Two months after an abortion ban went into effect in Idaho, medical clinics in Washington are reporting an increase in patients crossing the border for care. But rather than a one-time surge tied to specific legislation, advocates describe an ongoing, sustained need for abortion access in Washington as more states throughout the country adopt abortion bans and more patients are forced to travel from as far away as Texas and Florida to seek treatment in a state where abortion is still legal.

“It’s been the death by 1,000 cuts,” said Paul Dillon, vice president of public affairs for Planned Parenthood of Greater Washington and North Idaho, who traces the increase in out-of-state patients back to 2010, with the rise of the Tea Party and state-level abortion restrictions that diminished access even with Roe as a legal backstop. But pre-existing gaps in access aren’t always the result of new laws. Even in Washington, said Dillon, geography can be a barrier for health care of many kinds. “We’re the closest provider for a patient who would have to drive from Republic, which is three, three and-a-half hours away,” he said.

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