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What happened to the GOP’s promises to support women and families after Roe?

North Carolina’s new abortion ban exposes the GOP’s failures to shore up government assistance for parents and children.

A protester in a crowd holds up a sign that reads “Abortion is healthcare.” Allison Joyce/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Last summer, after the Supreme Court’s Dobbs decision overturned the federal right to have an abortion, much ink was spilled on the possibility that Republicans, eager to pass a new round of abortion bans, would feel compelled at the same time to improve the social safety net to help the women and children their new laws would affect.

But that spending has largely not materialized. Though nearly 20 states have banned abortion over the past year, experts say few have put meaningful dollars into supporting children and families.

In recent weeks, it might have seemed as though that was changing. In Florida, which passed a six-week abortion ban last month, state legislators voted to expand children’s health insurance and put real money behind those plans. In North Carolina, a 12-week abortion ban includes some additional support for children and families — but the provisions are not as generous as they might first appear.

The two states’ approaches reveal a party struggling to figure out how to tamp down the political backlash that has followed the end of Roe: Are symbolic gestures enough? Or do Republicans really have to get serious about shoring up government assistance for children and families?

North Carolina recently has been the most prominent battleground over abortion rights in America. The state legislature passed a 12-week abortion ban, which was vetoed by Democratic Gov. Roy Cooper. Republicans possessed enough seats in the legislature to override Cooper’s veto on Tuesday.

In addition to banning abortion after 12 weeks, with some exceptions for rape, incest, or the health of the mother, the North Carolina law requires multiple in-person appointments before a person could be prescribed medication for an abortion. It also introduces intrusive reporting requirements, such as mandating that doctors report a patient’s fertility history to the state government after an abortion, including information such as their number of live pregnancies, previous pregnancies, and previous abortions.

The law does include some provisions that Republicans say will provide additional support for children and families, including a new paid parental leave policy and increased child care subsidies. These are the kinds of policies that some prognosticators expected post-Dobbs. But both programs have significant holes.

Paid parental leave applies only to state employees, not the private sector. Increasing the state’s child care subsidies for families already receiving them would not alleviate the main problem with accessing child care in North Carolina, as there are already 30,000 children in the state on a waitlist for financial assistance. The law does not do anything to get people off of that waitlist, such as by increasing the number of subsidies available.

“This bill would ban abortion and heavily restrict abortions for North Carolinians and would do very little to advance maternal and child health,” said Rebecca Kreitzer, a political scientist at the University of North Carolina who is following abortion legislation across the country.

The legislation also extends the period in which new parents can give up an unwanted child confidentially and without fear of prosecution — known as a safe surrender law — keeping with a trend of conservative states shoring up support for adoption in lieu of expanding the welfare state.

That follows the pattern in the nearly 20 states that have moved to ban or heavily restrict abortion since the Dobbs decision. States have either skipped any expansion of the safety net while advancing those bills or they have only made symbolic gestures, Kreitzer said.

In some states, legislators have stuck to policies more traditionally favored by conservatives, such as tax credits for donations to crisis pregnancy centers or additional funding for adoption agencies. Some states, including Wyoming, have extended their postpartum Medicaid benefits, but those efforts have failed in other states like Utah, and some, such as Missouri, have put restrictions on who qualifies for the additional support.

The bottom line is, there has decidedly not been an extensive expansion of social welfare programs in states where abortion is now largely illegal, and North Carolina — despite gesturing in that direction — is following the same pattern.

“These bills being introduced and passed are symbolically doing things to advance women’s and children’s health but are not going to substantively have an impact,” Kreitzer said.

Florida actually has expanded its welfare state

There may be one exception to this: Florida’s recent expansion of its children’s health insurance program. That bill, which passed last week, less than a month after Gov. Ron DeSantis signed a six-week abortion ban, is perhaps the most substantial expansion of the welfare state that passed soon after new restrictions on abortion went into effect.

The legislation, which is now heading to DeSantis’s desk, would extend eligibility for low-cost health insurance from 200 percent of the federal poverty level to 300 percent (about $69,000 for a family of three). It was the first expansion of the program, called KidCare, in 25 years. It passed through the state legislature unanimously.

The bill also set aside about $100 million to initially fund the expansion and to increase reimbursement rates to doctors and other medical providers so they would be more likely to accept the program’s coverage at their practices.

There have been some concerns about the premiums that families will be required to pay; the state will set those rates at a later date. But “in general, it’s a good thing,” Joan Alker at the Georgetown Center for Children and Families told me.

Unlike the North Carolina bill, the expansion of KidCare was not explicitly linked to the abortion ban. But they were moving in tandem through the state legislature; one House committee considered the abortion ban and the health insurance legislation back to back. House leaders also touted their plans to expand government support for new mothers as they celebrated the passage of the six-week abortion ban.

DeSantis is expected to be the most viable challenger to former president Donald Trump in the Republican primary and, in general, he is regarded as the elected official with the next-best odds of being the next president, behind Trump and President Joe Biden.

But to get elected, he’ll need to court social conservatives, which the six-week abortion ban helps to do, without alienating more moderate voters who will be critical to the general election. An expansion of health insurance for kids would be one way for DeSantis to make that case.

It remains to be seen whether that calculus works out for DeSantis; polling suggests Florida’s six-week ban is not popular in the state. But pairing stricter abortion rules with a more meaningful expansion of the welfare state could, in theory, provide a path through the Dobbs backlash, which has already contributed to the party’s poor showing in the 2022 midterm elections.

Republicans across the country find themselves in uncomfortable political territory as they attempt to deliver on their decades-long promises to roll back abortion rights. In South Carolina, new proposed abortion restrictions have been tripped up by the objections of Republican women in the legislature. Nebraska’s proposed abortion ban has likewise been stymied so far by a holdout Republican lawmaker. In North Carolina, the legislature has altered its rules so that veto overrides can be brought up for a vote without any notice — a parliamentary maneuver that, in Kreitzer’s eyes, reveals the leadership’s discomfort with a drawn-out debate.

“Republicans knew that if they took the time to really debate it, it might not pass,” she said.

In general, conservatives seem to be operating with a sense of impending political doom, facing a stark reality that many voters aren’t as comfortable with going as far as Republicans had long promised they would.

But rather than lower their ambitions — or, with the exception of Florida, try to ameliorate the backlash by meaningfully expanding the social safety net — they seem intent on pushing new restrictions through while they have the chance.

“The urgency to pass this, to pass drag bans, to pass these cultural war things, the writing on the wall is indicating that things are moving in the other direction,” Kreitzer said. “Future elections might not go their way.”