AILSA CHANG, HOST:
Texas Governor Greg Abbott addressed a rally earlier this year celebrating the abortion ban that took effect after the Supreme Court overturned Roe v. Wade.
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GREG ABBOTT: As long as I am governor of the great state of Texas, Texas will always protect the unborn. Thank you all. God bless you.
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CHANG: Well, in fact, just a few weeks ago, Abbott signed a law giving doctors leeway to provide abortions in Texas when patients face certain serious pregnancy complications. NPR's Selena Simmons-Duffin asked the Democrat from Houston who wrote that bill how she got it passed.
SELENA SIMMONS-DUFFIN, BYLINE: Here is the problem as State Representative Ann Johnson sees it.
ANN JOHNSON: There are two groups of people that are talking past each other on a term.
SIMMONS-DUFFIN: That term is abortion. For doctors, she says, an abortion is any termination of pregnancy. That includes if the fetus has a fatal condition or if the pregnant patient is facing a serious medical complication. For politicians who oppose abortion rights, she says...
JOHNSON: They believe abortion to be the elective procedure on a completely healthy fetus.
SIMMONS-DUFFIN: Johnson is a Democrat. She says even if the goal of the Texas abortion bans was to stop those elective abortions, the law makes no distinction. Abortion in Texas is banned from conception full stop. There is a medical exception, but it's extremely narrow. Someone has to be close to death. Very few cases qualify.
JOHNSON: The doctors and the hospitals and their lawyers were reading all of the Texas statutes, some of which from the early 1900s, that went back into effect when Dobbs came out and saying, look. We can't tell you what to do here. The language is confusing. The terminology and the definitions are confusing.
SIMMONS-DUFFIN: The laws also come with extremely steep penalties for doctors like life in prison, the loss of their medical license and $100,000 in fines. Johnson's district, Texas 134, includes the Houston Medical Center. She says after Roe v. Wade was overturned by the Supreme Court and the Texas abortion bans took effect, people would stop her when she took walks around the district.
JOHNSON: Many of them would say, I know who you are. I'm a physician. And we'd talk about the concern that they had.
SIMMONS-DUFFIN: The laws don't just affect OB-GYNs, she says, pointing to a recent law that imposes criminal penalties on prescribers of certain medications that can cause abortions like methotrexate, a drug used to treat cancer and autoimmune disorders.
JOHNSON: If you have a general practitioner or a dermatologist that's treating psoriasis or rheumatoid arthritis of a 34-year-old woman who has no intentions of getting pregnant and then she gets pregnant six months later and that pregnancy terminates because of that medication...
SIMMONS-DUFFIN: That doctor could get charged with a felony, she says. There have also been real-life stories, including many reported by NPR, in which patients facing pregnancy complications could not get doctors or hospitals to provide abortions early enough to fend off infections, hemorrhage and more. Johnson heard from her constituents about women whose water broke too early.
JOHNSON: The stories that I was hearing is that women were suffering permanent physical medical conditions because of a very basic event that happens in pregnancy, which is a ruptured membrane.
SIMMONS-DUFFIN: When this happens at 17 weeks of pregnancy, for instance, there's no way for the fetus to survive, and the patient is at high risk of infection, even sepsis. Johnson is an attorney by profession. She says she had to think creatively about how to make the abortion laws work better for doctors by allowing them to intervene during complications. She also believes many of her Republican colleagues who voted for these laws did so without realizing the wide-ranging impact they would have on medical care. So a few weeks after the legislative session started at the beginning of the year, she introduced a bill. Originally, the bill broadly allowed doctors to provide medically necessary services.
JOHNSON: We actually filed this bill early on in the session, and nobody noticed it, which was by design.
SIMMONS-DUFFIN: Since Democrats are in the minority in the Texas legislature, she had to figure out a way to get bipartisan support. The Senate sponsor of the bill was none other than Republican State Senator Bryan Hughes, the author of SB 8, what's known as the bounty hunter law that allows private citizens to sue anyone for aiding and abetting a Texas abortion. Hughes did not respond to repeated requests for comment on this story. Johnson says he was a big help in lining up key supporters across the legislature.
JOHNSON: I'm glad that we were able to have honest conversations. This would not have happened without having him in the Senate get this through.
SIMMONS-DUFFIN: The final bill is not as broad as the original. It outlines two conditions where doctors can provide abortions - preterm premature rupture of membranes, the medical term for when someone's water breaks too early, and ectopic pregnancy, which happens when a fertilized egg implants somewhere besides the uterine lining.
JOHNSON: Yes, there are absolutely other pregnancy complications. In this moment, we could get the bipartisan agreement of the recognition of ectopic pregnancy and ruptured membrane.
SIMMONS-DUFFIN: Johnson says she's proud of HB 3058. She says no other piece of legislation that addressed abortions even got a hearing.
JOHNSON: I think what was key about this legislation is that it did not have the term abortion in it. And because of that, it did not become a political football.
SIMMONS-DUFFIN: It passed at the last possible moment, she says.
JOHNSON: And I am glad that the governor signed it. To me, it is a first step. I just very strongly feel we need to do more.
SIMMONS-DUFFIN: The next regular legislative session won't be until 2025. In the meantime, a law that actually widens access to abortion in Texas, at least in some cases, will take effect September 1. Selena Simmons-Duffin, NPR News.
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