Unpacking HB 40

An Analysis of Illinois’s Abortion Bill, and What its Passage Means for Partisan Politics in the Midterm Elections.

On Sept. 25, 2017, Illinois Gov. Bruce Rauner, a Republican, signed a controversial bill that expands access to abortion for low-income and state-insured women. His signature was the only form of Republican support lent to the legislation. This move puts Rauner in stark opposition to his own party – especially when compared directly to its national leadership – and promises to be a focal issue of the gubernatorial primaries coming up in March. Rauner is already facing two Republican challengers to his incumbency, one of whom – State Rep. Jeanne Ives – is running in direct response to the signing of HB 40.

Looking back at the 2016 election, abortion law was discussed for less than five minutes during the presidential debates, yet it was all the time Trump and Clinton needed to reaffirm their respective party’s stances.

Though Trump claims he is anathema to establishment politics, even he did not dare buck the Republican Party’s hardline pro-life agenda when seeking its nomination, which it has staunchly defended since 1976 when both parties declared an official stance.

Now that Trump is our president-elect, his answer to a single question posed during that five-minute span of the debate has become central to the future of abortion law:   

Chris Wallace asks, “Do you want to see the Court overturn Roe v. Wade?”

Trump responds, “Well, if we put another two – or perhaps three – justices on, that’s really what’s going to be happening. That will happen, automatically, in my opinion because I am putting pro-life justices on the Court. It will go back to the states, and then the states will make a determination.”

Already, Trump is preparing the Supreme Court to revisit the 1973 case that granted women the right to an abortion, having appointed conservative justice Neil Gorsuch shortly after his inauguration.

Considering three of the Supreme Court’s other eight justices are 79 or older, Trump may very well have the opportunity to appoint another and shift the majority to his favor. In this case, Roe’s 45-year precedent could be reversed, and the states could be enforcing their own abortion laws before his term is up.

Timeline by Cody Corrall, 14East.

Anticipating such a chain of events, State Rep. Sara Feigenholtz introduced House Bill 40 to the General Assembly to preemptively protect the legality of abortion in Illinois.

Unsurprisingly, the bill aggravated hyper-partisan tensions in Illinois – the same that played out on the national debate stage.

Unsurprisingly, Rauner was uncertain whether he should sign the bill into law after it passed both chambers of the Legislature, considering his party’s hardline anti-abortion stance.

What is surprising, however, is that Rauner signed the bill anyway – after publicly stating in April that he would veto — making Illinois’s so-called Abortion Bill law.

HB 40’s Effects:

Two years after Roe, the following was included in Illinois’s 1975 Abortion Law:

“…if those decisions of the United States Supreme Court are ever reversed…then the former policy of this State to prohibit abortions unless necessary for the preservation of the mother’s life shall be reinstated.”

This is commonly referred to as the “trigger law” because overturning federal abortion law automatically triggers Illinois’s law to revert.

Sarah Feigenholtz cited the trigger law as her reason for filing HB 40 when she did: “If the Supreme Court ever overturns Roe, immediately in the state of Illinois all abortions become illegal and criminalized. We should strike those words to get ahead of what could be a nightmare scenario for women in this state.”

Beyond eliminating the trigger law, HB 40 effectively makes abortion more accessible to low-income and state-employed women. As Feigenholtz argued, “No matter what kind of insurance a woman has, she has the right to have abortion care in her insurance plan,” according to an interview with the Sun-Times.

According to Illinois Policy, more than 100,000 workers participated in State Employees Group Insurance Program (SEGIP) in 2016 – over 350,000 in total counting dependents and retirees. These workers include Chicago law enforcement, public defenders, CPS workers and CTA employees, to name a few.

Given that number, consider how many women have worked for the state over the years. Abortion was not an option under their insurance, except in cases of rape, incest or when the mother’s life was endangered.

Additionally, the Department of Health and Family Services (HFS) can now inform low-income pregnant women about the option of abortion, as well as provide financial assistance via Medicaid. Per the its 2018 Budget Briefing, the HFS is “the largest insurer in Illinois.” “649,346 have enrolled under the ACA as of January 2017.” (HFS)

As the Office of Management and Budget (OMB) pointed out in its impact report of HB 40, the lifting of prohibitions on low-income and state-employed women’s access to abortion does open the state to increased cost liabilities for SEGIP and Medicaid.

These costs will be paid for by Illinois’s General Revenue Fund, which is supported by taxpayer dollars. This is certainly a main source of controversy, and incites many Republican’s ire. State Rep. Jerry Long, for instance, wrote in a statement that it is “deeply concerning that we are forced to discuss taxpayer funding of abortions.”  It is important to note, however, that taxes are not increasing as a result of HB 40.

The OMB could not provide an estimate of HB 40’s impact on the budget, as it is unknown how in-demand these services are. However, the HFS estimated its increased cost for abortion services resulting from House Bill 40 to be approximately $1.8 million – and it is assumed more Medicaid than SEGIP patients will have abortions.

This is not the figure Republican leadership has been citing as the cost. For example, Illinois RNC Committeewoman Demetra Demonte estimated the cost to be 60 million:

“Instead of working to solve our state’s catastrophic challenges, Madigan Democrats just passed a radical bill for taxpayer funded abortions, at a cost of $60 million, while we don’t have a budget. Springfield yet again shows it’s tone-deaf to the concerns of Illinoisans.”

The religious conservative group Illinois Right to Life estimated HB 40 would prompt a 30 percent increase in abortions in Illinois – a rise from 39,000 to 51,000 annually. In actuality, Right to Life’s projection is based on data obtained from the HFS showing state Medicaid outlays for abortion in the 1970s, prior to the General Assembly prohibiting the use of such funds in the 1980s.

In the peak year – 1978 – abortion outlays totaled $1.8 million (with approximately 12,000 abortions performed). Illinois Right to Life then estimates the additional cost today to be 12,000 times $1,650, or a  $19.8 million increase.

That $1,650 is their cited cost of the average Medicaid abortion, the source of which is a dubious figure concerning Planned Parenthood (claiming 15 Medicaid-covered abortions in Illinois cost almost $300,000, making the average around $1,650) and a faulty link to the Illinois Department of Healthcare and Family Services Legislative Affairs that displays only a 404 error message.


By most metrics, $1,650 is an unusually high price point. Information from The University of Chicago

Thus, it is crucial to note that only second-trimester abortions cost $1,500 (or more, depending on complications). From LiveScience: “As of 2006, 88 percent of abortions occurred before the end of the first trimester, making second-trimester abortions relatively rare.” The Guttmacher Institute also found that in addition to medical complications, a lack of access is driving women to get second term abortions. One of their senior fellows told LiveScience, “Things like finding an abortion provider, making arrangements and tracking down the money are barriers. … If we remove these barriers to first-trimester abortion services, this could potentially decrease the need for second-trimester abortion services.”

In addition to being much less expensive, first-trimester abortions are also significantly less risky and invasive. Illinois increasing access with HB 40 will surely result in an average abortion cost that is less than $1,650.

Therefore, I posit the the $60 million cost estimate presented by some Republicans  is so high because it does not reflect the true demand for late-term abortions and the factors causing even 12 percent of abortions to be performed in the second trimester. Neither the HFS nor OMB can provide a concrete projection of demand, making this $60mil estimate possible until proven otherwise. For this reason, the OMB should not have provided such an ambiguous statement on the bill, as it leads to speculation that cannot be refuted.

I sent the OMB a Freedom of Information Act request concerning any documentation of their cost estimate – even if it is a wide range – as some other Republicans are attributing the $60 mil to the OMB itself (which I can find no proof of), but did not receive any response from the agency.

Additionally, the state may now fulfill grant requests from nonprofits with a reproductive health-oriented mission, whereas it previously could not. It is unclear how often the state will take advantage of this lifted prohibition, as Planned Parenthood – the largest nonprofit (and most controversial) of the sort – already receives federal funding from Title X and Medicaid.

Is there still a possibility of inappropriate use of these grant funds, yes – especially with our state’s track record. However, if monitored responsibly, these grants could be used to improve access to and quality of sexual education and medical resources, such as clinics that provide free condoms and STI screenings.

In addition, HB 40 will also reduce liabilities to federal programs for low-income pregnant women, which would offset part of its increased costs. For example, HFS has a program called Temporary Assistance for Needy Families (TANF) which “provides temporary financial assistance for pregnant women and families with one or more dependent children.”

Per the Illinois Center for Budget and Priorities, Illinois spent about $1.38 billion in federal and state funds under TANF in 2015, 63 percent of which went toward cost of childcare.  

By the same token, other state programs like food stamps may also see a decrease in liabilities in the long run because under HB 40, it is likely many welfare recipients will opt to choose an abortion instead of years of child care assistance.  

Consider that low-income women who do cannot receive financial assistance for abortion through Medicaid or insurance must pay for abortion out-of-pocket. Scraping together hundreds of dollars is a challenge for many women, and the longer it takes them, the more expensive the procedure becomes. Indeed, many women carry pregnancies to term simply because they cannot afford to terminate the pregnancy, and if those women cannot afford a procedure costing less than $2,000, then they surely cannot bear the financial burden that is raising a child without assistance from the state. This is supported by a University of California–San Francisco study (based on a nationally representative survey) that found “85 percent of women who had difficulty obtaining an abortion reported their reason for not getting one was the cost.”

The same USCF research group also found that:

“low-income women who were denied an abortion because they could not afford it, and subsequently had a child, were more likely to be unemployed, relying on public assistance programs and living below the federal poverty line than their counterparts – women of the same income-level who were able to obtain an abortion.”

So, while HB 40 will increase state expenditures for Medicaid and SEGIP, it will also decrease expenditures for welfare programs for pregnant women and young mothers as demand declines.

It is also likely fewer children would be enrolled in Medicaid under the ACA in the long run (in terms of per capita, not absolute numbers) due to an increase in the number of low-income women opting for an abortion. HFS reports nearly 1.5 million children from low-income families are currently receiving Medicaid assistance.  

In the long run, this could positively affect our economy and society– as it can be projected that fewer women and families would depend on welfare without the additional costs of a[nother] child.

These beneficiaries will likely be able to afford better housing, make a greater income and have a greater quality of life – in terms of material goods, net wealth, retirement savings, etc. This is not to say having a child negatively impacts your quality of life, but having a child you cannot support – financially and emotionally – certainly will.

Rauner’s Decision and its Impact on Partisan Politics Going Forward:

Knowing that HB 40 will incur increased liabilities for taxpayer-funded services, why did Rauner sign this bill rather than veto it? Democrats do not have a super-majority in the Senate, so they could not override if he decided to kill the bill as he originally promised.

This is a critical question, especially when calling attention to the fact that HB 40 was passed by Illinois Democratic votes alone. Not one Republican voted in favor. Thus, Rauner is the only Republican lending his [de facto] support of the Abortion Bill.

Looking back at Rauner’s platform when he ran for office in 2014, his central tenets were economic growth and fiscal conservatism. Supporting a taxpayer expansion of government services  much less abortion certainly violates his conservative principles. However, as I pointed out, HB 40 could positively contribute to long-term economic growth and urban development – if the number of pregnant women and families on welfare declines.

It is likely, however, that the public’s opinion of HB 40 and his own ideology were the greatest influences on Rauner’s decision.

Rauner’s 2014 campaign was also purportedly “neutral” in terms of social issues.

The New York Times reports Rauner had tried to “broker a compromise” on HB 40 and ultimately failed – leading him to originally come out against the legislation.

Even more significant, Rauner told the Sun-Times he was himself pro-choice, and defended Roe’s precedent of women’s right to abortion: “I fundamentally believe abortion should be a woman’s private decision, hopefully in consultation with her loved ones and faith community, and that decision should not be impeded by government.”

Rauner has made other, more openly pro-choice comments on the 2014 campaign trail. In a statement on a 2014 questionnaire from Personal PAC, Rauner wrote:

“I dislike the Illinois law that restricts abortion coverage under the state Medicaid plan and state employees’ health insurance because I believe it unfairly restricts access based on income. I would support a legislative effort to reverse that law.”

Diana Rauner even helped purchase a full-length advertisement in the Chicago Tribune on behalf of Personal Choice For Illinois stating, “We write as longtime supporters of reproductive rights to celebrate the fact that in this election both candidates for Illinois Governor are pro-choice.”

Unsurprisingly then, Rauner’s promise to veto HB 40 was met with intense pro-choice opposition, which cited his own campaign promises (and those made by Diana on his behalf). The “Call BS” campaign was spearheaded by Personal PAC and Men4Choice, which sought to call attention to Rauner promising to veto a bill he had voiced support for not two years ago. Their message: “Rauner lied.”

The Call BS campaign – which launched in August – came on top of the overwhelming success of the national women’s march supporting women’s rights and the Public Policy Polling’s finding that 73 percent of all Illinois voters, and 85 percent of Millennials, agreed with Roe’s precedent of a right to privacy (see timeline).

It can be posited that the evidence of voter support for HB 40 and organized opposition to the Republican Party’s anti-abortion stance resonated with Rauner’s own beliefs, and swayed him to lend his signature to the bill.

Rauner’s decision clearly defied the wishes of his own party, and yet, he defied partisanship in favor of “doing what was right for the people of Illinois,” as cited in the Sun Times.

Rauner risked alienating his own supporters in his upcoming election over this decision, already succeeding in turning a few allies into enemies.

Peter Breen – the House Republican Floor Leader – told the Tribune, “In the face of overwhelming evidence of Rauner’s inability to competently administer the Illinois government… and inability to keep his word and his commitments, I can no longer support him. And whether or not they are able to agree publicly, I know hundreds of elected Republicans, along with hundreds of thousands of Republican voters, who feel the same way I do.”

Indeed, there is significant national pressure to conform to the Republican Party’s pro-life platform. Since Reagan appealed to social conservatives in his 1980 election, the Christian Coalition has consistently made up a significant bloc of the Republican Party’s vote. Pro-choice candidates risk permanently alienating that base, which is sizable and very politically active. However, due to the sheer number of moderates and socially-liberal Republican voters in Illinois, our state’s Republican leadership is uniquely poised to challenge that mentality.

The move to support HB 40 could ultimately work to Rauner’s advantage.

Rauner is an incumbent Republican in a state whose politics are significantly impacted by the deep blue pull of Chicago’s Cook County, facing a growing lineup of Democrats to challenge his governorship. Chicago – one of the nation’s largest urban centers – has always played an outsized role in the state’s politics. In the 2014 gubernatorial election in which Rauner won his governorship, Cook County Residents made up almost 40 percent of the voting electorate, according to CNN 2014 exit polls. While Cook County is the only county in which Rauner lost to Quinn, without his 35 percent of the urban vote, Rauner would have lost the election. SIU’s Public Policy Institute’s March 2017 public opinion survey found “…his [Rauner’s] disapproval rating in Chicago has grown consistently, from 31 [percent] disapproving in March 2015, to 58 percent today—almost doubling.” If Rauner’s disapproval rating in Chicago jumps above 65 percent, his shot at reelection is incredibly slim (unless turnout increases dramatically across the rest of the state).

Rauner’s Democratic opponents in the 2018 election have already criticized him for aligning himself and his policies with the Trump Administration. Had Rauner vetoed HB 40, he would have received major heat from his chorus of challengers, including candidate State Rep Daniel Biss (D), who was a sponsor of the legislation and is running for governor himself.

By choosing to sign the bill, however, Rauner denied his alignment with Trump’s ideology, gave himself common ground with the Democrats, and presented a broader appeal to a large population of Illinois voters — especially younger ones who are quickly becoming the majority of the populace.

While the Illinois House Republican Leader Jim Durkin is “urging unity within the GOP” and a re-commitment to Rauner’s 2014 agenda of economic growth, Breen Breen and a few prominent political groups — including Family PAC — are already actively calling for the Republican Party to find and back a different candidate than Rauner.

Enter Jeanne Ives (R), a junior State Congressperson of the 42nd Ward. She announced her candidacy for governor in direct response to Rauner signing HB 40, admitting it was the catalyst for her 2018 run.  

Ives is one of the most conservative members of the Illinois State General Assembly in terms of voting record. She was elected in 2013 after previously serving on the Wheaton City Council.

During the an interview with Chicago Tonight(PBS), in which Ives confirmed her candidacy, she she directly criticized Rauner:  

“Rauner has discredited himself as a Republican. He signed into law very extreme measures: the man who claimed to have no social agenda ended up only having a social agenda, and he did not get things done for the taxpayers and businesses of this state.”

The central tenet of her platform: fiscal conservatism. In response to whether she would support legislation overturning HB 40, Ives said she has “no social agenda” but would sign such a bill [overturning HB 40] “in a heartbeat” – “for the taxpayers,” according to Politico.

During her interview with PBS, Ives said she “was essentially drafted from the grassroots: activists and everyone else who has been frustrated with Gov. Rauner’s record.”

Ives is required to attain 5,000 petitioner signatures to get her name on the ballot – all candidates must prove they meet a minimum threshold of popular support to run for office. The Ives campaign started the petition process on Oct. 28 and does not know how the size of her support thus far.

Ives is the second to announced her candidacy after William Kelly, journalist and creator of the production company RevDigital, announced he was running to “replace Rauner with a real Republican” in a July interview with Chicago Tonight. Kelly previously ran for Chicago Comptroller in 2010 and Mayor in 2014.  

Kelly takes issue with Rauner’s decisions that contradict the national Republican Party’s platform and values, such as supporting Chicago’s status as a sanctuary city, and personally donating to Planned Parenthood.

Even though Rauner surely did alienate a portion of his voters, his decision to sign HB 40 has broader appeal to the majority of Illinois constituents, and presents an opportunity to bring more moderates into the fold of his coalition — namely those that are socially liberal. Or perhaps, bring them back into his coalition is more appropriate to say.

CNN’s 2016 election exit polls for the state of Illinois estimated 44 percent of Illinois residents identify as moderates (compared to the 28 percent that identify as either liberal or conservative, respectively). In 2016, the clear majority of those moderates voted Democratic, and that is not confined to the Chicago metropolitan area. Compare this to the 2014 midterm election map  – which Rauner also won.

A sizable portion of Rauner’s supporters are inclined to vote Democratic, especially when faced with hyper-partisan choice like abortion. Furthermore, moderate, suburban women are a key demographic to win over in the 2018 election, and Rauner’s decision to sign HB 40 puts him in a better position to do it.

If he can demonstrate this to his party, he may just survive the internal challenge to his candidacy, further shaking up the partisan politics that have dominated Illinois for decades, and are so ubiquitous to American politics today.

Rauner’s Republican challengers wholly reject this, however. William Kelly told PBS: “Perhaps the Republican Party officials think Rauner supporting Planned Parenthood will help him win a general election, but it is not going to go over in the Republican Primary.”

It is true that those who vote in primary elections are more ideologically extreme than general election voters, according to the American Political Science Association, and when turnout is low these voters to select more partisan nominees. Renowned political scientist Alan Abramowitz posits this phenomenon contributes to the polarization of our electorate.

Thus, the turnout of moderate Republican voters is paramount to Rauner securing the nomination. With a “war-chest” campaign budget of over $70 million, Rauner certainly has the greatest amount of resources to get those moderates to the polls. Indeed, his campaign has already spent $50+ million in the election according the Illinois Sunshine Foundation. In comparison, Ives has raised only $32,000. Kelly has stated to the same program that he has funds in excess of $100,000, although any funds he has remain unfiled so the Sunshine Foundation has yet to release a concrete figure.

With the primary election quickly approaching (March 20,, 2018), it is unlikely either candidate will raise near enough funds to compete with Rauner. However, in the world of billionaire politics – and with such an influential and currently-Republican-controlled office on the line – one or both may very well receive an outpouring of monetary support from party donors, especially if their campaigns catch the attention of President Trump or Steve Bannon– who have both been backing right-wing, social-issue-driven Republican candidates in gubernatorial elections in states across the country, notably California and Virginia.  

Ives herself said in the PBS interview that she is against “crony handouts from special interest groups.” The integrity of that statement will certainly be tested throughout the course of this election.

While I respect Ives’s ethical stance on campaign contributions, as a weapon in the 2018 battleground, ethics will be hard fought against Rauner’s sheer amount of funding and name recognition. Kelly knows this. He made the following appeal on PBS: “If there is even one person who is willing to put up 7-figures to defeat Bruce Rauner, they can go to williamkelly.org because I am the only man to do it.” I do not think Trump and the special interests backing the alt-right could find a candidate more susceptible to monetary manipulation if they tried. NBC reported in 2015 that the politico has been courting the Republican donor elite for years – describing him as a “political gadfly.”

That being said, all the money in the world cannot “buy” votes. It is ultimately up to the people of Illinois to decide who they want to represent them, and also the importance of special interests and hyper-partisanship in Illinois politics going forward. In this case, Republicans of Illinois must define their own values, or else fall in line with national leadership at the risk alienating the majority of Illinois voters.


Claire Anderson is the co-president of DePaul University’s IMPACT (I Matter, Political Activism Can Too)

Header photo by Cody Corrall


Correction: An earlier version claimed “abortion may not have been an option under insurance.” The sentence has since been changed to say “Abortion was not an option under their insurance, except in cases of rape, incest or when the mother’s life was endangered.”