Ohio Republicans are defying voters to pursue a backdoor abortion ban

It seems that Republican lawmakers in Ohio can’t take no for an answer. Despite a 2023 ballot measure codifying reproductive freedom in the state constitution, Republicans are still trying everything they can to make abortion inaccessible. These efforts include attempts to restrict medication abortion and shutter clinics.

Ohio is yet another example of the limits of direct democracy alone: While people can vote to uphold rights they care about, lawmakers who oppose those rights can still work to chip away at them.

The 2023 vote was a resounding 57% yes to 43% no — meaning abortion rights are more popular in Ohio than Donald Trump was in any of his three victories there. Issue 1 said Ohioans have the right to make their own decisions about abortion through fetal viability, contraception, miscarriage care, and more. And it declared that the state shall not “burden, penalize, prohibit, interfere with” a person voluntarily making reproductive decisions.

Despite the will of the people, the state Attorney General and Republican lawmakers are still trying to enforce as many abortion restrictions as possible. Local reproductive freedom advocates believe that abortion opponents want to test the bounds of what exactly it means not to burden or interfere with the right to get an abortion.

In recent weeks, lawmakers have signaled a new strategy to ban abortion without passing an explicit ban: they’re coming for telemedicine abortion and for clinics’ Medicaid funding. And restricting both could function as a backdoor ban. As Jaime Miracle, deputy director of the pro-choice organization Abortion Forward, told a local outlet: “We’re seeing bill after bill after bill trying to undo the will of the voters.” 

More than one in four abortions nationwide are done with pills via telehealth, typically using the medications mifepristone and misoprostol sent by mail. Ohioans have only been able to get telehealth abortions from in-state providers for the past year after a judge paused a law requiring in-person visits for abortion separated by a 24-hour waiting period; the judge said the law was unconstitutional under the 2023 amendment. But House Republicans recently passed a bill, dubbed the “Patient Protection Act,” that would effectively ban telemedicine abortions, though you wouldn’t know it by reading the bill. It would require in-person appointments for medications that the Department of Health determines have “severe adverse effects” in more than 5% of users. The bill doesn’t explicitly name medication abortion, but anti-abortion groups mentioned it in their testimony.

Ohio is yet another example of the limits of direct democracy alone: While people can vote to uphold rights they care about, lawmakers who oppose those rights can still work to chip away at them.

If that bill doesn’t work, the Attorney General is hoping to ban telehealth abortions via an ongoing lawsuit over the state’s six-week ban. A judge struck down the ban in late 2024 — again, citing the constitutional amendment — though the state is still in court trying to enforce about a dozen other provisions in the law. One such provision makes it a felony to perform an abortion without checking cardiac activity via an ultrasound; it also allows the State Medical Board to revoke doctors’ licenses if they don’t complete that step. Requiring an ultrasound means patients have to be seen in person, which is just another way to end abortion pills by mail. The ACLU of Ohio argues that the other components of the law hinge on the six-week ban being in place, so a judge should keep the rest of the law blocked. 

State lawmakers are also seeking to codify a federal ban on Medicaid reimbursements for birth control and other services if a clinic also provides abortion. (President Donald Trump signed that law in July; Planned Parenthood called it a backdoor ban.) Ohio already bans Medicaid from covering abortions in nearly all circumstances, so HB 410 would mean that the state’s 13 clinics wouldn’t get reimbursement for providing contraception, cancer screenings, STI testing, and more for patients with Medicaid insurance. 

Planned Parenthood Advocates of Ohio testified that the bill is an attempt to force clinics to stop providing abortions — or to simply close their doors altogether. “What you’re saying is that the only way that we could survive and stay open is if we absolutely drop abortion care services, which I can tell you, is absolutely not happening, because it is a constitutionally protected right,” said Danielle Firsich, director of Public Policy for Planned Parenthood Advocates of Ohio. So abortion could remain legal, but there would be fewer and fewer places to access it.

Co-sponsor Rep. Jean Schmidt (R) claimed in a committee hearing that her bill doesn’t interfere with the constitutional amendment. “Although I do not believe they should exist, entities that provide elective abortions can continue to operate in Ohio and allow women to exercise that constitutional right to choose — the state will simply not provide the funding,” Schmidt said.

Disputes over these laws, should they pass, will end up at the state supreme court — which has a conservative supermajority.

Direct democracy can be a force for good, but it’s not always enough to protect people’s rights. In order to have state policies that actually reflect the will of the people, not well-funded activist groups, we need to ban gerrymandering, protect access to the ballot, and end unlimited spending on elections. Without taking those steps, electing politicians who support the will of the voters is increasingly difficult — and that may have been the point all along.

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Susan Rinkunas is an independent journalist covering abortion, reproductive health, and politics. She is a cofounder of Autonomy News, and a contributing writer at Jezebel. Her reporting has appeared in The Guardian, Slate, The New Republic, The Nation and more.

As a Democracy Docket contributor, Susan covers the intersection of abortion, bodily autonomy and democracy.