Gov. Jan Brewer's decision to have the federal government, rather than the state, set up a health-care exchange means that state lawmakers will avoid a new battle this year over abortion and contraception coverage.
While details about the insurance plans that will be available are still sketchy, state lawmakers will not have a say over whether abortion or contraception coverage is included in the private plans that consumers will be able to purchase though the exchanges, which will be online marketplaces where consumers can compare and purchase insurance plans.
While Republican lawmakers will miss the opportunity to further restrict reproductive rights, they have passed a remarkable number of restrictions over the last four years.
Women in rural Arizona now have to travel to Tucson or Maricopa County to get an abortion. They have to plan on staying at least overnight, since they now have to meet with a physician and have an ultrasound examination at least 24 hours before the procedure. A nurse practitioner can no longer provide the state-mandated information about abortion; instead, a physician must do it. A medical abortion induced by pills must now follow the same regulations as surgical abortion. The ability of a minor to get an abortion without parental consent has been sharply curtailed. And employers with a religious affiliation can refuse to offer birth control as part of their health-insurance plan.
"Well over a dozen significant restrictions have been passed over the last four years," says Bryan Howard, the executive director of Planned Parenthood of Arizona.
Two Arizona laws passed earlier this year remain on hold while federal courts decide whether they're constitutional.
One law, the Mother's Health and Safety Act, would prevent abortion in the 20th week of pregnancy or later. During hearings on the bill, a physician testified that some serious birth defects aren't detected until that point in the pregnancy, giving women little time to decide whether to have an abortion or carry a child to term who will die shortly after delivery.
The Center for Reproductive Rights, representing three Arizona obstetrician-gynecologists, has filed suit against the law. The case gets right to the limits set by Roe v. Wade regarding how states can regulate abortion. Center for Reproductive Rights attorneys argue that the state can regulate, but not ban abortion before a fetus is viable; attorneys for the state argue that limiting abortion to situations where the mother's life is in danger after 20 weeks of pregnancy constitutes a regulation and not a ban.
U.S. District Court Judge James Teilborg refused to block the law in July, but his decision was overturned by the 9th U.S. Circuit Court of Appeals, which enjoined the law from going into effect. Last month, attorneys for the state asked the appeals court lift that injunction; the court has yet to rule.
Howard says he wouldn't be surprised to see the case go the U.S. Supreme Court as a vehicle to overturn Roe v. Wade.
The second state law that's tied up in the courts would block Planned Parenthood from receiving any federal health-care dollars that pass through the state, even for services that are not associated with abortion, such as pap smears, cancer screenings and birth-control services.
Planned Parenthood filed suit to block that law, saying that federal law did not allow the state to block funding for a qualified health-care provider based on the fact that it also provided abortion services. U.S. District Court Judge Neil Wake issued an injunction against the law; last month, Arizona appealed that ruling to the 9th Circuit.
The Obama administration has filed briefs opposing the state's position.
Howard says that the GOP's efforts to chip away at abortion rights are costing them votes among women.
"Access to preventative health care—and women's health care, specifically—is not some intellectual or political argument for the vast majority of American women," Howard says. "It's basic health care that they're consuming every month of every year."
Republicans lost four seats in the Arizona Senate and four seats in the Arizona House in November's election. In the Senate, Republicans now hold a 17-13 advantage, rather than the 21-member supermajority they had over the last two years.
"In terms of repairing the damage that's been done to access to women's health care over the last four years, progress was made that was necessary but not sufficient," Howard says about the recent Arizona elections.
The opposition to abortion rights and hostility to Planned Parenthood had an impact on the federal level, too, says Howard. He points to Mitt Romney's failure to win over women in last month's presidential election after he promised to end any federal funding for Planned Parenthood.
"We absolutely saw the gender gap play a role in President Obama's re-election," Howard says.
Comments about pregnancy, rape and abortion also sank the hopes of Republican Senate candidates Todd Akin in Missouri, and Richard Mourdock in Indiana.
"These were serious red states that elected Democrats because of the outlandishness and the disconnect," Howard says. "While reproductive health care might not be the first thing in an exit poll that somebody cites about why they voted the way that they did, a candidate's position on access to health care makes a statement about their values. And women voters in particular will interpret: 'This candidate gets me,' or, 'This candidate doesn't understand me or how I'm living or what my life is like ... so I can't trust him to do the right thing on the economy, either.'"