After more than 11 hours of debate on the Senate floor, three bills seeking to bolster abortion rights in Colorado cleared the chamber Wednesday, advancing to the House for consideration.

If signed into law, the bills would shield abortion patients and providers from interstate investigations, expand insurance coverage for abortion care, and prohibit what supporters call “deceptive” advertising from crisis pregnancy centers.

The bills are the first legislative action Colorado lawmakers have taken up on the subject since the Supreme Court overturned national abortion protections in the Dobbs v. Jackson Women’s Health Organization ruling last year. Two months before the ruling, state lawmakers enshrined abortion as a fundamental right with the Reproductive Health Equity Act.

Senators passed the three bills in identical votes of 22-13, with all Republicans voting “no” and all Democrats voting “yes,” except for Sen. Kevin Priola, D-henderson, who switched parties last year.

Senate Bill 188 would protect abortion patients and providers giving and receiving care in Colorado from facing criminal or civil consequences from other states in which abortion is illegal.

After the Dobbs ruling, 14 states have passed laws banning or limiting abortion, with many more currently trying to enact blocked bans.

“We need this legislation to protect individuals from threats and bounties and bans that are coming forward from other states,” said bill sponsor Sen. Julie Gonzales, D-denver.

“Other states have no right to impose their regressive statutes on us here in our state. We know what kind of care our communities need and that freedom must be protected.”

The bill builds on an executive order signed by Gov. Jared Polis in July, directing state agencies to withhold records from states that may impose criminal or civil penalties on those who receive or provide abortions in Colorado. The bill would enshrine this executive order into state law, as well as prohibit the state from recognizing criminal prosecutions or civil lawsuits regarding legally protected abortion care.

In addition to abortion, the bill would also extend these protections to gender-affirming care received by transgender individuals. Other states have moved to ban or limit gender-affirming care, with more than 20 states considering such legislation in 2023. Gender-affirming care includes social, psychological or medical

interventions, such as hormone therapy and surgical procedures. During the Senate debate, some opponents lamented the thought of Colorado becoming a hub for interstate abortion access.

“We are signaling to the rest of the union and the rest of the world that ... Colorado will proudly end the life of any unborn child at any time during pregnancy,” said Sen. Kevin Van Winkle, R-highlands Ranch. “It seems to invite anyone wanting an abortion to come to our state to end the life of a child. ... It is wrong. It promotes a culture of death.”

Proponents countered that Colorado is and should continue to be a safe haven for people seeking abortion, particularly if their home state’s abortion ban puts their health and safety at risk.

During a committee hearing on the bill, Lauren Miller said she traveled from her home in Texas to Colorado to receive an abortion after one of her twins was determined to be unviable. Miller said continuing to carry the unviable twin risked killing her and the viable twin, but Texas’ law did not allow her options to terminate the pregnancy.

Miller begged Colorado lawmakers to “not abandon us to the cruelty imposed by the leadership in our states” while testifying in support of the bill.

Other opponents said the bill disrespects the laws of other states, saying even if people travel to Colorado for abortion care, it could violate their home state’s law.

But bill sponsor Sen. Sonya Jaquez Lewis, D-longmont, said it is the other states that are threatening Colorado’s sovereignty. Jaquez Lewis, a pharmacist, said if she lawfully fills a prescription for an abortion-inducing medication in Colorado that is later brought to an abortion-banning state with her name printed on the bottle, she could be summoned, investigated, or even extradited and arrested, even though she broke no laws in Colorado. “These state laws are out of control and not acceptable. This bill gives us the opportunity to stop it,” Jaquez Lewis said. “Bounty hunter laws have created a climate of fear and intimidation. It will prevent Colorado health care workers from offering care and prevent patients from seeking care.”

In the month after the Dobbs decision, the Colorado-based Cobalt Abortion Fund reported that 94% of its clients seeking practical abortion support came from out of state, including 66% from Texas alone.

In January, 750 people traveled to Colorado Planned Parenthoods from out of state for abortion care — compared to only 1,500 people during the entirety of 2021, according to Planned Parenthood of the Rocky Mountains.

Seven states and the District of Columbia have passed similar protections against interstate investigations regarding abortions, and 12 governors have issued executive orders establishing such protections, according to the Center for Reproductive Rights. Other states including Washington, New Mexico, Minnesota and Vermont are currently considering similar legislation.

Senate Bill 189 would require health insurance carriers that serve large employers — those with more than 100 employees — to pay for abortion coverage without deductibles, copays or coinsurance.

Health insurance for the small group and individual market would provide that coverage depending on how the federal Centers for Medicare & Medicaid Services, which regulates the Affordable Care Act, views those services. Under the ACA, any state insurance mandate would be reviewed under the lens of how it affects premiums.

If the mandate has the potential to increase premiums, the state would technically be required to defray those extra costs, although that scenario is rare and has never happened in Colorado. An actuarial review of SB 189 said the bill would result in a minimal decrease in costs, around 15 cents per member.

“We should offer the full suite of reproductive health care ser-------vices in our state, and having insurance cover those is a necessary step, in my opinion, to make sure that folks have that choice when it comes to their health care,” said bill sponsor Sen. Dominick Moreno, D-commerce City.

“SB 189 is the next step in making sure that abortion access isn’t just protected, but that people can actually get it.”

The bill gives employers the option of refusing to offer abortion services if it conflicts with their religious beliefs, so long as the decision is in line with federal court decisions.

The measure’s insurance mandate also applies to treatment for HIV and other sexually transmitted diseases. It prohibits health insurance carriers from requiring HIV patients use step therapy, a requirement that patients try a lower-cost drug before moving on to a more expensive one. For other care, the bill prohibits a carrier from requiring deductibles, copays, coinsurance, or imposing a lifetime maximum benefit for treating a sexually transmitted disease or for sterilization services.

The bill also expands the kinds of health care providers that can give contraception, including procedures, supplies or information, to a minor without first needing to obtain parental consent or provide notification. The law allows only for physicians to provide those services; the bill would add, for example, nurse practitioners.

Much of the debate from critics in the Senate centered on whether the bill would significantly expand coverage for abortion services as the sponsors say.

Sen. Jim Smallwood, R-parker, said the bill would not apply to the vast majority of Coloradans, such as those who are uninsured, covered by military plans, or covered by Medicaid or Medicare. Smallwood said these residents could seek abortion care thinking it will be free, only to be charged and put in a bad financial position.

“I have to think that the proponents haven’t thought this through, because if they had, it would be utterly irresponsible for them to propose something like this in the first place that’s going to work so infrequently,” Smallwood said. “At the end of the day, what have we really done with this bill? Provide confusion.” Some opponents also argued that the bill would result in taxpayer funding for abortions if it does end up causing an increase in insurance premiums.

Others said the bill would interfere with parental rights, as the bill removes the requirement that, when a minor receives contraception services, a notification be sent to their parent, guardian or someone who makes a referral for those services, such as a member of the clergy, family planning clinics, or schools or colleges.

Proponents rejected the arguments from critics as baseless, and claimed that the bill is essential for giving Colorado voters what they’ve repeatedly asked for — abortion access.

“The voters were loud and clear in Colorado. We’ve established that access to a full range of reproductive care is something we value. The keyword there is ‘access,’” said bill sponsor Sen. Lisa Cutter, D-littleton. “Existing gaps in our coverage of reproductive care can cause significant barriers to access.”

Senate Bill 190 would prohibit crisis pregnancy centers from advertising abortions, emergency contraceptives or referrals that they don’t actually provide, classifying it as “deceptive advertising.” The centers, dubbed “anti-abortion clinics” by opponents, counsel pregnant women against having an abortion, advocating for parenting or adoption instead. Bill sponsor Sen. Janice Marchman, D-loveland, said the centers pretend to offer abortion care but don’t, using “disinformation, intimidation, shame and delay tactics” to prevent people from accessing abortion care.

The American Medical Society Journal of Ethics called the centers unethical, claiming they spread misinformation and give the impression that they offer medical services and advice, “yet they are exempt from regulatory, licensure, and credentialing oversight that apply to health care facilities.” A 2012 study from the National Library of Medicine claimed that 86% of the centers provide misinformation on abortion.

“A woman should be able to understand what all of her options are,” said Sen. Jessie Danielson, D-wheat Ridge. “That woman will not receive that information if she walks into a crisis pregnancy center.

... To advertise that you provide a comprehensive set of services for someone seeking reproductive health care is false. It’s misleading.”

In Colorado, there are 51 of these crisis pregnancy centers, compared to 20 abortion clinics.

Supporters of crisis pregnancy centers denied misleading patients, arguing that they legitimately provide services, including health education, ultrasound and counseling. They said SB 190 would unfairly limit their advertisement, potentially prohibiting them from saying they offer “help with unplanned pregnancies” without specifying the services provided.

While Republican senators backed crisis pregnancy centers and said the bill would violate their freedom of speech, most of their opposition surrounded a different component of the bill: classifying providing abortion “reversal” treatment as unprofessional conduct.

“This bill seeks to eliminate alternatives to abortion,” said Sen. Barbara Kirkmeyer, R-brighton.

“It is a woman’s right to choose life for her child. … For some women, that means she should be able to choose the abortion reversal pill. It is her right to make that choice. It should be her choice.”

The controversial abortion reversal practice claims that the hormone progesterone can stop a medication-based abortion after a patient has completed the first part of the twostep process.

Crisis pregnancy centers support the practice, pointing to a small-scale 2012 study which found that 4 in 6 women who had begun medication abortions were able to carry their pregnancies to term after taking progesterone. However, the study has been criticized for having methodological flaws, and subsequent research has concluded that there is insufficient evidence to support abortion-reversal treatment.

A larger 2019 University of California study attempted to test the effectiveness of abortion pill reversal, but the study was ended prematurely due to safety concerns after three participants required ambulance transport to a hospital for treatment of severe vaginal bleeding, NPR reported. The American College of Obstetricians and Gynecologists also rejects prescribing progesterone to reverse abortions, saying it is “not based on science and do not meet clinical standards.”

The bill was amended to require the state medical, nursing and pharmacy boards to evaluate the practice of abortion reversal by Oct. 1. If the boards all agree that it’s a valid medical practice, then it will be considered professional conduct. If not, it will be unprofessional conduct.