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Vermont lawmakers have given final approval to a bill intended to increase safeguards around reproductive and gender-affirming health care.

Democrats said would fill “technical gaps� and improve the state’s current shield laws � which provide legal cover for Vermont health care providers and patients.

“We are not adding any new health care activities,� said Winooski Rep. Daisy Berbeco, a Democrat, to House members last week. “These are things that are already legally protected in Vermont.�

The legislation would make abortion medication accessible online, broaden which health care service advertising is regulated by consumer protection law, and add privacy options for providers of reproductive and gender-affirming care.

Some Republicans questioned whether certain measures in the bill � like preventing misleading or deceiving health care services advertising � were necessary, or were examples of overregulation.

But S.28 proponents emphasized the need to bolster protections in order to preserve reproductive and gender-affirming care services.

nationwide: harassment, � and now, interstate prosecution. In late January, a by another state for providing medication abortion across state lines.

to enact shield protections, and so far,

How well these protections hold up for providers prescribing medication abortion across state lines via telehealth could be a major factor in the overall availability of abortion, according to Middlebury College economics professor Caitlin Myers.

“The stakes are high,� said Myers, who studies abortion care access across the U.S. “Shield laws really increased the visibility, the accessibility of medication abortion, and a lot of people are ordering abortion medications under these laws.�

S.28 would update state statute to allow providers to use online questionnaires to prescribe abortion medication. The questionnaires would be “developed by or in consultation with health care providers with clinically appropriate expertise� that would allow a provider to get a patient’s medical history and ask follow-up questions.

Several , including West Windsor OB-GYN Renee Johannensen, . They said studies have

“It should be noted that this type of care is typical in the provision of reproductive healthcare,� Johannensen wrote. “[It] is often specifically what people want because of issues with privacy, for instance if they are victims of domestic violence.�

Elodie Reed

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And Johannensen said without the ability to use online questionnaires, Vermont’s shield laws don’t effectively work to prescribe abortion medication to people in other states.

The , and the all told lawmakers they supported the use of online questionnaires for abortion medication.

The Vermont Board of Medical Practice, however, disagreed, that the practice would “not constitute quality care.�

Another measure in S.28 would put all advertising about health care services under state consumer protection law.

“Advertising strategies and educational information about health care options that lack transparency, use misleading or ambiguous terminology, misrepresent or obfuscate services provided, or provide factually inaccurate information are a form of manipulation that disrespects individuals, undermines trust, broadens health disparity, and can result in patient harm,� the bill reads.

Applying this standard to all health care services is a broadened version of language in Vermont’s existing shield law intended to protect patients. That current law specifically targets centers that discourage abortion, also known as crisis pregnancy centers, and

Two Vermont crisis pregnancy centers and the anti-abortion organization National Institute of Family and Life Advocates sued the state over the existing law in 2023. The lawsuit alleges in part that Vermont is censoring crisis pregnancy centers from advertising their services.

A federal judge last summer allowed the suit to move forward, writing: “Plaintiffs have stated a plausible claim for violation of their First Amendment rights.�

Branches Pregnancy Resource Center

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Courtesy

about S.28, Sharon Toborg, the Vermont Right To Life Committee policy analyst, said the state was opening itself up to more litigation with the language in the bill.

“S.28 defines all ‘advertising� about health care services or proposed services � by any person � as commercial speech, even if there is no economic motivation underlying the speech,� Toborg wrote. “It is not permissible to simply decree speech is ‘commercial� as an excuse to restrict it.�

Some of the remaining measures included in S.28 focus on improving privacy for providers of reproductive and gender-affirming health care.

For instance, the legislation allows providers to request the removal of their name or initials from “non-controlled� medicine prescribed for reproductive or gender-affirming care.

Charlie Neibergall

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Associated Press

The Vermont Medical Society applauded this effort in its testimony to legislators.

“As prescribing medication for abortion and gender affirming care become more and more politicized and legally risky for both patients and prescribers, removing prescriber identifying information from pill bottles that may cross state lines is one additional step Vermont can take to protect access to these evidence-based medications,� the organization wrote.

Pharmacy representatives told lawmakers they understood the intent of removing provider names from prescriptions, but they weren’t sure how to put it into practice.

“Despite the willingness, the implementation of S. 28, Sec. 11. would be, as far as we can tell, impossible,� .

The association noted that there is no option in pharmacy software to replace a prescriber’s name on a label with the more general name of the provider’s facility.