle the ripple effects of its abortion ban taking effect.

“The people who want to ban abortion want to see more babies born. But I haven’t seen the same policymakers prepare for that,” she said. “They’re not expanding prenatal care. They’re not expanding maternity care. They’re not expanding parental leave and other supports that are going to be much more needed in a post-Roe world.”

With the country poised to become divided into abortion deserts and abortion havens in the next few weeks, only a few states, including Michigan, could conceivably go either way.

Rep. Donna Lasinski, the Democratic minority leader of the Michigan state house, told POLITICO that precarity has motivated voters in a way she’s never seen — evident in the outpouring of residents volunteering for the ballot initiative campaign, donating, and calling her and her colleagues’ offices to ask what they can do.

“I think we had gotten so used to, as a nation, the debate about Roe v. Wade, and saw it as just one long argument between a couple that’s been married for 50 years and that was going to continue forever,” she said. “I think that veil has been drawn back. I think folks understand now that someone else isn’t going to take care of this for them — that they are going to have to stand up and take care of it themselves.”