Democrats and abortion rights advocates are seeking clarity on federal restrictions and challenges ahead of the Supreme Court releasing a decision expected to reverse the 50-year-old precedent set by Roe v. Wade.

The Supreme Court is expected to issue its decision in Dobbs v. Jackson Women’s Health Organization this month, with both abortion rights advocates and opponents preparing for states to regain the ability to regulate abortions before a fetus can survive outside the womb. 

Were the high court to overturn the legal precedent established by the 1973 Roe decision, access to legal abortions would become a patchwork, and the nonpartisan Kaiser Family Foundation said 17 states would effectively outlaw most abortions.

Polling released by KFF on Thursday showed that 45 percent of people living in these 17 states are unaware that abortion would become illegal in their states if Roe is overturned. Forty-two percent said they were unsure and 13 percent said they believed abortion would be legal.

The survey also found that 74 percent of individuals in these states oppose laws that would ban abortion.

The survey was released during a week when Democrats have been increasingly calling on the Biden administration to put safeguards in place to protect some types of abortion access ahead of a decision in Dobbs.

“Democrats need to use every tool at their disposal to protect women and their constitutional right to an abortion. President Biden’s executive authority to marshall the resources of the entire federal government is one of our most powerful tools,” said Sen. Elizabeth Warren, D-Mass., one of 25 Democrats who wrote to Biden on Wednesday.

The letter, spearheaded by Warren and Senate Health, Education, Labor and Pensions Chair Patty Murray, D-Wash., calls on the administration to take action to increase medication abortion access, clarify how sensitive reproductive health data would be protected and create a reproductive health ombudsman at the Department of Health and Human Services. 

Senate Finance Chair Ron Wyden of Oregon and House Energy and Commerce Chairman Frank Pallone Jr. of New Jersey, meanwhile, sent a letter to Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure on Wednesday asking for a briefing before June 24 on steps the administration will take to prevent family planning providers such as Planned Parenthood from being excluded from some state Medicaid programs.

“Moreover, we are concerned that more states will take similar steps to exclude reproductive health providers from Medicaid without clear and immediate agency action,” wrote the Democratic lawmakers, who have joint jurisdiction over Medicaid. 

Abortion providers have warned that because of how Medicaid coverage works, patients in a state that bans abortion may not be able to easily access abortion in states that have not banned abortion.

While most abortions for Medicaid recipients are not covered by federal funding, some states cover abortion through state funds. However, all states are currently permitted to cover abortion under Medicaid in instances of rape, incest or to save the life of the mother. 

Tammi Kromenaker, the owner and clinic director of Red River Women’s Clinic, North Dakota’s only abortion clinic, said her state is already in a unique geographic situation. 

Minnesota Medicaid covers abortion, but North Dakota and South Dakota do not. The clinic is able to accept Minnesota Medicaid coverage.

“We know it’s not easy. You can’t just accept Medicaid from another state,” she said Wednesday during a roundtable with Physicians for Reproductive Health and the Abortion Care Network.

The process involves a number of administrative requirements, and the providers must be credentialed and provide a lot of information, which she said takes up additional resources on the administrative side of the clinic. 

“The Medicaid reimbursement rates for states that do cover abortion are abysmal. We’ve received maybe $75 for a medication abortion patient from Minnesota,” she said. “That barely covers the cost of the medication itself, let alone the rest of the care for the patient.” 

Mercedes Sanchez, communications director for Cedar River Clinics in Washington state, said the administrative burden can lead clinics to decide to not accept Medicaid at all, which can further reduce access.

Democrats are also facing roadblocks on a state level. 

Wisconsin Gov. Tony Evers signed an executive order Wednesday calling for a special legislative session starting June 22 to pass legislation to repeal the state’s abortion ban that would take effect if Roe is overturned.

“This isn’t about politics — it’s about empathy, compassion, and doing the right thing. There’s no time to sit around and wait for this decision to arrive on our doorstep,” Evers said in a statement.

The Republican-controlled Wisconsin Legislature does not intend to proceed with the bill. Wisconsin Senate Majority Leader Devin LeMahieu criticized Evers and Democrats’ push to change the law. 

“Wisconsin law has not changed, and our pro-life position has not changed,” LeMahieu said. “We will gavel out of another blatantly political special session call from this partisan governor.”