[Senate Hearing 118-255]
[From the U.S. Government Publishing Office]



                                ------                                
                                                        S.   Hrg. 118-255

                  NO RIGHTS TO SPEAK OF: THE ECONOMIC
                   HARMS OF RESTRICTING REPRODUCTIVE
                                FREEDOM

=======================================================================

                                HEARING

                               before the

                        COMMITTEE ON THE BUDGET
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               ----------                              

                           February 28, 2024

                               ----------                              

             Printed for use of the Committee on the Budget
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             





                                 
                                 
                                 
                                 
                                 
                                 
                                 


                                                        S. Hrg. 118-255
 
                  NO RIGHTS TO SPEAK OF: THE ECONOMIC
                   HARMS OF RESTRICTING REPRODUCTIVE
                                FREEDOM

=======================================================================

                                HEARING

                               before the

                        COMMITTEE ON THE BUDGET
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               __________

                           February 28, 2024

                               __________

             Printed for use of the Committee on the Budget
             
             
             
             
             
             [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 
	     



                            www.govinfo.gov
                            
                            
                            
                           ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 55-276          WASHINGTON : 2024                     
                            
                            
                        COMMITTEE ON THE BUDGET

               SHELDON WHITEHOUSE, Rhode Island, Chairman
PATTY MURRAY, Washington             CHARLES E. GRASSLEY, Iowa
RON WYDEN, Oregon                    MIKE CRAPO, Idaho
DEBBIE STABENOW, Michigan            LINDSEY O. GRAHAM, South Carolina
BERNARD SANDERS, Vermont             RON JOHNSON, Wisconsin
MARK R. WARNER, Virginia             MITT ROMNEY, Utah
JEFF MERKLEY, Oregon                 ROGER MARSHALL, Kansas
TIM KAINE, Virginia                  MIKE BRAUN, Indiana
CHRIS VAN HOLLEN, Maryland           JOHN KENNEDY, Louisiana
BEN RAY LUJAN, New Mexico            RICK SCOTT, Florida
ALEX PADILLA, California             MIKE LEE, Utah

                   Dan Dudis, Majority Staff Director
        Kolan Davis, Republican Staff Director and Chief Counsel
                   Mallory B. Nersesian, Chief Clerk 
                  Alexander C. Scioscia, Hearing Clerk
                            C O N T E N T S

                              ----------                              

                      WEDNESDAY, FEBRUARY 28, 2024
                OPENING STATEMENTS BY COMMITTEE MEMBERS

                                                                   Page
Senator Sheldon Whitehouse, Chairman.............................     1
    Prepared Statement...........................................    35
Senator Charles E. Grassley......................................     3
    Prepared Statement...........................................    37

                    STATEMENTS BY COMMITTEE MEMBERS

Senator Patty Murray.............................................    17
Senator John Kennedy.............................................    19
Senator Debbie Stabenow..........................................    21
Senator Mike Lee.................................................    23
Senator Jeff Merkley.............................................    25
Senator Mike Braun...............................................    27
Senator Alex Padilla.............................................    28
Senator Tim Kaine................................................    30
Senator Chris Van Hollen.........................................    32

                               WITNESSES

Prof. Caitlin Myers, John G. McCullough Professor of Economics, 
  Middlebury College.............................................     6
    Prepared Statement...........................................    39
Dr. Leilah Zahedi-Spung, MD FACOG, Maternal Fetal Medicine, 
  Complex Family Planning, Physicians for Reproductive Health....     8
    Prepared Statement...........................................    49
Mrs. Allie Phillips, Mom and Activist............................    10
    Prepared Statement...........................................    53
Mrs. Leslie Ford, Adjunct Fellow, Center on Opportunity and 
  Social Mobility,...............................................
    American Enterprise Institute................................    11
    Prepared Statement...........................................    56
Mrs. Tamra Call, MSN, RN, Executive Director, Obria Medical 
  Clinic.........................................................    13
    Prepared Statement...........................................    62

                                APPENDIX

Responses to post-hearing questions for the Record
    Mrs. Ford....................................................    65
Chart submitted by Senator Kennedy...............................   120
Statement submitted for the Record by Intersections of Our Lives.   121
Statement submitted for the Record by Reproductive Freedom for 
  All............................................................   125


                  NO RIGHTS TO SPEAK OF: THE ECONOMIC



                   HARMS OF RESTRICTING REPRODUCTIVE



                                FREEDOM

                              ----------                              


                      WEDNESDAY, FEBRUARY 28, 2024

                                           Committee on the Budget,
                                                       U.S. Senate,
                                                    Washington, DC.
    The hearing was convened, pursuant to notice, at 10:00 
a.m., in the Dirksen Senate Office Building, Room SD-608, Hon. 
Sheldon Whitehouse, Chairman of the Committee, presiding.
    Present: Senators Whitehouse, Murray, Wyden, Stabenow, 
Merkley, Kaine, Van Hollen, Padilla, Grassley, Braun, Kennedy, 
R. Scott, and Lee.
    Also present: Democratic Staff: Dan Dudis, Majority Staff 
Director; Melissa Kaplan-Pistiner, General Counsel.
    Republican Staff: Chris Conlin, Deputy Staff Director; 
Krisann Pearce, General Counsel; Ryan Flynn, Staff Assistant.
    Witnesses:
    Prof. Caitlin Myers, John G. McCullough Professor of 
Economics, Middlebury College
    Dr. Leilah Zahedi-Spung, MD FACOG, Maternal Fetal Medicine, 
Complex Family Planning, Physicians for Reproductive Health
    Mrs. Allie Phillips, Mom and Activist
    Mrs. Leslie Ford, Adjunct Fellow, Center on Opportunity and 
Social Mobility, American Enterprise Institute
    Mrs. Tamra Call, MSN, RN, Executive Director, Obria Medical 
Clinic, Ames, Iowa

          OPENING STATEMENT OF CHAIRMAN WHITEHOUSE \1\
---------------------------------------------------------------------------

    \1\ Prepared statement of Chairman Whitehouse appears in the 
appendix on page 35.
---------------------------------------------------------------------------
    Chairman Whitehouse. Good morning. I will call this session 
of the Senate Budget Committee to order. I have the permission 
from my distinguished Ranking Member's staff to proceed. We 
have multiple committees upon which we serve in the Senate and 
from time to time it's important to go check in at another 
committee to get in the queue properly. And so, Senator 
Grassley will be along. I will make my opening statement, yield 
to him, and then I'll introduce the first three witnesses. 
Senator Grassley will introduce a witness. Senator Lee will 
introduce a witness, and then we will proceed.
    We're here today to discuss women's rights. Their right to 
bodily autonomy, their right to set the course of their own 
life, and their right to economic freedom. I hear often that 
the Budget Committee should only be concerned with debt and 
deficits, but any serious conversation about debt and deficits 
must also analyze threats to economic growth and stability. 
Debt and deficits do not occur in a vacuum. They result from 
the fiscal decisions that we make and from what we do that 
strengthen or that weaken our economy.
    Reproductive rights, it turns out, are intrinsically tied 
to economic opportunity. Reproductive justice is economic 
justice. Restricting one restricts the other. As Professor 
Myers, the leading economist in this space, will testify today, 
we can measure the economic harms from dismantling Roe v. Wade, 
especially in already marginalized communities. The Dobbs 
decision triggered an immediate crisis for millions of women as 
antiquated state bans snapped back into place and some states 
implemented new restrictions on reproductive freedom.
    Our witnesses, Allie Phillips and Dr. Zahedi-Spung will 
explain how these Draconian state laws put patients, their 
families, and physicians into heartbreaking situations. About 
25 million women of reproductive age live in states with severe 
restrictions on abortion. Most in states that failed to expend 
Medicaid and already had higher rates of maternal death. Black 
women are disproportionally affected, as many live in southern 
states with the worst restrictive policies, with existing 
structural barriers to care, and with already high rates of 
pregnancy-related complication and death.
    Doctors too lose their freedom to practice medicine as they 
are trained. Delivering patient-centered, evidence-based care. 
I hear from Rhode Island OB/GYNs about their colleagues in 
other states being put in impossible positions with the lives 
of women and babies put in jeopardy. For a great many reasons, 
often deeply personal and harrowing, one in four women seek an 
abortion before age 45, one in four.
    That freedom to decide if and when to have a child affects 
a woman's life trajectory and her family's financial security. 
As the pivotal Turnaway Study found, women denied an abortion 
who had to carry a pregnancy to term were four times more 
likely to live in poverty, and the reverse holds true too. 
Reproductive freedom and choice, including abortions and 
contraception, lowers maternal mortality, alleviates health 
risks, increases women's earnings, increases the probability 
that women attend college, and boosts local economies.
    Freedom turns out to have economic value. In Planned 
Parenthood v. Casey, these economic values were actually part 
of the Court's holding. The Court said the ability of women to 
participate equally in the economic and social life of the 
nation has been facilitated by their ability to control their 
reproductive lives. Economists and researchers have since 
quantified the damage of state abortion restrictions to local 
and state economies and the correlation is easy. The more 
extreme a state's restrictions the more its economy suffers.
    A new study estimates that state abortion restrictions cost 
the national economy, on average, $173 billion per year. In 
overturning Roe and Casey, a small right-wing majority of a 
captured Supreme Court inserted the government into the 
personal life decisions of millions of women, removing that 
freedom, never minding those consequences. This is a Court with 
members on a mission. This freedom fell at their hands. Next, 
maybe the freedom to take mifepristone, an abortion medication 
long proven safe and effective. Next, could come the freedom to 
use contraception, even in vitro fertilization is under the gun 
under the hands of right-wing extremists.
    A Republican led Congress and a second Trump Administration 
could mean a national abortion ban. If re-elected, Trump could 
abuse executive power to remove mifepristone from markets or 
try to prevent abortion medications or even contraceptives from 
going through the federal mail. The Republican effort to ban 
mail order medication could cause even larger economic damage 
than Dobbs. Generations of women fought for the freedom to make 
their own personal decisions. They fought and they won, and 
their victory brought economic gains, in which we all share.
    But now, extremists are trying to undo it all, leaving 
young women and girls in America with fewer rights than their 
grandmothers. Women and girls have lives worth respecting and 
protecting and no one should be forced to carry a pregnancy to 
term against their will. Stripping women of this freedom casts 
a long shadow over their lives and over their families' lives 
and it casts a long shadow over our economy as well.
    Congress should safeguard access to abortion and 
contraception and codify Roe into law. This is something women 
should decide. It's just not the government's business. And I 
will now turn it over to Ranking Member Grassley.
    Senator Grassley. Good morning, Mr. Chairman.
    Chairman Whitehouse. Good morning, sir.
    Senator Grassley. And I'm sorry I missed the last three 
hearings because I couldn't be here.
    Chairman Whitehouse. Well, it's great to have you back and 
to have you healthy enough to be back and participate in the 
hearings again, so bravo.

           OPENING STATEMENT OF SENATOR GRASSLEY \2\
---------------------------------------------------------------------------

    \2\ Prepared statement of Senator Grassley appears in the appendix 
on page 37.
---------------------------------------------------------------------------
    Senator Grassley. Thank you. We're tackling a very serious 
topic this morning. Abortion, above all, is a moral and legal 
issue. Abortion is not an issue that lends itself to being 
looked at solely through an economic lens. After all, life is 
priceless. There's a reason this Committee historically hasn't 
delved into this issue. It's not an issue easily distilled down 
to dollars and cents typical of budget issues that this 
Committee normally works on. In fact, it is rather 
dehumanizing.
    The Chinese Communists are the best example of this when 
they instituted the one child policy, targeting female babies 
to extermination and they did this thinking it would help their 
economy, but looked what happened. Now, the Chinese realize 
it's backfiring and hurting the economy. I think right now we 
just saw statistics. They're no longer the largest population 
in the world after being supplanted by India.
    Look at Western nations like our own. We also realize we 
need more people to sustain the economy and protect Social 
Security. I guess that's one reason that we're the most 
immigrant welcoming nation by taking one million people legally 
every year into our country. So yes, having and raising 
children has cost, but so does abortion on the demand in a 
culture that lacks respect for life.
    That said, here we are. I'm pro-life, pro-family, pro-
woman. These views are not in conflict. Worthy alternatives to 
abortion exist in all but the rarest of circumstances. Numerous 
programs at the federal, state, and local levels are available 
to help women, children, and families in need. To better assist 
families, Congress should focus on reforms that increase 
coordination between all the federal programs we have. Congress 
should simplify access to these programs. It should reduce 
duplication, promote work or education, and eliminate marriage 
penalties in our tax laws.
    For years, I've been championing supporting moms and kids. 
I've worked to support and improve our adoption and foster care 
systems. I've long been a strong supporter of tax incentives 
and laws to promote adoption and reduce financial burdens 
associated with adopting a child. As then chairman of the tax 
writing Finance Committee, now 20 years ago, I helped to 
shepherd the bipartisan tax relief package that included much 
needed update on the adoption tax credit.
    Additionally, I'm a member of the Congressional Coalition 
on Adoption and founder and co-chair of the Senate Caucus on 
Foster Youth and have worked for years to improve policies and 
support for those who open their hearts and homes to children 
in need. I'm also an advocate of the Maternal, Infant, and 
Early Childhood Home Visiting Program, which serves many 
mothers and children across Iowa and other states. It's 
critical that we support the most vulnerable in our society and 
this program has been a successful tool to improve the 
livelihoods of at-risk families.
    This Congress, I've introduced the bipartisan Healthy Moms 
and Babies Act with Senator Maggie Hassan. The bill is a 
culmination of my work as Finance Committee Chairman, where I 
solicit ideas from senators, stakeholders, including Iowa 
healthcare providers and advocates on ways to improve maternal 
and childcare.
    The public is debating many abortion issues, following the 
Supreme Court Dobbs decision. Today this Committee will hear 
from two witnesses who can tell us about the types of programs 
supporting pregnant women and families. We'll also hear how 
folks in our local communities stand by their neighbors to let 
them know that they aren't alone and do have options. That's a 
type of message everyone can get behind. Thank you, Mr. 
Chairman and thank all of our witnesses for appearing today.
    Chairman Whitehouse. Thank you, Senator Grassley, and 
again, welcome back. Our first witness today is Professor 
Caitlin Myers of Middleburg College. Professor Myers is an 
applied microeconomist who uses statistical methodologies to 
measure the causal effects of reproductive policies on 
demographic, health, and economic outcomes. Her work has been 
published in leading journals in economics and public policy.
    She maintains and distributes data on abortion access to 
researchers and the public through the Abortion Access 
Dashboard and Open Science Framework. Professor Myers, thank 
you very much for being here.
    Next, we will hear from Dr. Leilah Zahedi-Spung. Dr. 
Zahedi-Spung is a board-certified OB/GYN and maternal fetal 
medicine physician in Colorado. She received her bachelor's 
degree in Biology and Psychology from the University of Georgia 
and her medical degree from Emory University.
    She serves as a member of the Society for Maternal-Fetal 
Medicine (SMFM) Productive Health Committee and a member of the 
Education Committee through the Society for Family Planning. 
Dr. Zahedi-Spung, welcome.
    Then we will hear from Mrs. Allie Phillips. Mrs. Phillips 
is a life-long Tennessean, a mother, and an activist. She 
shared her heart-breaking abortion story online and drew 
international attention. Turning her pain into passion, Mrs. 
Phillips has dedicated her time to speaking out and fighting 
back. Mrs. Phillips, we appreciate very much you taking the 
time to join us.
    And I will now turn to Senator Lee and Ranking Member 
Grassley, to introduce their witnesses.
    Senator Grassley. I have the privilege of introducing an 
Iowan from Story County, Iowa, Mrs. Tamra Call, Masters of 
Science in Nursing (MSN) and Registered Nurse (RN). She is 
Executive Director of the Obria Medical clinic in Ames, Iowa. 
Obria is a fully licensed community care clinic. It provides 
professional medical services, including consultations, well 
women care, pregnancy testing, ultrasound, health education and 
referrals. Obria employs board certified OB/GYN physicians, 
registered nurses, nurse practitioners, medical assistants, and 
support staff. Mrs. Call holds a bachelor's degree in Nursing 
and master's degree in Public Health Nursing from the 
University of Kansas.
    I'm also pleased to welcome Brece Call, Mrs. Call's 
daughter, to our hearing as well. Thank you both for being 
here.
    Chairman Whitehouse. Senator Lee, you have an introduction 
to make.

                    STATEMENT OF SENATOR LEE

    Senator Lee. Yes. Thanks so much, Mr. Chairman and Ranking 
Member Grassley. It's an honor and a privilege to be able to 
introduce my friend Leslie Ford as one of our witnesses today. 
Leslie's an Adjunct Fellow at the American Enterprise 
Institute's Center for Opportunity and Social Mobility and 
she's also the president of an entity called Ford Policy 
Solutions and a member of the State of Virginia's Department of 
Social Services State Board of Social Services, which is 
authorized to adopt and recommend policy solutions on various 
social programs within the Commonwealth of Virginia.
    She has personally served in the White House as a domestic 
policy advisor and a special assistant to the President from 
2018 to 2020, working on reforms to social safety net programs 
and also for the Administration's antipoverty agenda. But most 
importantly, it is a great opportunity for me to introduce and 
endorse her because she's a former member of my staff. She's 
served as a policy advisor in my office where she oversaw a 
policy portfolio on health, education, labor, and pensions and 
worked on the development of a whole of health and social 
safety policy bills and amendments, helped put together 
groundbreaking legislation in a number of areas, including 
education reform, welfare reform, just to name a few.
    She has, of course, moved on and become a thought leader 
and someone who's contributed to meaningful and prudent welfare 
reforms and antipoverty measure and so I look forward to 
hearing from all of our witnesses, but especially Leslie 
Ford's. Thanks.
    Chairman Whitehouse. Thank you very much, Senator Lee. Dr. 
Myers, please proceed.

   STATEMENT OF PROFESSOR CAITLIN MYERS, JOHN G. MCCULLOUGH 
         PROFESSOR OF ECONOMICS, MIDDLEBURY COLLEGE \3\
---------------------------------------------------------------------------

    \3\ Prepared statement of Dr. Myers appears in the appendix on page 
39.
---------------------------------------------------------------------------
    Dr. Myers. Chairman Whitehouse, Ranking Member Grassley, 
and members of the Committee, thank you for the opportunity to 
testify today. My name is Caitlin Myers. I'm the John G. 
McCullough Professor of Economics at Middlebury College. As a 
labor economist, I study the causal effects of contraception 
and abortion access on economic outcomes. I'm not here as an 
activist. I'm here as a scientist presenting facts and evidence 
on the ways in which reproductive policy is also fundamentally 
economic policy.
    Women make up nearly half of the U.S. labor force. Their 
increased work hours and earnings since the late 1970s have 
boosted the U.S. economy by about 11 percent and prevented 
middle-class household incomes from stagnating. The decision of 
whether and when to become a mother is the single largest 
economic decision many women will make in their lifetimes. Men 
and women's earnings trend pretty similarly right up until the 
point of parenthood. But when they become mothers, women's 
earnings fall off a cliff, declining about 30 percent and 
opening a gender gap that persists, even after the kids grow up 
and leave the home.
    Much of this gap is explained by the challenges women face 
balancing work and motherhood and it is exacerbated by the lack 
of paid family leave and high cost of childcare. Of course, 
none of this implies that women, men, and society don't benefit 
greatly from children. I'm a mother of four and for a time in 
my life I was the widowed, single mother of preschool aged 
children. I have no doubt motherhood reduced my own economic 
productivity. I'm also sure it's entirely worth it for me, and 
a decision that I would make again.
    But that's the point: the tradeoffs and decisions about 
whether and when to become a parent are inherently personal and 
closely tied to our economic lives, and even the best laid 
plans of mice and men, and let's add women, can go awry. 
Abortion is a common reproductive healthcare need. Before 
Dobbs, nearly one million pregnancies ended in abortion each 
year. That's about 20 percent of all estimated pregnancies.
    At that rate, a quarter of women will obtain an abortion in 
their lifetime. And when they do, women are often in precarious 
and vulnerable situations. Most are young mothers, nearly 
three-quarters are low income, more than half report a recent 
disruptive life event, like the loss of a job or a housing 
instability. The most frequent reasons women cite for seeking 
an abortion relate to their finances, aspirations, and ability 
to care for other children.
    This brings me to a key point. Access to contraception and 
abortion empowers women to plan their economic futures. 
Expansions in reproductive autonomy have gone hand-in-hand with 
women's economic progress. The introduction of the birth 
control pill in 1960, followed by the legalization of abortion 
in the early 1970s, accompanied a period of epochal, social, 
and economic change marked by women gaining greater education, 
strengthening attachments to the labor force, entering new 
occupations, and increasing their earnings.
    Now, we all know the maxim that correlation isn't 
necessarily causation, but in this case, it is. Ample evidence 
from multiple independent research teams uses statistical tools 
for causal inference that isolate and measure the effects of 
reproductive autonomy. The legalization of abortion rewrote 
women's lives. It reduced teen motherhood by one third and 
reduced teen marriages by one fifth. It reduced the maternal 
mortality of Black women by 30 to 50 percent.
    It allowed women to complete their education and increase 
their earnings and in doing so it improved the lives of 
children, reducing the number living in poverty and the numbers 
experiencing abuse or neglect. As they grew into adulthood, 
these children themselves had higher rates of college 
graduation, lower rates of single parenthood, and were less 
likely to be poor.
    And it's not as though the salience of abortion access has 
gone away. For instance, one study finds that as a result of 
being denied a wanted abortion, women experience a 78 percent 
increase in past due debt and an 81 percent increase in adverse 
credit events, like evictions and bankruptcies.
    Since the Dobbs decision, 14 states are enforcing near 
total abortion bans, impacting nearly a quarter of American 
women by increasing their travel distance to the nearest 
provider.
    The average affected woman now faces a journey of more than 
300 miles one way. If any of my kids needed healthcare 300 
miles away, I'd have them there tomorrow, but not everyone is 
in such a privileged position. I grew up in Burnsville, West 
Virginia and LaGrange, Georgia, and I know many people for whom 
coming up with the money, childcare, and multiple days off work 
on short notice is just not possible.
    But you don't need to rely on anecdotes. The data tell us 
that as much as a quarter of people in banned states seeking 
abortions do not find a way to travel hundreds of miles to 
obtain one. This is especially true for young women and women 
of color. And even for those who can make the trip, appointment 
availability has been severely constrained at many of the 
facilities on the frontlines to receive them.
    The first set of post-Dobbs bans is estimated to have 
resulted in about 30,000 births in 2023 that would not have 
occurred absent state bans. These children were likely born 
into some of the poorest and most economically fragile 
families, many of which contain other children as well. Right 
now, the Dobbs story is an inequality story, not a macro-level 
shock story. But depending on future policies, this could 
change.
    If abortion access were further restricted, if Congress 
were to enact a national ban, then we would begin to play the 
1970s in reverse, watching a reduction in women's capacity to 
fully participate in our nation's economy.
    To conclude, however one feels about the ethics of making 
contraception and abortion accessible, there's no denying that 
reproductive policies impact the economic lives of women and 
their families. Reproductive autonomy is inextricably linked to 
economic opportunity.
    Chairman Whitehouse. Thank you very much, Professor Myers.
    Dr. Zahedi-Spung, please proceed with your testimony.

STATEMENT OF DR. LEILAH ZAHEDI-SPUNG, MD FACOG, MATERNAL FETAL 
MEDICINE, COMPLEX FAMILY PLANNING, PHYSICIANS FOR REPRODUCTIVE 
                           HEALTH \4\
---------------------------------------------------------------------------

    \4\ Prepared statement of Dr. Zahedi-Spung appears in the appendix 
on page 49.
---------------------------------------------------------------------------
    Dr. Zahedi-Spung. Good morning, Chairman Whitehouse, 
Ranking Member Grassley, and distinguished members of the 
Committee. My name is Dr. Leilah Zahedi-Spung, and I use she/
her pronouns. I am a board certified, fellowship trained 
obstetrician/gynecologist, maternal fetal medicine, and complex 
family planning physician.
    I provide high-risk obstetric care, including ultrasounds 
and genetic testing, perform deliveries, and provide abortion 
care.
    I am here today as a Fellow with the Physicians for 
Reproductive Health. I am also a Fellow with the Society for 
Maternal Fetal Medicine and the American College of 
Obstetricians and Gynecologists. I'm a brown woman who passes 
as White, the child of a first-generation immigrant from the 
Middle East, a mother, and a proud Southerner. I grew up and 
was trained in the Southeast and I have cared for that 
community for the majority of my career.
    I became a doctor because of my commitment to care for 
people without judgment throughout the course of their lives. 
Whether I'm caring for someone who's ready to build or create a 
family, already parenting, grieving due to an unexpected 
diagnosis, or caring for someone who does not want to be 
pregnant, all of my patients have something in common. They're 
making thoughtful decisions about their health and wellbeing 
and deserve high-quality healthcare, regardless of who they are 
or where they live.
    I want to be clear today that abortion is lifesaving, 
necessary, compassionate, essential healthcare and should be 
available throughout pregnancy. I've had the honor of caring 
for a number of families who needed abortion care for a range 
of reasons, all of them medically necessary. I walked that 
journey with them, and they were so thankful to be able to 
access abortion care in their community. Since then, I've heard 
from a number of those families about subsequent pregnancies 
that led to healthy babies at the right time in their lives for 
them.
    Unfortunately, the Supreme Court's decision in Dobbs, which 
overturned the constitutional right to abortion wreaked havoc 
on communities across this country. It wreaked havoc on the 
lives of people seeking care and the physicians who are doing 
their best to care for their communities. This is also true for 
myself and my family.
    After finishing my Fellowship at Washington University in 
St. Louis, I was incredibly excited to move back to the South 
to care for my community. Shortly after moving to Tennessee, I 
realized I was the only physician who was trained to provide 
later abortion care. Prior to Dobbs, I was taking care of 
miscarriages, emergencies, and devastating circumstances for my 
entire community. Following the Court's decision, Tennessee's 
abortion ban, one of the most extreme bans in the country, went 
into effect.
    This ban did not have any exceptions, not even for life-
threatening emergencies and imposed severe criminal penalties. 
It became very clear quickly that I could no longer provide the 
care that my patients needed and deserved without facing 
significant risks to both myself and my family. And one of the 
hardest decisions I've ever had to make, my family and I 
decided to move once again to Colorado.
    The reality is I'm not alone. Many providers have been 
forced to shift care or services they provide, relocate, or 
cease offering care altogether. As a physician in Colorado, I 
am seeing first-hand the consequences of this moment and they 
are far-reaching. I am able to provide care for people based on 
what patients and I decide together is the safest and 
healthiest for their lives without political interference, but 
so many of the patients who travel to us don't have that option 
at home.
    As states continue to ban abortion, patients are having to 
travel farther and farther distances away from their homes and 
their communities, not only for their abortion care, but for 
all types of primary and preventive care. And while I am 
grateful to be able to care for these people who have made it 
to us, I can't help but think about all of the people we know 
who've been forced to remain pregnant and don't have the means 
and resources to pay for the travel, childcare, additional time 
off from work, or keep up with the increased costs as they're 
pushed later into pregnancy.
    We know from recent data that already thousands of people 
have been forced to remain pregnant since the Dobbs decision. 
This is exceptionally dangerous, given the state of maternal 
mortality and morbidity in this country and especially for our 
people of color. We already know the consequences when someone 
is denied an abortion because even before the Supreme Court's 
decision, it was incredibly difficult for many people to access 
this care.
    Studies have shown us that people who are denied an 
abortion are more likely to fall into poverty, increase their 
amount of debt, and generally, have worse financial security 
for years following their abortion denial.
    Inability to access abortion care has severe consequences, 
and this is especially true for our Black, Indigenous, and 
People of Color, who face systemic racism in all aspects of 
their lives.
    We cannot forget how collective, economic security benefits 
all of us and how abortion care restrictions harm our 
communities as a whole. Despite all of these threats, I am 
unwavering in my commitment to support people in my home and 
community in whatever way I can. It shouldn't have to be this 
way. People should be able to get care in their own communities 
in a manner that is best for them with the people they trust. I 
urge you to listen to the stories being told today by the 
people who provide and access abortion care. I hope these 
stories help you understand that abortion care is not an 
isolated political issue and to see how profoundly restrictions 
on abortion care access harm all of us and the people that we 
love. Thank you for having me.
    Chairman Whitehouse. Thank you very much, Doctor. Mrs. 
Phillips, please proceed.

       STATEMENT OF ALLIE PHILLIPS, MOM AND ACTIVIST \5\
---------------------------------------------------------------------------

    \5\ Prepared statement of Mrs. Phillips appears in the appendix on 
page 53.
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    Mrs. Phillips. Chairman Whitehouse, Ranking Member 
Grassley, and members of the Senate Budget Committee, thank you 
for inviting me here today. My name is Allie Phillips and I 
live in Clarksville, Tennessee. My husband, Brian, works for a 
forklift company and I run a small daycare out of our home. 
Together, we are raising Adalie, my six-year-old daughter.
    We are not a wealthy family. We work hard to pay our bills 
on time each month. I spent the first several years of Adalie's 
life as a single mom, working three jobs while also finishing 
up my bachelor's degree. Brian, Adalie, and I were so excited 
to learn that I was pregnant in the fall of 2022 and even more 
thrilled to find out that we were having a little girl, Miley 
Rose.
    Everything was going perfectly until the day of my routine 
anatomy scan, at 19 weeks, when my doctor told us that they had 
found multiple concerning fetal issues. Several days later as I 
waited to meet with the fetal specialist, I had no way of 
knowing that the next 10 minutes would change my life forever. 
The fetal specialist came in to go over the results and that 
list was extensive. Miley's kidneys, bladder, and stomach were 
not functioning, only two of the four chambers in her heart 
were not working. There was no amniotic fluid protecting her 
and she had a rare brain condition. Her growth was a month 
behind, and she had no lung development.
    We were told that Miley was not compatible with life. 
Completely broken, I asked what'd we do now? The doctor 
suggested I had two options. That I could terminate the 
pregnancy, but due to Tennessee's ban on abortion, I would have 
to travel out of state for that healthcare. My second option 
would be to continue my pregnancy, but risk a miscarriage, a 
still birth, or giving birth for her to be put right into 
hospice care. And the doctor warned that the longer I stayed 
pregnant the worse Miley's condition would get and the more at-
risk my health would become.
    Knowing I had a daughter and a family to live for, we made 
the difficult decision to seek an abortion. So, instead of 
grieving this devastating news, my mother and I began 
researching and calling clinics in states that allowed 
abortions after 20 weeks. Many did not have open appointments 
for weeks and the longer I waited the more extensive and 
expensive the procedure became. Ultimately, I found a clinic in 
New York City that could get me in the following week.
    Then I had to book flights, find a hotel, arrange ground 
transportation, and childcare for Adalie. We had to quickly 
figure out how to afford all of it. We didn't have thousands of 
dollars sitting in our bank account. I had to start a Go Fund 
Me effort online to help cover the unexpected medical and 
travel costs. Without the help of strangers on the Internet, I 
would not have had the freedom to leave Tennessee or to make my 
own medical decisions, rights that my state denied me.
    Days later, I arrived at a New York City clinic alone, due 
to security concerns, only patients are allowed in. I was there 
for several hours when a new ultrasound showed that Miley's 
heart was no longer beating. Sorry.
    Chairman Whitehouse. Take your time.
    Mrs. Phillips. Distraught, I called Brian, my husband, to 
tell him over the phone that our much-wanted daughter was 
already gone, and that the abortion scheduled for the following 
day would be done immediately. I went into surgery alone and I 
sat in recovery alone. I grieved her loss alone in a city I've 
never been in, far away from the comfort of my home, my family, 
and my friends. No one should be treated this way, not in 
Tennessee and not in the other 13 states that now criminalize 
abortion, the standard of care that I needed in my situation.
    Two days later, I flew back home to Tennessee. I had to go 
back to my life like nothing ever happened. I've never felt as 
small and inconsequential or unsupported as I did then. I was 
so depressed that I couldn't go to work for another week after 
we got back and altogether Brian and I lost three weeks of pay, 
which is rough for a family that lives paycheck to paycheck. My 
parents had to help us pay our bills the following month, so we 
didn't lose our home.
    We want to have another child, but we're terrified because 
Tennessee still bans abortion and criminalizes doctors for 
providing essential healthcare for pregnant patients. Thank you 
for letting me honor Miley's memory by sharing our story today. 
Millions of people live under these laws just like Tennessee's 
and I know that I was lucky to get the care I needed, but no 
one should have to rely on luck to get essential healthcare. We 
must have a federal right to access the healthcare we need no 
matter where we live or how much we earn. Thank you.
    Chairman Whitehouse. Thank you very much, Mrs. Phillips. 
Our next witness is Mrs. Ford.

STATEMENT OF LESLIE FORD, ADJUNCT FELLOW, CENTER ON OPPORTUNITY 
     AND SOCIAL MOBILITY, AMERICAN ENTERPRISE INSTITUTE \6\
---------------------------------------------------------------------------

    \6\ Prepared statement of Mrs. Ford appears in the appendix on page 
56.
---------------------------------------------------------------------------
    Mrs. Ford. Chairman Whitehouse, Ranking Member Grassley, 
and Committee members, thank you for the opportunity to testify 
today. My name is Leslie Ford. I'm an Adjunct Fellow at the 
Center for Opportunity and Social Mobility of the American 
Enterprise Institute. My research focuses on helping vulnerable 
families find pathways out of poverty into opportunity.
    I'd like to make three points about vulnerable mothers 
experiencing normally an unplanned pregnancy. First, many women 
considering abortion face significant challenges, but abortion 
is not the answer. We have the duty to focus on real solutions. 
We should hesitate to make policy based on research that says 
abortion results in better outcomes for women, including the 
Turnaway Study. It is scientifically difficult to isolate the 
effects of an abortion on women's long-term outcomes. At best, 
these studies only point to correlations. We should not draw 
conclusions from them.
    Instead, we should focus on the factors that lead women to 
consider abortion. Nearly 9 in 10 women who chose abortion are 
unmarried. Over half of women who chose abortion are in their 
twenties and another 8 percent are in their teens. Many women 
who seek abortion do so because they fear economic hardship and 
a majority of post-abortive women say that they chose that 
option because they experienced pressure to abort from the 
important people in their lives. We must address the 
socioeconomic challenges that push them towards abortion.
    This leads me to my second point. The safety net should be 
reformed to address many of the challenges that women 
considering abortion face. The safety net does robustly support 
vulnerable, low-income mothers, giving them access to food 
assistance, cash assistance, health insurance, and in many 
cases housing assistance and childcare. Yet, despite good 
intentions, the safety net often impedes the path back to self-
sufficiency. Most notably, the safety net broadly discourages 
work, even though employment is the best way for moms to break 
the cycle of poverty and a key indicator of whether their 
children will end up in poverty as adults.
    Major programs also have benefit cutoffs or phase outs that 
disadvantage married couples. In other words, the safety net 
traps people in poverty by discouraging both work and marriage. 
The safety net should be reformed to promote what social 
scientists call the Success Sequence. This is the completion of 
at least a high school education, full-time employment, and 
marriage before welcoming children. But even when an unplanned 
pregnancy may interrupt the completion of these milestones, 
there are still immense benefits to completing the steps after 
giving birth.
    When following up with mothers 15 years after a non-marital 
birth, there is nearly a 70-percentage point difference in the 
likelihood of being in poverty between those who complete the 
milestones and those who do not. We can and must do more to 
encourage these mothers to find the pathway back to self-
sufficiency.
    My final point is that the government can't do everything. 
Mothers need the support of their communities. This means that 
child support services must do even more to ensure that 
noncustodial fathers contribute to their child's needs. We 
should also engage nonprofit community partners that support 
women through and after unplanned pregnancies. I'd like to 
highlight here the more than 2700 pregnancy resource centers 
nationwide that provide wraparound services for mothers in 
crisis, including essential care from cribs to housing and so 
much more.
    I want to conclude by reiterating that unplanned 
pregnancies present real challenges for mothers, but abortion 
isn't the answer. We can and must support these women, 
empowering them to overcome the challenges they face. Reforming 
the safety net is a crucial step. Like every American, low-
income mothers deserve and desire real opportunity for 
themselves and their children. And it's absolutely essential to 
support mothers with the power of community. All mothers, 
particularly single mothers, deserve a consistent and 
supportive community to walk alongside them, helping them 
welcome their children into the world and giving those children 
the brightest future possible. Thank you and I look forward to 
answering your questions.
    Chairman Whitehouse. Thank you very much. And next, we have 
Mrs. Call.

  STATEMENT OF TAMRA CALL, MSN RN, EXECUTIVE DIRECTOR, OBRIA 
                 MEDICAL CLINIC, AMES, IOWA \7\
---------------------------------------------------------------------------

    \7\ Prepared statement of Mrs. Call appears in the appendix on page 
62.
---------------------------------------------------------------------------
    Mrs. Call. Thank you, Chairman Whitehouse and Ranking 
Member Grassley and the other members of this Committee, for 
giving me an opportunity to testify today. My name is Tamra 
Call and I'm the Executive Director at Obria Medical Clinic of 
Ames. Our mission is to provide reproductive healthcare and 
support women in a way which empowers them to make informed, 
life affirming decisions. Ames is home to Iowa State University 
and 30,000 university students. I also want to note there are 
several Obria Medical Clinics around our country. Obria has 
been certified by the Accreditation Association for Ambulatory 
Health Care or AAAHC, which accredits outpatient clinics, 
surgery centers, and college student health centers. 
Certification from AAAHC reflects a dedication to high quality 
client healthcare. We operate in compliance with all Health 
Insurance Portability and Accountability Act (HIPAA) laws and 
our clinic is staffed by an OB/GYN, nurse practitioners, 
radiologists, and highly trained registered nurses.
    At Obria, we have the privilege of working with smart, 
strong, and resilient women. Overwhelmingly, the needs women 
communicate to our staff are not much different than what we 
all need, healthy relationships with people who will support us 
without judgment and empower us on the journey to be 
successful. Obria provides healthcare services at no cost, 
including pregnancy testing, early ultrasound imaging, 
monitoring for possible ectopic pregnancy or miscarriage, and 
providing medical and emotional support, as well as after 
abortion care. We see hundreds of women at Obria every year. We 
see women who are in college and afraid they will have to drop 
out if they chose to carry their pregnancy. Some are 
professional women who already have children, but weren't 
planning to have more. Some women are struggling to make ends 
meet and adding a child feels impossible. Others do not have 
support from the father of the baby.
    I'm extremely grateful and humbled to have the opportunity 
today to share a story that is representative of the hundreds 
of women we have seen at Obria. Her name has been changed to 
protect her identity.
    I'd like to introduce you to Aisa, who moved from Pakistan 
to the United States, along with her two young children for a 
job at Iowa State University. She made the move because her 
husband was not supporting her or her children. Aisa's husband 
came to the U.S. to visit the children and during this visit 
Aisa became pregnant. She knew her husband would not provide 
support and she felt very overwhelmed at the thought of caring 
for three young children. Aisa felt an abortion was her only 
option. Aisa scheduled an appointment at our clinic to get more 
information about the decision she needed to make. The nursing 
staff performed a pregnancy test and provided her with 
information about abortion, adoption, and parenting. I have 
copies of those brochures with me today and am happy to share 
them with you.
    The staff listened to her concerns and provided support. 
Aisa had an ultrasound and when she saw her baby's heartbeat, 
she knew she wanted to parent. She felt heard, understood, and 
supported, which empowered her to carry her pregnancy. She is 
now successfully parenting her three children and has 
maintained her job at Iowa State University.
    Obria provides numerous support services and referrals for 
women. Obria is a Qualified Entity in the State of Iowa to 
provide Presumptive Eligibility Insurance. This means that 
prenatal care is covered immediately while the full Medicaid 
application is being processed. Obria also assists women in 
applying for Special Supplemental Nutrition Program for Women, 
Infants, and Children (WIC), the supplemental nutrition 
assistance program, the Family Investment Program (FIP) in 
Iowa, and childcare assistance. The State of Iowa has a live 
map of childcare providers and openings. Obria also connects 
women with housing resources. We provide women with referrals 
to childbirth classes, parenting classes, Early HeadStart and 
Parents as Teachers. Obria offers a community moms group to 
foster connection and support among women with young children. 
We also have referral partners to assist women with food 
stability, applying for jobs, basic finance classes, 
transportation needs, and medical care.
    A woman should never feel that abortion is her only option. 
When a woman walks into our clinic, she often feels abortion is 
her only option. The staff at Obria prioritize open 
communication, allowing the woman to actively participate in 
her reproductive healthcare decisions. The woman is met with a 
holistic approach that considers her physical, emotional, 
social, and financial wellbeing. This approach not only 
supports the woman in making an informed choice, but also 
reinforces her autonomy and empowerment in navigating her 
reproductive journey. The information and relational support a 
woman receives at Obria instills in her the confidence she 
needs to be successful.
    Most of our clients, whether they chose to carry their 
pregnancy or not, return to Obria for care. What starts as a 
positive pregnancy test ends in a trusting relationship where 
we can provide support to women for years. Thank you.
    Chairman Whitehouse. Thank you. I think it's a bit of a 
human experience that when extremists want to take away rights 
and freedoms, they speak in platitudes and generalities and 
jargon, if you will, so Mrs. Phillips, thank you very much for 
bringing home the real, immediate, and practical consequences 
of that on your particular family. Obviously, it was horrible 
for you. I understand it was a pretty difficult period for 
Brian and Adalie as well.
    Mrs. Phillips. Yes. And thank you again for allowing me to 
share my story. Brian is not Adalie's biological father. He's 
her stepdad and he was beyond thrilled to have his first 
biological child. Adalie, who is an autistic, ADHD child full 
of energy and spunk, has always said when she grows up, she 
wants to be a big sister. That's what she wants to be and so 
she was over the moon excited when she found out I was 
pregnant. She would sing to my belly every night Twinkle 
Twinkle Little Star and she would make little toys for her 
sister to have when she was here.
    Trying to explain death to a then five-year-old is already 
hard. Trying to explain death of an unborn fetus, unborn baby 
is even harder. I had to explain to her that Miley was very 
sick and that she was causing mommy to be very sick and that we 
had to let Miley go in order for mommy to stay. And as hard as 
it was, she understood that she needs her mom and that her mom 
can, potentially, if we decide to try again later on down the 
road. It was very hard for our family. As a matter of fact, I'm 
in the year mark of when it happened. March 7th is when I 
arrived to New York City. February 24th was the day I found out 
it wasn't compatible, so it's very hard for me to be here today 
to talk about it, but I know how important it is because my 
experience isn't exclusive. It's not unique. Millions of women 
face what I do every day.
    Chairman Whitehouse. In your testimony, you used a phrase 
``standard of care,'' which is a medical phrase and I'd like to 
turn to Dr. Zahedi-Spung to describe a little bit what standard 
of care means in the context of Mrs. Phillips' experience and 
discuss a little bit, if you will, the conflict that this 
extremism has created between the established medical standard 
of care for certain situations and laws that have been forced 
onto these families.
    Dr. Zahedi-Spung. Thank you so much, Chairman Whitehouse, 
for that question. So, standard of care is a phrase that's used 
within medical societies in order to determine what is best to 
take care of a patient. How we move forward, what the evidence 
supports, what science supports. In the situation like what Ms. 
Phillips went through, standard of care is a deeply personal 
decision for what that family wants. But ultimately, when we 
have a pregnancy that is not going to result in a live birth, 
the risks of continuing that pregnancy far outweigh the benefit 
of continuing it for many families because of the risks of 
pregnancy itself. Pregnancy is not a benign condition. We 
already know that we're one of the few industrialized countries 
that has a worsening and increasing maternal mortality across 
this country and abortion care is very necessary healthcare in 
order to provide the standard of care, not to mention the same 
procedure that is used, the Dilation and Curettage (D&C), for 
abortion care is also used for miscarriage management. During 
my time in Tennessee, because of the way that the law was 
written, ectopic pregnancies, treating ectopic pregnancies, 
which are pregnancies that are dangerous and life-threatening 
because they implant outside of the uterus was technically an 
abortion in the State of Tennessee. So, you have providers who 
were deferring care that was lifesaving because of their fear 
of criminalization.
    When someone's water breaks early, the standard of care is 
to end that pregnancy because of the risk to that pregnant 
person and we have evidence across the country, including in 
places like Texas, that say that if you continue a pregnancy 
where their water is broken, you increase their likelihood of 
maternal morbidity and mortality fivefold.
    Chairman Whitehouse. Senator Grassley.
    Senator Grassley. I'm going to start with Mrs. Call. Your 
clinic provides post-abortion care. Could you tell us a little 
bit about the care for these women and include the types of 
medical complications and emotional hurdles from an abortion 
these women can experience.
    Mrs. Call. Yes. Thank you, Senator Grassley. So, when a 
woman initially comes to our clinic, one thing that we prepare 
them for is what the abortion procedure will entail. We give 
them factual information on that, and we let them know what the 
signs and symptoms of complications may be so that they know if 
they need to seek care after an abortion. We have had women 
come to us that are continuing to have pregnancy symptoms after 
an abortion and we provide them with an ultrasound to check for 
any retained products following that abortion. And if there 
are, they're at risk for infection and we treat them with 
Cytotec to help through that. We also provide women with 
emotional support. By far, the complications that we hear most 
often from our clients are difficulty sleeping, depression, and 
difficulty in their relationships.
    We once had a woman call us after an abortion. She was 
struggling with feeling suicidal. Her family knew that she had 
had an abortion, and they were supporting her, but she didn't 
feel like they fully understood and so our nurse was able to 
connect her with resources to help her. She worked through the 
emotions that she was experiencing following that abortion.
    We also have women who come to us after an abortion, or a 
miscarriage and they say they just felt completely unprepared 
for the products of conception that would pass in their home 
while they are alone. When they see limbs and faces and eyes in 
their bathrooms at home, they are shocked and grieved at the 
loss of the child that they were carrying.
    Senator Grassley. Okay. Mrs. Ford, you made a point in your 
testimony about our safety net system being disjointed and 
difficult for women and new mothers to navigate. Are there 
programs and agencies that are more complicated than others and 
what can agencies currently do to make these programs easier 
for women to navigate?
    Mrs. Ford. Thank you, Ranking Member Grassley. Yes, I would 
say that women normally experience our safety net is deeply 
fragmented. So, if they're looking for food assistance, they go 
to one agency. If they're looking for health insurance, they 
have to go to another agency and usually fill out a different 
application. If they're looking for help turning away from a 
situation with domestic violence, that's again a different 
application and a different caseworker. If they're looking for 
assistance getting back into the workforce and looking towards 
Workforce Innovation Opportunity Act funding, it is again, not 
just a different application, but a different location. I would 
actually point to the State of Utah as being the most fully 
integrated state. Their Department of Workforce Services has 
integrated more than 50 federal programs into the single agency 
and caseworkers are empowered in the State of Utah to be able 
to connect the person in front of them to any one of 50 
programs that fits their needs and that they are eligible for. 
Most states are not able to do that. Even in the state I served 
on, the State of Virginia, the Department of Labor is 
disconnected from the Department of Social Services, and you 
must fill out two applications and be treated by two different 
IT systems in order to access the services to treat the 
circumstances that normally one family would face. So, looking 
at integration should be a top priority to be able to assist 
families that are in need.
    Senator Grassley. Now, Mrs. Call, I've got a minute plus 
for you maybe to take any time that you didn't have time in 
your five minutes to tell us anything else that the Committee 
ought to know about your work with helping women who are 
pregnant or want to be pregnant.
    Mrs. Call. Yes. Thank you. We're talking about economics 
today and women do often tell us when they come to our clinic 
that they're considering an abortion because of the financial 
concerns of adding a child to their family. One of these women 
was actually a teenage mom who came to our clinic with a three-
year-old son. They were living in her car, and she did not want 
to bring another baby into that situation. And so, she felt, 
again, that abortion was her only option, but after meeting 
with our staff and being listened to and heard and understood, 
the staff was able to give her information about adoption, 
which she considered but decided not to choose. The staff was 
able to help her find housing in our community, help her to get 
onto WIC, to apply for Medicaid, to receive food assistance. 
And when she had those resources, she felt empowered to carry 
her child and we have the pleasure of continuing to have a 
relationship with this woman. And the father of the baby 
initially was in and out, but he has chosen to be involved and 
to assist her. And just last week, we were able to help him 
find a job that has full benefits and will enable him to 
provide for his family and so we are able to be that safety net 
for these women and children and men.
    We never have a woman come to us and say I wish I would've 
aborted my child. Every woman who comes to our clinic who is 
financially strapped or in difficult situations they want to 
keep their children and they just need the resources to be able 
to do that and the network of people around them who will 
support them and walk through that with them without any 
judgment or shame. Thank you.
    Senator Grassley. Thank you, all of the witnesses.
    Chairman Whitehouse. I am particularly grateful that 
Chairman Murray is here because she's at the point of trying to 
head off a House Republican caused government shutdown, so the 
fact that she's here is very significant. Chairman Murray.

                  STATEMENT OF SENATOR MURRAY

    Senator Murray. Thank you very much, Mr. Chairman. I really 
appreciate your having this hearing today. You know, since 
Republicans overturned Roe v. Wade reproductive rights have 
really been under attack like never before in our country and 
I'm really glad that we are here today to talk about something 
that doesn't get enough attention, and that is the strong 
connection between reproductive rights and economic security. 
Because when Republican politicians take away a woman's control 
over her own body, they're also taking away women's ability to 
plan their families, their finances, and their futures on their 
own terms.
    The connection is more painfully clear than ever in the 
post-Dobbs America where your ability to get an abortion 
depends on where you live and whether you can afford to travel 
out of state. Can you take the day off, can you afford 
transportation, do you have a place to stay, do you need 
childcare? Mrs. Phillips just described all of that that 
happened to her. And there's a deeply cruel irony faced by 
women who are unable to get abortions because of costs, women 
who are forced to stay pregnant by Republican politicians.
    If someone cannot afford to get the healthcare she needs, 
what do they think is going to happen when she's forced to have 
that child? How will she make ends meet? Republicans' 
antiabortion extremism doesn't just mean forcing women to stay 
pregnant. Ultimately, it often means women forced out of the 
workforce and into financial hardship with no support to speak 
of.
    Here we are where Republicans want women to stay pregnant, 
but they don't want to address the childcare crisis. They want 
to force women to stay pregnant, but today House Republicans 
want to not fully fund WIC. Republicans want to force women to 
give birth, but they don't want moms to have paid leave so they 
can recover from childbirth and spend time with their newborn. 
So, it's pretty clear that Republicans want to force women to 
stay pregnant, but won't lift a finger to help new parents.
    I want you to know that Democrats are working hard to help 
make sure women are able to decide when and how they start a 
family, and we actually support those programs that families 
need. That is a pretty big difference to me, Mr. Chairman.
    Mrs. Phillips, I want to start with you. Thank you again 
for sharing your story. I know how challenging that is and I 
want to make it clear that you are not alone. There are 
literally hundreds of women out there, probably thousands, who 
are facing the same choices you do. You're sitting next to a 
witness who just described a totally different scenario that 
doesn't even apply to you and wanting a rule of this land that 
will keep you from getting the healthcare you needed, and that 
story is not alone. Everyone needs to understand that. Can you 
talk to this Committee again about the financial barriers that 
are out there for women who seek abortions, such as you had to 
do through no want in your life, but because that's what 
happened to you and what that meant to you and your family when 
you were forced to go out of state all alone?
    Mrs. Phillips. Yes. And thank you so much for the question 
and the opportunity to continue to speak on my story. I will 
start by addressing the Committee by saying pregnancy isn't a 
one size fits all situation. Every pregnancy is different, 
every reason to need an abortion is different. What my fellow 
witness over here explained did not apply to my situation. This 
was a planned for and wanted pregnancy and unfortunately for us 
it wasn't in the cards for us to bring that baby into this 
world. And as a low-income family, as you spoke, I was a single 
mom for the first three years of my daughter's life. I took two 
weeks off of work when she was born, unpaid, and had to go back 
because I didn't have any other option but to work to take care 
of my child.
    I actually started the in-home daycare in my home to be 
home with Miley because we couldn't afford the infant 
childcare, which is about another mortgage payment in the State 
of Tennessee. Without the platform that I had online and 
without sharing my story, and thank God it went viral when it 
did, because without the help of complete strangers I would not 
have made it to New York. I don't know if I would be sitting 
here today talking to you.
    Senator Murray. Thank you. I really appreciate that. And 
Dr. Myers, just in the last few seconds I have, women of color, 
especially Black women, this is really worsened longstanding 
inequities that they have faced. Can you talk about how 
abortion bans and restrictions have created new financial 
burdens for women, especially women of color?
    Dr. Myers. Yes. Thank you for that question. Every single 
study of which I am aware that isolates and measures the 
effects of abortion restrictions on people's lives finds that 
women of color experience greater effects of those 
restrictions, experience restrictions as greater barriers than 
non-Hispanic, white women. The reasons are complex. Women of 
color, especially Black women, have higher rates of unintended 
pregnancy that are driven by lower access to contraception, 
lower rates of insurance, and being more likely to live in 
contraceptive deserts. Also, race and poverty interact in 
complex ways that create greater financial barriers of 
traveling, taking time off work, accessing childcare for women 
of color, and so, we often see much greater effects on that 
population.
    Senator Murray. Thank you very much. Thank you, Mr. 
Chairman.
    Chairman Whitehouse. Senator Kennedy, then Senator 
Stabenow.

                  STATEMENT OF SENATOR KENNEDY

    Senator Kennedy. Thank you, Mr. Chairman. Professor Myers, 
you are here at the invitation of my Democratic colleagues, is 
that right?
    Dr. Myers. That's correct.
    Senator Kennedy. In his opening statement, my good friend, 
Senator Whitehouse said, and I want to quote ``Reproductive 
justice is economic justice.'' Do you agree with that?
    Dr. Myers. I might as an economist use the word ``rights,'' 
but yes, I do agree with that.
    Senator Kennedy. Okay. That's not true for the baby, is it?
    Dr. Myers. Well, first of all, I would refer to a fetus----
    Senator Kennedy. Yes, but that's--well, a fetus. I refer to 
it as a baby. That's not true for the baby, is it?
    Dr. Myers. The evidence that I presented to you, Senator 
Kennedy, was evidence about measurable effects on the lives of 
women, families, and----
    Senator Kennedy. I got that part, but that's not true for 
the baby, is it?
    Dr. Myers. I'm sorry. I don't really understand that 
question.
    Senator Kennedy. Let me be clearer. I'm sorry.
    Dr. Myers. As an economist, I measure effects using data. 
I'm not here to talk about ethics, assignment of personhood. 
That's not my role.
    Senator Kennedy. Yes. But you said that you agreed with the 
Chairman's statement that reproductive justice is economic 
justice. There is no economic justice for the baby because the 
baby's dead, right?
    Dr. Myers. I wouldn't refer--I don't really know how to 
answer your question. I would refer----
    Senator Kennedy. Well, is the baby dead or alive?
    Dr. Myers. We're referring to a fetus.
    Senator Kennedy. Okay. Is the fetus dead or alive after an 
abortion?
    Dr. Myers. The fetus would be dead after an abortion.
    Senator Kennedy. Okay. All right. If the mother is healthy 
and the baby is healthy, do you support abortion up to the 
moment of birth?
    Dr. Myers. So, you know, I think that's a really hard 
question to answer because that just doesn't happen. You're 
asking me about something that simply doesn't happen. I will 
tell you----
    Senator Kennedy. Well, it's legal in Vermont, New Jersey, 
Oregon, Colorado, New Mexico, Alaska, and the District of 
Columbia and the loon wing of the Democratic Party supports 
abortion up to the moment of birth. So, do you support that or 
oppose it?
    Dr. Myers. Let me say I'm here to talk about the economics 
of abortion.
    Senator Kennedy. You're here as an expert. What's your 
belief?
    Dr. Myers. I think you're asking me as a person, which I'll 
answer as a person.
    Senator Kennedy. Okay. You tell me as a person.
    Dr. Myers. I will tell you, as a person, that I have 
ambivalence about abortion. I will tell you, as a person, I 
haven't personally had an abortion and I will also tell you, as 
a person, looking at the evidence around me and understanding 
how complex the decisions are that people face, I'm just simply 
uncomfortable thinking that there's a simple answer that 
applies to everyone.
    Senator Kennedy. I don't think you're going to answer my 
question.
    Dr. Myers. I trust women and their healthcare providers.
    Senator Kennedy. It's real simple. You either support 
abortion or a healthy mother and baby up to the moment of birth 
or you don't, and I don't think it's a difficult question. How 
about you, Doctor, do you support if the mother is healthy and 
the baby is healthy, do you support abortion up to the moment 
of birth?
    Dr. Zahedi-Spung. So, Senator, you're using really 
inflammatory language to talk about a medical procedure and 
it's not a simple yes or no, not to mention when you make 
statements like that, you're erasing the grief and the trauma 
that my patients are going through.
    Senator Kennedy. You're not going to answer my question 
either, are you?
    Dr. Zahedi-Spung. It's not a question that can be answered 
in an appropriate way, Senator.
    Senator Kennedy. I think I know your answer. Mrs. Ford, 
okay, let's take a baby at 21 weeks, this is a baby at 21 
weeks, okay. The baby can feel pain, right?
    Mrs. Ford. Yes.
    Senator Kennedy. And the baby's pretty developed, right?
    Mrs. Ford. Yes.
    Senator Kennedy. And do you know the name of the procedure 
that the doctor would use to abort that baby at 21 weeks?
    Mrs. Ford. I'm not a doctor, but I believe it's a D&R.
    Senator Kennedy. It's called Dilation and Evacuation (D&E), 
is that right?
    Mrs. Ford. As far as I understand, yes.
    Senator Kennedy. Yes. And first, the doctor would dilate 
the cervix and then the doctor would take what's called a--the 
doctor would call it a Sopher clamp. It's really a pair of 
pliers with sharp teeth on the end and without giving the baby 
any pain medication, the doctor would go through the vagina, 
through the uterus, and start tearing the baby apart; is that 
right?
    Mrs. Ford. As far as I understand the procedure.
    Senator Kennedy. Yes. And she might start with the legs and 
pull them out and the arms and pull them out, right? And then 
she might go for the heart or the spine and just pull the baby 
out piece by piece, is that right, without giving the baby pain 
medication.
    Mrs. Ford. That's what I understand the procedure to be.
    Senator Kennedy. But then you've got to get the head out. 
The baby's dead, but maybe not, maybe it's still in pain, but 
then you've got to get the head out. And even with the cervix 
dilated, you've got to get the head out, which is hard. So, 
then the doctor would go in and use those pliers to crush the 
baby's head; is that right?
    Mrs. Ford. As far as I know.
    Senator Kennedy. And then she'd pull the head out, the 
crushed skull out, right?
    Mrs. Ford. Mm-hmm.
    Chairman Whitehouse. Senator Kennedy, your time has expired 
here.
    Senator Kennedy. Well, you gave the others plenty of time, 
Mr. Chairman.
    Chairman Whitehouse. Just letting you know your time has 
expired. You have other senators waiting.
    Senator Kennedy. Well, I was waiting when you were letting 
others. I'm sorry you don't want to hear about what happens in 
an actual abortion, but that----
    Chairman Whitehouse. I don't think anyone else has gone 
over.
    Senator Kennedy [continuing]. Was what we were here to talk 
about.
    Chairman Whitehouse. No one else has gone over. Some of the 
witnesses went a little bit long, but on both sides.
    Senator Kennedy. I thought we were here about protecting 
mothers and killing babies.
    Chairman Whitehouse. I'm going to turn to Senator Stabenow.
    Senator Kennedy. Well, I'm sorry you don't want to hear it.
    Chairman Whitehouse. I'm sorry this had to take place in 
front of you. My apologies.
    Senator Kennedy. I know it's ugly, but it's the truth.

                 STATEMENT OF SENATOR STABENOW

    Senator Stabenow. Thank you, Mr. Chairman. Mrs. Phillips, 
I'm so sorry you just had to hear that, particularly as you're 
talking about the one-year anniversary of what you had to go 
through. It was shameful and I'm very, very sorry. No one here 
should be judging you or any other woman who has to make 
decisions based on their life and what's happening in their 
pregnancy and so thank you so much for being here.
    This is about the freedom to make decisions, healthcare 
decisions for women, half the population, freedom to make our 
own healthcare decision. In Michigan, after Roe v. Wade was 
overturned, women--people across Michigan put this on the 
ballot for our Commission and Constitution in 2022. 
Overwhelming, Democrats, Republicans, people of all ages voted 
to put that in Michigan's constitution, the freedom to make our 
own reproductive healthcare decisions, which is great. Except 
now we are here with a national abortion ban being talked about 
by our Republican colleagues and if we have a Republican 
President, a national abortion ban takes that all away. And we 
also know that In Vitro Fertilization (IVF) now, which is the 
choice to have a baby and go through IVF, that also potentially 
is going to be taken away and probably birth control is next.
    So, this is about basic freedom and so I just want to 
start, though, a little differently than I had planned. But 
Mrs. Call, you talked about no one should feel abortion is 
their only option. I couldn't agree more. I work on nutrition 
issues and healthcare issues. I've been at the forefront of all 
of these issues. I could not agree more, but listening to Mrs. 
Phillips' story today, do you think she had another option?
    Mrs. Call. Yes. Thank you for the question, Senator 
Stabenow. So, I am not a medical doctor, but I do know our OB/
GYN has worked for over 30 years and has delivered over 4,000 
babies and I know he has cared for multiple women who were in a 
similar situation to Mrs. Phillips, and I know that he worked 
closely with them----
    Senator Stabenow. I am, just in the interest of time, I 
don't want to interrupt you, but you're saying--her baby was 
dead, but she had another option.
    Mrs. Call. Well, when her baby is dead, it's no longer an 
abortion. At that point, it's a dilation and curettage (D&C), I 
believe, medically.
    Senator Stabenow. Okay. All right. Thank you. I appreciate 
your work, but again, there's a lot of different stories to 
tell here. Also, I wanted to ask Mrs. Ford--you talked about 
the safety net. I couldn't agree more on that. Right now, we 
have a situation where we're working to fully fund WIC for 
pregnant moms and babies, healthy food, nutrition, and so on. 
Do you support WIC as a--funding WIC?
    Mrs. Ford. WIC is an important resource for mothers, 
especially providing formula to their children.
    Senator Stabenow. Yes. So, we shouldn't have waiting lists, 
which is going to happen if we don't fully fund WIC. It seems 
to me if there's a nine-month pregnancy, you can't have a 
waiting list, right? And so, Mrs. Call, you mentioned WIC as 
being a support and that's something that you would support?
    Mrs. Call. Yes.
    Senator Stabenow. Also, I've been trying for years--
actually, Senator Grassley and I, for years, to put in place 
quality standards for labor and delivery under Medicaid. Half 
our babies are born with Medicaid healthcare and Republican 
colleagues have stopped that here in the Senate for years. We 
don't have national quality standards. I assume, as part of the 
safety net, Mrs. Ford, you would support having quality 
standards for labor and delivery.
    Mrs. Ford. Yes, across labor and delivery and especially 
post-abortive care. Fewer than 20 states actually track post-
abortive outcomes and most abortion clinics actually--women who 
are experiencing trouble are normally referred to a hospital 
Emergency Room (ER).
    Senator Stabenow. Right. Well, I'm talking of just healthy 
babies. We should have that.
    Mrs. Call. Yes, across the board for any (unintelligible).
    Senator Stabenow. And colleagues should be working together 
to do that.
    Mrs. Call. Yes.
    Senator Stabenow. Yes, we should also. And I assume, Mrs. 
Call, you would support having quality standards as well.
    Mrs. Call. Yes, I agree.
    Senator Stabenow. Which is not happening because of folks 
here in this body. So, Mrs. Phillips, let me go back to you. 
Thank you, again. How has this horrible experience that you had 
to go through changed the way you think about your family's 
future and the kind of world you want your daughter to grow up 
in?
    Mrs. Phillips. Thank you for that question, Senator. It has 
been extremely difficult. As I stated before, this was a 
planned and wanted pregnancy. We still want to expand our 
family. That's something we plan to do, but unfortunately, 
while the ban still sits in Tennessee, we're terrified. It was 
a very traumatic experience that I had to go through, that my 
family had to go through. My card here says, ``Mom and 
Activist.'' Since what happened to me happened, I have turned 
to activism because my daughter is growing up in a state 
without bodily autonomy. My daughter is growing up in a state 
that lawmakers are telling her that she doesn't have a choice. 
It's one thing to put me through it. I'm a 29-year-old woman, 
but to put a child through something like that is inexcusable. 
And I would say that I'm hopeful that we can come to an 
agreement, a nonpartisan agreement in our state capitol and 
restore abortion access so I can continue my plans of my future 
in expanding my family because that's something I desperately 
want to do, but I'm terrified to do.
    Senator Stabenow. Thank you. American women deserve the 
freedom to make our own decisions. And Mr. Chairman, this side 
of the dais trusts women.
    Chairman Whitehouse. Senator Lee.
    Senator Lee. Thank you, Mr. Chairman----
    Chairman Whitehouse. Sorry to interrupt. Followed by 
Senator Merkley.
    Senator Lee. At the outset, I feel the need to point out 
something that I think a casual observer might miss from some 
of the comments. The Dobbs decision did not criminalize 
abortion. The Dobbs decision didn't do anything to affect the 
legal status of abortion, other than to return the decision, 
the primary decision on abortion, back to the states. They 
concluded that this has always been an issue that was before 
the states prior to Roe v. Wade and its progeny. The Supreme 
Court in Dobbs simply undid Roe and said this is a decision 
that most of the time, that is, you know, unless we're dealing 
with something the District of Columbia, the military 
installations using government funds or something like that, 
isn't normally going to be federal action and so they returned 
it back to where it was.
    Now, states have been more or less out of this arena for 
about 50 years. They had been out of the arena for about 50 
years as most abortions occurring in America couldn't be 
meaningfully restricted in light of Roe v. Wade and its 
progeny. States are getting back to that business now after it 
had been usurped by a judicial oligarchy of sorts for nearly 
half a century. And so, yes, states will handle this 
differently, but states handle many things differently. 
Everything from occupational licensing to what procedures might 
be performed in certain states, even the criminal laws of one 
state differ from those of another.
    Those laws are made by men and women elected by the 
citizens of those states. Sometimes those laws can end up 
having unforeseen consequences. Sometimes tragic ones. Those 
laws could be changed from time to time, but it's important to 
focus on what this is about and what it is not. It is, at the 
end of the day, something that is in the hands of the American 
people. This is part of what having a democratically elected 
government means. It's what it focuses on.
    I've heard several mentions made to the idea that there're 
suddenly going to be a national abortion ban, a federal 
abortion ban enacted. To my knowledge, Republicans who now 
control the House haven't even pushed for a vote on that 
elsewhere. The same can't be true of the Born Alive Protection 
Act. It's a different circumstance. Where as a child is born 
alive, I would hope we could all agree regardless of what your 
religious, moral, or policy feelings about abortion are, I 
would hope we could all agree that once a child is born there 
are all kinds of protections and that allowing someone to be 
killed can result in all kinds of ramifications.
    Mrs. Ford, I'd like to start with you. I'd like you to talk 
to us a little bit about the marriage penalties that exist in 
our current tax code and our social safety net at the federal 
level and what harmful effects they might have on things like 
family formation? How do they harm, for example, married 
couples with children in a way that doesn't affect other 
families?
    Mrs. Ford. Yes. I'd like to start by pointing out that 
marriage penalties in the safety net, which exists primarily in 
a program explicitly like the Earned Income Tax Credit you can 
earn thousands more if you are unmarried and have children 
versus if you are married and have children. But there are also 
implicitly throughout the rest of our programs. For instance, 
if you don't declare the partner who you are not married to 
within the home, you can receive thousands more Supplemental 
Nutrition Assistance Program (SNAP) benefits or Temporary 
Assistance for Needy Families (TANF) benefits or any other 
number of benefits.
    And the effect that we see that this has had in our culture 
is within the unmarried birth rate. We have the highest 
number--percentage of children living in single-parent homes in 
the world. It is about a quarter of U.S. children live in 
single-parent homes as compared to 7 percent around the world.
    Senator Lee. Are you suggesting that we have, thus, 
incentivized out of wedlock birth and childrearing?
    Mrs. Ford. The information seems to be falling that way 
because when we track Centers for Disease Control and 
Prevention (CDC) data, if you're looking at college educated 
women, 10 or 11 percent have children out of wedlock. That's 
roughly similar to what was happening in the 1960s. When you 
were looking at less educated women, it comes close to 60 
percent. It really does hit on education levels and income 
levels whether a child is going to be born out of wedlock. And 
we know very clearly from the data that there is an impact to 
having two parents in the home. This is why Melissa Kierney's 
recent book The Two Parent Privilege was published. She is not 
right-leaning. This is following the data. There is a huge 
benefit to having two parents in the home with the child.
    Senator Lee. How does that contribute to the perpetuation 
or even exacerbation of existing inequities along racial, 
economic, and other demographic lines?
    Mrs. Ford. We know that if there is a single mom or a 
single parent who is raising her child alone, she is much more 
likely to experience economic hardship and it is much more 
likely for her children to experience intergenerational 
poverty. The 60 years that Aid to Families with Dependent 
Children (AFDC) was run in this country showed that economic 
outcome. This program which provided cash assistance to single 
mothers by the mid-1990s, nine in ten women were unemployed, 
one in seven children were on the program. And after it was 
reformed to focus on work the out-of-wedlock birth rate 
stabilized. Women returned to work by nearly 20 points and 
child poverty in this country dropped by 60 percent.
    Senator Lee. Human beings are rational actors and when we 
incentivize the wrong things sometimes, we'll get those things 
and those things can sometimes harm a lot of people, especially 
the most vulnerable. Thank you, Mr. Chairman.
    Chairman Whitehouse. Thank you, Senator Lee. The order I 
have set this stage, depending on attendance, is Senator 
Merkley, Senator Braun, Senator Padilla, Senator Kaine, Senator 
Wyden. That's the sequence, but if people aren't here, you can 
be bumped up the sequence. Senator Merkley.

                  STATEMENT OF SENATOR MERKLEY

    Senator Merkley. Thank you. Dr. Zahedi-Spung, if in some 
states--I want to understand if an ultrasound reveals that the 
fetus does not have a heartbeat in some states would it be 
basically the law now requires that woman to carry that child 
until there is a miscarriage--that child who does not have a 
heartbeat?
    Dr.  Zahedi-Spung. I don't know of any states that require 
people to carry pregnancies that are true miscarriages. What I 
can say, though, is that with procedure bans around D&Cs and 
D&Es, it can require a patient to have experienced a 
miscarriage where the fetus's heart stops beating to deliver 
that fetus and undergo an induction instead of having a medical 
procedure that could end their suffering quickly.
    Senator Merkley. That was exactly the situation we were in 
with our first child. We lost our first child at four months. 
And I think it would've been extremely difficult for Mary to be 
required by the state to carry that child post that point.
    Dr. Zahedi-Spung. I'm sorry.
    Senator Merkley. I want to turn, Professor Myers, to the 
poison pill riders that the House has proposed, including 
riders that restrict access to medical or medication abortion. 
What would be the economic impact of passing an appropriations 
bill with some of these extreme anti-abortion riders?
    Dr.  Myers. Thank you for that question. The economic 
impacts could be tremendous, depending on the rider. But I'd 
really like to talk about medication abortion for just a second 
because mifepristone has become incredibly important to the 
provision of abortion in this country. Even before Dobbs, more 
than half of all abortions were provided as medication 
abortions. And right now, about 40 percent of the brick-and-
mortar abortion facilities in this country only provide 
medication abortion. The remaining facilities, with very few 
exceptions, provide both medication and procedural abortions.
    If mifepristone access were meaningfully reduced, it would 
upend the provision of abortion in this country. It could end 
telehealth provision, which has become extraordinarily 
important to people. It could shutter providers, brick-and-
mortar providers across the country, including in states that 
have been supportive of abortion rights and might not 
understand the threat that faces them, and it would create 
really limited appointment availability at many of the 
facilities that remain.
    Senator Merkley. Thank you very much. And Dr. Zahedi-Spung, 
I want to turn back to you. Based on your experience now in 
Colorado, let's say with the expanded access to abortion after 
the Dobbs decision, have you seen an increase in the number of 
folks coming into Colorado from out-of-state?
    Dr. Zahedi-Spung. Thank you for that question, first off, 
but we've certainly seen an increase in the number of abortion 
care procedures that we're providing. Our group has seen an 
eight times increase in care provision in the last year and a 
half since the Dobbs decision in addition to about a 40 percent 
increase in procedural abortion and care that's been seen. It's 
hard to quantify how much of that is from out of state versus 
just more patients needing the care and not being able to 
access it.
    Senator Merkley. Has that created delays in the state for a 
woman's access to reproductive care?
    Dr. Zahedi-Spung. Yes, certainly. I mean there's only a 
certain number of us who can provide this care, given you have 
to have specialty training in order to do it. And none of us 
ever want to delay a patient receiving necessary medical care, 
but there's only so many hours in the day where we can actually 
provide that care.
    Senator Merkley. Oregon has certainly seen that. It's 
reported that as much as a thousand percent increase in 
patients crossing the state line from Idaho.
    Mrs. Phillips, thank you for sharing your story, a story I 
could connect with, with my own family's experience, although 
not all of the pieces of it that were so powerful. Because of 
the restrictive laws in Tennessee, is it the case that your 
doctor was not even able to offer advice to you on how to 
obtain an abortion?
    Mrs. Phillips, Thank you for that question, Senator. My 
doctor had taken an oath to provide the utmost care for her 
patients and at that point in time the way she understood 
Tennessee's law was that she could not offer me resources. She 
stated that I would have to do the research on my own and that 
I was left to essentially defend myself, my own life and 
fertility.
    Senator Merkley. Yeah. Thank you very much. Thank you, Mr. 
Chairman. Thank you all.
    Chairman Whitehouse. Senator Braun, followed by Senator 
Padilla.

                   STATEMENT OF SENATOR BRAUN

    Senator Braun. Thank you, Mr. Chairman. This question will 
be for Mrs. Call. I'm going to kind of preface it with these 
comments. Colleagues before me have had questions about the 
nature of life and human essence and I think it made the point 
that it's hard to distill that into economic terms. When you 
try to do it, especially through an institution that has now 
become one that has no problem with borrowing and spending 
money from future generations just to tell where we're at 
there. This is the Budget Committee. We are now borrowing a 
trillion dollars every six months. And you know who's back 
that's going to be upon, our kids and our grandkids.
    That's probably a more pertinent subject to what we're 
talking about here today, but on the subject matter we've got 
here, that has no good ending to it. That is about as bad a 
business plan as anyone would ever want to be a part of. But 
here to try to speak about this in economic terms, I think from 
the state I'm from, this is a question of being pro-family, 
pro-mother, and that would be a place, I think, that would be a 
legitimate place to have a discussion just not trying to even 
do anything about it. If you're for it, when you're borrowing 
it from your kids and grandkids. Indiana has effective public 
and private healthcare networks that help women without urging 
them to destroy an innocent life. The General Assembly's 
fulfillment of Indiana's culture of life includes the decision 
to disburse TANF funds to pregnancy care centers in an 
alternative to abortion programs. Mothers should not feel 
alienated from assistance and forced into abortions.
    Sadly, the Biden Administration embraces a culture that 
wants to do the opposite, to strip support for pregnant women 
and their unborn babies. I just think it's the wrong place to 
go. My question is what'd you tell young families and worried 
mothers when they need help with an unexpected pregnancy? 
Should they be leaning towards that, taking the tools away from 
states that want to maybe talk about life and preserving it? 
What's your opinion on that?
    Mrs. Call. Yes. So, your question is what we tell families 
about that? Can you repeat exactly what question you want me to 
answer?
    Senator Braun. So, when you have families confronting these 
issues, what is your advice as opposed to what the Biden 
Administration, I think, has been pushing. They can take funds, 
borrowed money, to facilitate ending life. I mean what should 
be the message?
    Mrs. Call. So, I mean, what I believe the message should be 
is that there are people here who are very ready and willing to 
support you and the state is ready and willing to support you, 
our local community is ready and willing to support you. I'm 
very thankful that the State of Iowa recently passed the More 
Options for Maternal Support (MOMS) Program, which provides 
state funding to centers like ours so that we can truly support 
these women where they are. And I want to be very clear. We 
never suggest to a woman what she should or should not do. We 
just simply give her the information, let her know all of the 
resources that are available to her because, as it's been said, 
it can be tricky to navigate all of these systems and 
institutions and so we're just there to be an advocate for her 
and to help her walk through that as she considers her 
decision.
    Senator Braun. And have you had any outreach from the Biden 
Administration to help you in your programs?
    Mrs. Call. No.
    Senator Braun. Zero.
    Mrs. Call. Zero.
    Senator Braun. And I think that's just something if you're 
going to try to push one dynamic, at least to be fair, it ought 
to be something that you're willing to do with the other point 
of view as well. Thank you.
    Mrs. Call. Thank you.
    Chairman Whitehouse. Senator Padilla.
    Senator Padilla. Thank you, Mr. Chair.
    Chairman Whitehouse. Then Senator Kaine.

                  STATEMENT OF SENATOR PADILLA

    Senator Padilla. I just wanted to lead with a couple of 
datapoints and I first just thank you all for your testimony 
and participation today. It's an important and timely 
conversation, obviously.
    About 42 percent of adults, up from 33 percent just about 
five years ago, say that they have either used fertility 
treatments or personally know someone who has. And there are 
currently an estimated 1.5 million frozen embryos nationwide. 
The recent ruling in Alabama effectively bans IVF in certain 
states because it would subject people involved in all steps of 
the process to unreasonable, criminal liability.
    As Republicans continue to stumble over the flawed 
arguments against reproductive rights, what I see happening is 
they're realizing that it's one thing to say that you're 
opposed to abortion, in theory, and it's a whole other thing to 
try to legislate in this new reality. Now, it's offensively 
hypocritical for so many House GOP members, for example, lining 
up to pledge support for IVF while simultaneously signing onto 
so-called Parenthood legislation with no carveout for embryos 
and clinics.
    My first question, Dr. Zahedi, how would you square 
Republican support for IVF with support for Personhood 
legislation like the Life at Conception Act?
    Dr. Zahedi-Spung. So, thank you for that question, Senator. 
And if I'm understanding your question, I think the hardest 
part about all of this discussion is that reproductive justice 
is both about choosing when to have a family and choosing when 
not to, and then the safety around how you choose to parent 
your children as well. And the argument around IVF, I mean, 
they are in conjunction with the argument about why abortion 
care is necessary medical healthcare is that you're taking away 
the autonomy of families to make the decisions that are best 
for them and you're erasing grief and trauma for those families 
that are having to make decisions that are very difficult. 
Having known plenty of colleagues as well as friends who've had 
to go infertility treatment that is a very difficult road for 
them and then to have their time and energy and responsibility 
taken from them by the state and told what they can and can't 
do with that is just as scary as what we're seeing with the 
patients who are coming to us for abortion care.
    Senator Padilla. I appreciate the perspective as a 
physician in this because for a party that claims to be about 
rights and freedoms and liberties, they're taking away rights 
and freedoms and liberties from families across the country.
    Dr. Myers, can you talk a little bit more about the 
societal and economic impacts of banning IVF?
    Dr. Myers. Yes. And I'll preface it by saying, since this 
has been a bit of a mixture of the personal and professional, 
my oldest child is an IVF baby and the product of a frozen 
embryo transfer. This really hits close to home for me, seeing 
what's happening in Alabama. So, reproductive autonomy isn't 
just about young people avoiding parenthood until they're 
ready. It's about all people being able to become parents when 
they want to and IVF has helped millions of people, including 
me. The economic evidence suggests that it allows women to 
spend more time seeking the right partner, investing in 
education, and investing in their careers. And in a country and 
moment when we're increasingly seeing people delaying 
parenthood, a lack of access to IVF is very concerning from an 
economist perspective.
    Senator Padilla. Thank you very much. And if I can, in my 
brief time remaining, I do want to touch on another topic 
because I think as Dr. Zahedi exemplifies, there are across the 
country obstetricians, gynecologists, and nurses that are 
leaving their practices in states like Idaho, Texas, Oklahoma, 
and Tennessee while new doctors are avoiding those states 
altogether. Facing the departure of respected and talented 
physicians many hospitals have since closed their labor and 
delivery units in these Red states. So, the brain drain extends 
beyond just maternity care.
    Following the Dobbs decision, a growing number of companies 
have updated their health insurance policies to include 
abortion travel benefits and it's because they recognize the 
impact that state laws restricting abortion care have on their 
ability to attract and retain talent. Dr. Zahedi, you left 
Georgia and Tennessee, as you shared in your testimony as a 
result of Dobbs and the states' abortion restrictions, I can 
imagine Republican attacks on reproductive healthcare is 
driving obstetricians and other healthcare professionals from 
Red states. How does this impact access to essential healthcare 
services, including prenatal visits, including access to 
contraception, including maternal/fetal medicine and postpartum 
care, cesarean sections more in those states that are being 
left behind?
    Dr. Zahedi-Spung. Thank you so much for that question, 
Senator. I have a deep concern for what's going to happen in 
this country as these rights continue being taken away. We know 
even prior to Dobbs that states that had abortion care 
restrictions had worsening maternal mortality and morbidity and 
that was still divided and worsened across racial lines as 
well. So, now that we're adding in the factor that physicians 
are afraid to be in states where there are significant abortion 
bans, they're eliminating an entire workforce.
    And in addition, almost 50 percent of the OB/GYN residents 
in this country are training in states with abortion care 
restrictions. We will graduate an entire generation of OB/GYNs 
who don't know how to do D&C for miscarriage management, who 
aren't equipped to counsel patients appropriately about the 
findings of their pregnancies, who aren't going to be able to 
provide necessary, emergency medical care in these communities. 
And I'm very afraid what that's going to mean for their 
patients.
    Idaho, for example, has had multiple maternity wards closed 
over the last several years, as almost 25 percent of their OB/
GYN workforce has left and there is maybe two maternal/fetal 
medicine physicians left in the entire state. Patients are 
traveling 200 miles one way for prenatal care now in a state 
that already had really terrible maternal mortality and 
morbidity. I worry what that means for the residents of that 
state and how we're going to continue to watch women die.
    Chairman Whitehouse. Senator Kaine and then Senator----
    Senator Padilla. Mr. Chair, just in closing, because 
obviously we have and will continue to have fiery debates as 
policymakers and we're seeing what impact it's had on medical 
professionals in states across the country, but the ultimate 
consequence--and this is why you're having this hearing, the 
ultimate consequence is on women and families and that needs to 
be at the center of our actions here. Thank you.
    Chairman Whitehouse. Senator Kaine and then Senator Van 
Hollen, unless Senator Wyden returns. Senator Kaine.

                   STATEMENT OF SENATOR KAINE

    Senator Kaine. Thank you, Mr. Chair. Mrs. Phillips, your 
testimony was incredibly powerful, and I really want to thank 
you for sharing it. And the legal system in Tennessee and this 
country has really failed you. I was listening to Mrs. Call 
earlier saying that in her work she tries to inform people and 
tries to be non-judgmental and let them do what they chose to 
do. Your state does not let you do that. Your state does not 
let physicians do it. The fact that you have a physician who's 
taken an oath to provide you patient care is so afraid of 
criminal liability or loss of licensing privileges that when 
you're given this devastating news you and your mom have to go 
online and search to find a place thousands of miles from where 
you live, far away from any family in a city that you've never 
visited, if I remember your testimony right, to terminate a 
failing failed pregnancy. I mean the cruelty is astounding, 
astounding.
    I mean I just would like to go back and just clip that 
piece of the testimony from Mrs. Call earlier, we want to 
accompany women and let them decide what's in their best 
interest. If that's what a healthcare provider testifies, why 
wouldn't a state legislature or a court system or Congress have 
that same attitude?
    I want to push back a little bit on Senator Braun's notion. 
He was pushing a line that the Biden Administration is 
interested in abortion and not on moms, and so let me correct 
that. The American Rescue Plan was the first piece of 
legislation that was passed under the Biden Administration of 
the 117th Congress and my colleagues were here, and it passed 
by one vote, one vote. Every Democrat voted for it. Every 
Republican voted against it. The American Rescue Plan included 
a really important provision for moms and kids. Prior to it, 
Medicaid would cover a mom after delivery for 90 days. More 
than half the births in this country are Medicaid births.
    Prior to the American Rescue Plans, moms would be covered 
for 90 days. In the American Rescue Plan, we allowed states to 
expand that 90 days to a year, where the mom gets covered for a 
year because there are so many challenges that mothers face 
post-delivery. That passed by one vote. Democrats did that. Joe 
Biden and Kamala Harris did that. Every Republican voted 
against mothers. They voted against mothers. And guess what 
states have done with that mandate? We extended it in an 
appropriations bill the next year. Forty-five states have 
decided to embrace this optional mandate that we allowed them 
to do, embracing the Biden/Harris policy, embracing a policy 
the Democrats supported and every last Republican in the Senate 
opposed.
    Mr. Chair, you've been here longer than me. There are days 
when you're here and you wonder if you do anything. Then there 
are days you're here when something happens by one vote, the 
American Rescue Plan, moms get Medicaid coverage. We saved two 
million workers' pensions. Saving the Affordable Care Act in 
August of 2017. It happened by one vote. The Inflation 
Reduction Act to bring down prescription drugs happened by one 
vote. The American Rescue Plan had another pro-mom, pro-family, 
pro-kid provision, the Child Tax Credit that reduced infant 
poverty by 45 percent within six months passed by one vote. 
Every Democrat supported it. Every Republican opposed it.
    I gather from your testimony, Professor Myers, that one of 
the reasons that women often cite for terminating pregnancy is 
financial pressure. The financial pressure of healthcare 
expenses, the financial pressures of raising kids and finding 
childcare. Knowing that you're going to be covered for 
healthcare in the year after delivery, knowing that you can get 
a child tax credit to help with the expenses these are the 
kinds of policy that are pro-mom and pro-family and might even 
help the U.S. deal with the declining birth rate and turn it 
around and we could start to have a growing birth rate again if 
families felt that they had a financial cushion and the 
financial pressure wasn't causing them to consider terminating 
a pregnancy. Am I right about that?
    Dr. Myers. Yes, I think you are, Senator. Thank you for the 
question. American birth rates have been plummeting and the 
reasons are very complex, but I think we should all be very 
concerned about that through multiple lenses, including a 
fiscal lens. And one of the reasons that people give for 
delaying becoming parents or having fewer children is financial 
concern. And so, I agree with Mrs. Ford that we could bolster 
the social safety net. We could reduce marriage penalties, I 
think that's a really good idea, but you just can't leave out 
the other financial concerns that affect families. And the 
Child Tax Credit was an incredibly important piece of that 
social safety net, expanding Medicaid is an incredibly 
important piece, making welfare benefits more accessible, doing 
things like reducing child caps. There are so many other things 
we need to do to bolster the social safety net and in doing so 
we would likely help work against this concerning trend of 
declining births.
    Senator Kaine. Thank you. I yield back, Mr. Chairman.
    Chairman Whitehouse. Senator Van Hollen.

                STATEMENT OF SENATOR VAN HOLLEN

    Senator Van Hollen. Thank you, Mr. Chairman, and thank all 
of you for your testimony here today. And Mrs. Phillips, I 
wasn't in the room, but I saw your testimony on C-SPAN as the 
hearing progressed and I want to thank you for being here and 
sharing your very personal story and it does Miley Rose's 
memory great credit that you're here speaking on behalf, not 
just for yourself, but as you said, millions of other American 
women.
    So, now you've experienced a Senate hearing. Lots of things 
have been said and so I just want to give you the opportunity, 
as we close, I may be the last senator to ask questions. After 
you've heard everything here today, is there anything that you 
would like to say in response and make sure that we can correct 
any misperceptions that some people have expressed.
    Mrs. Phillips. Yes. And thank you so much, Senator, for 
giving me this opportunity. I will start by saying that I made 
a promise to Miley that her name would not die with her, so 
that is why my activism is so important to me is, so people 
know who she is.
    I want to make two statements before I go into my final 
thing that I would like the Committee to know. I think it was 
Senator Kennedy came to this hearing knowing that there was 
going to be a mother here who had to make the difficult 
decision to terminate a 20-week pregnancy and he decided it was 
in his best interest to show a 21-week fetus and his testimony 
was nothing but fearmongering. From my experience, that was not 
my experience what he was trying to persuade.
    Also, Mrs. Call, to answer your question to what he had 
asked, my procedure was an abortion. It is on my medical 
paperwork that I had an abortion, even though my daughter was 
deceased. It is not back and forth. An abortion is a medical 
procedure, whether that fetus is deceased or not. But I would 
like to ask the Committee to remember my story and to remember 
that I'm one of thousands, if not millions of people in this 
country that need or needed abortion access and to remember 
that it's not black and white and one size does not fit all. We 
can't be putting politics into healthcare decisions and also to 
remember these facts. That abortion access is essential 
healthcare, no matter how you want to look at it. It's 
essential healthcare for so many and exceptions don't work. I'm 
a living testimony to that.
    Tennessee had a very vague exception to protect the life of 
the mother. My life was at risk, and I did not qualify. I would 
ask the Committee to consider passing a law that allows access 
without exception, just all across the board because when 
someone needs healthcare, they should be able to receive that 
healthcare when they need it and not have to navigate the 
hurdles like I did. Because like I said, I don't know if I 
hadn't made it to New York if I would be here with you today. 
So, I'm very thankful for the opportunity that I was given to 
get to New York and now this opportunity to fight back against 
the extreme bans that we're facing in many states.
    Senator Van Hollen. Thank you, Mrs. Phillips. Thank you for 
your earlier testimony and that powerful closing. And Dr. 
Zahedi-Spung, if I could just ask you to elaborate a little bit 
more on the real challenges doctors face in trying to navigate 
these legal areas. Senator Padilla asked some of the questions 
I'd planned to ask about the impact on doctors and their 
decisions to have to move to other states and how that leaves 
women in the workforce in states like Tennessee at greater 
risks, but it's because doctors don't want to end up being 
fined or worse for their actions. And I know from your 
testimony that you call upon your fellow physicians when you 
were in Tennessee, and others to do, to try to navigate these 
things and how it's an impossible standard. Can you just talk 
about that, that kind of experience of having to go through 
these difficult decisions when people are talking about 
imposing legal penalties?
    Dr. Zahedi-Spung. Thank you so much for that question, 
Senator. I'm a physician and not a lawyer. I did 11 years of 
training in order to become a doctor and trust my own clinical 
gestalt and then a law went into effect that took my ability to 
care for my patients in the way that was necessary away from me 
and from so many others. I'll never forget after the days after 
Dobbs the number of conversations I had with our hospital 
lawyers, my criminal defense attorney, the lawyers across the 
country who were trying to navigate the everchanging experience 
for patients and providers, and I wasn't able to care for 
patients because I was trying to figure out if I could even 
take care of them.
    I had a hematologist call me and ask if he could give 
chemotherapy to a breast cancer patient who he'd just found out 
was pregnant because he was worried that if he did and she 
miscarried he'd go to jail for taking care of his patient. It 
was--it is still terrifying. We navigate this on a regular 
basis with patients who are coming to us with very complex 
care, trying to make sure that they have all of the follow-up 
and the care that they need back home while still protecting 
their privacy. It's untenable and I am devastated I had to 
leave a place that I loved and a community that I cared deeply 
for, but I knew I couldn't do any good if I wasn't able to 
practice medicine anymore.
    Senator Van Hollen. Thank you, Doctor. Thank you.
    Dr. Zahedi-Spung. Thank you.
    Senator Van Hollen. Thank you, Mr. Chair.
    Chairman Whitehouse. Thank you very much. We thank all of 
the witnesses. There was a comment, a critique, Professor 
Myers, of your conclusions regarding the causal effect between 
reproductive care restrictions and the economy, and 
specifically the appropriate conclusions to be drawn from the 
Turnaway Study. You've not had a chance to respond to that. I 
think, in fairness, I should give you a chance to respond to 
that if you would care to.
    Dr. Myers. I would. Thank you, Chairman Whitehouse. I'd 
like to return to that. So, I want to say, first of all, very 
clearly that most of the evidence that I present and share in 
my testimony is not from the Turnaway Study. There's ample 
evidence from multiple independent research teams using 
different natural experiments to isolate and measure the 
effects of abortion and access. So, we're not just talking 
about the Turnaway Study, by any means.
    But when we are talking about the Turnaway Study, that 
evidence is causal. To illustrate one of the most important 
studies to come out of that research project--and I want to be 
clear, it's not mine, this is another team--took people who 
were in the Turnaway Study, they were seeking abortions, 
arriving at providers, and some of them were finding out that 
they were just past the gestational age limit to receive the 
abortion that they wanted and they were turned away. And others 
were just under it and received that abortion.
    Chairman Whitehouse. Hence, the name of the study.
    Dr. Myers. Hence, the name of the study. And the 
researchers connected all of these people to their Experian 
credit reports and they followed what their credit reports 
looked like for months, years before this pivotal event in 
their lives and the two groups trended incredibly similarly. 
They looked really, really similar right up until the moment 
that this happens to them and that's when there's this 
incredible divergence and all of a sudden the people who are 
turned away have this enormous increase in adverse credit 
events.
    I don't think a reasonable person can look at that evidence 
and say that's just a correlation. Something else happened that 
day that caused their credit to fall off a cliff.
    Chairman Whitehouse. All right. Well, thank you for that 
response. Thank you all for your testimony here today. I know 
that, Mrs. Phillips, this was particularly difficult for you 
and one of our colleagues made it even more difficult and I 
apologize for that, but I thank you very much for being here. 
The record will remain open in case anybody wishes to add 
anything for another week. With that, this hearing is 
concluded.
    [Whereupon, at 11:53 a.m., Wednesday, February 28, 2024, 
the hearing was adjourned.]

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