Glenn Hurst is a family physician in southwest Iowa and a Democratic candidate for U.S. Senate.

In my very first days of private practice, I met a patient with an aggressive form of breast cancer. She was young, in her 30s. She and her husband had two children under the age of 5 and were doing the same struggling most young middle-class Americans do at that point in life. They worried about bills, insurance, saving for big purchases. They were not likely thinking about retirement, and they had no plans for a medical emergency. Now their family was faced with a medical crisis that no one could have predicted.

I could tell her hands were full as her husband tried to wrangle the kids who were up and down the walls of the exam room as she explained her situation to me.

She told me how the cancer was discovered and that she immediately got an oncology consult. She heard their recommendations and was planning to do everything she could to fight this cancer. Everything moved quickly and efficiently, since time was of the essence if she was to be treated and survive to be there for her children and spouse. This meant radiation, surgery, and chemotherapy. It also meant an abortion.

Right before her cancer diagnosis, she had been given the good news that they were about to juggle another challenge and blessing together. That is, she had learned she was pregnant. Surgery would be risky in that state. Radiation could be damaging, and chemotherapy would almost certainly damage the fetus if not end the pregnancy tragically. For my patient, the risk could be fatal.

She was surprisingly practical as she asked for a referral. It was clear why she wanted it: she had a young family. They needed her and she wanted to be there with them and for them. But this is where the system ground to a halt. She was surprised at how difficult it was for her to get the procedure. Abortion was never something she had really thought about and the process was the opposite of what she had experienced compared to the cancer diagnosis.

Oncology could not figure out how to make the referral to an abortion provider. They suggest she establish with a primary provider, which is a good idea for any individual. Like any other new patient inquiring about becoming a new patient, she was told it would take weeks to get into other providers’ offices. It was just by chance that I had opened a new space in my practice and was ready for new patients the day they called.

But it was not all roses from there. Getting permission to see me was also a chore because of the role private insurance plays in limiting health care and provider access.

Insurance companies have already occupied a space in your exam room and even dictate which exam rooms you can access. Things like closed networks can keep you from seeing your provider of choice. Preauthorizations then second guess you and your provider’s plan. Pharmacy contracting keeps you from accessing your local pharmacies and convenient services. Limited enrollment periods, denials of service, exorbitant co-pays or deductibles make accessing care an obstacle course where if you lose, you may die.

My patient had already navigated that bureaucratic nightmare by the time she met with me. But she was surprised that along with being packed into her room with two boundless children, a concerned husband, me and my medical assistant, and the limits of her insurance, she found the government pounding at the door for access.

The government was trying to push their way in with mandatory waiting periods. She had no time to wait. Eventually, this intrusion was stopped by the courts. They were planning to deny access by banning abortion, for any cause, after 6 weeks. This limitation was also found to be unconstitutional and was stopped by the courts.

It is nothing short of miraculous that we were able to get her seen in my office, but then finding an abortion provider in our part of western Iowa became the next challenge. In the end, we had no choice but to send her to a clinic in Nebraska. It turned out that the regulatory uncertainty in Iowa had driven most providers away from offering this service.

Last week the U.S. Supreme Court allowed the Texas law that bans abortions after 6 weeks to remain in effect, banning nearly all abortions in the state. It has had a similar effect of driving providers out of the state or at least abandoning this potentially life-saving procedure.

The Texas law is written in a way that stirs images of George Orwell’s 1984, where individuals report on each other and Big Brother is always watching. By Texas law, any person is allowed to pursue legal action against anyone who assists in abortion services (from bus drivers to surgical technicians to physicians). Now Iowa has put forward a constitutional amendment to limit a woman’s right to access abortion services – it passed the first round of voting in the legislature and is awaiting the required second passage after the 2022 election before landing on a statewide ballot.

Abortion justice stands in peril across this nation. With the U.S. Supreme Court allowing Texas’s abortion ban to remain in effect, it is clear that politicizing the Supreme Court by nationalist oligarchs has been successful. As a body that once stood above partisan politics, it is now entangled in politics from which it may be impossible to unwind.

Their ruling fails women in that it continues to authorize state control of their bodies. It is inherently racist, ableist, and classist, making abortion a procedure reserved for the rich, those who can easily travel out of the state to have it performed. It fails all Americans in that it allows other states to put the same questionable law on the books, wasting taxpayer money and legislative time as its legality remains uncertain. Until it is ultimately rejected, these laws will allow not just the state, but also your neighbor, into your medical choices. As Iowa faces the possibility of such a law, every voice should be raised in opposition to the injustice of it.

Abortion justice is health care justice. Health care justice is economic justice, which is ultimately social justice. And social justice is the path to equity of opportunity, privilege, and property. Justice for all is the value that every person should be able to get behind.

Iowa needs leaders who will not equivocate on this value. We can provide the leadership who will not only support codifying Roe v. Wade but who are willing to write the law. I am committed to writing the law to make Roe v. Wade the law of this country.