The battle over abortion access could return to the ballot box in four states as the 2024 elections loom

• Millions of Americans lost legal access to abortion after the overturn of Roe v. Wade.
• But despite the loss in access, more and more Americans say abortion should be legal.
• Some states let voters amend its constitution via ballot initiative. Four are primed to do so.

Heading into 2024, most Americans favor access to legal abortions in all or most cases, according to a sweeping new survey by PPRI. The margin of support is growing, and not a single state in the US had a majority of citizens who supported overturning Roe.

This is why, after the overturn of Roe v. Wade and with many state legislatures moving to further restrict access to abortions, abortion rights advocates may find their best chances are via direct ballot initiatives at the state level.

There are already precedents for success. An anti-abortion ballot measure failing in Kansas last August was a harbinger of what was to come. Abortion rights advocates swept the board with ballot measures in the midterms, going a perfect six for six as they enshrined rights in state constitutions in Michigan and California while also beating back anti-abortion restrictions in much more conservative states like Montana and Kentucky.

"I think the accelerating trend of pro-active ballot measures reflects the fact that the only path to restore and ultimately expand access to abortion is going to run through the states," Sarah Standiford, national campaigns director for Planned Parenthood Action Fund, told Insider. 

Standiford pointed out that one of the particular draws of ballot measures is that they can go across party lines.

Even those who oppose abortion personally may "understand that personal, private medical decisions should not be made by politicians," she said.

Organizations opposed to abortion are also taking notice of the fight.

"SBA Pro-Life America opposes any proposal that cloaks this kind of extreme and unpopular agenda in deceptive language," Kelsey Pritchard, director of state public affairs for Susan B. Anthony Pro-Life America, said in a statement to Insider.

Seventeen states allow their citizens to amend their constitution via ballot initiative, according to Stateline. Other states also have varying mechanisms that put questions before voters, which is how Kansans ended up being the first state to consider abortion rights after Roe's reversal.

The strategy could pay political dividends for President Joe Biden and his fellow Democrats. Biden, who has vowed to run for reelection but has yet to announce formally, would have to look no further than the 2004 playbook George W. Bush and his allies used to secure a second term.

The GOP used state ballot initiatives banning same-sex marriage to juice turnout, including in the critical state of Ohio. (It is worth noting that some experts think that the effect, if any, it had on the race is overblown). 

Here are the four key states to watch in 2024:

Arizona

Few states may be more critical in 2024 than Arizona. President Joe Biden became the first Democrat to win the state in over two decades in 2020.

Flipping the state alone won't hand Republicans control of the Senate or the White House, but it could be the tipping point in either race. (Neither Biden nor Sen. Kyrsten Sinema, who became an independent earlier this year, have formally announced if they will run in 2024. Sinema looks to have an extremely tough path ahead, especially if national Democrats rally behind their eventual nominee).

According to PRRI's polling, 62% of Arizonans say abortion should be legal in most or all cases, compared with 35% who are against the practice in most or all cases.

Gov. Katie Hobbs, a Democrat who narrowly flipped the governor's mansion, previously outlined her opposition to a Republican-backed law prohibiting most abortions after 15 weeks. 

"I wasn't supportive of it when it passed, it's too restrictive," Hobbs told the Arizona Republic last November. "The majority of Arizonans support safe, legal abortion, and we need to roll back many of the restrictions that are in place now."

She had also planned to call a special session of the state's legislature to repeal a Civil War-era near complete ban on abortions but scrapped those plans after the Arizona Court of Appeals ruled that the 15-week ban supersedes the 1864 law that dates back to before Arizona even became a state.

Abortion rights advocates, through a group called Arizonans for Reproductive Freedom, are hoping to gain enough support to put a ballot question before voters that would take the 1864 law off the books and repeal the newer 15-week ban. The current ban's only exception after 15 weeks is if a medical emergency threatens the mother's life. There are no exceptions for rape or incest.

Organizers failed to get an abortion question before voters in 2022 after a last-minute scramble could not secure enough signatures in time.

Florida

Florida could not be in a more different situation. The state was one of the few places nationally where the red wave was actually felt in November. Gov. Ron DeSantis romped to reelection, and the GOP expanded its legislative majority.

DeSantis has already promised to expand his state's restrictions by signing a 6-week ban if the legislature can pass it. He's expected to decide on a presidential campaign following the legislative session, potentially handing him another conservative talking point right when he needs it most.

According to PRRI's polling, 64% of Floridians say abortion should be legal in most or all cases, compared to 34% who said it should be illegal in all or most situations.

Anti-abortion activists are also pushing restrictions on the ballot as well. One group, Protect Human Life Florida, is pushing an amendment that would effectively outlaw all abortions by enshrining personhood protections for the unborn into the Florida state constitution.

Ohio

Unlike Florida, Ohio has already passed a 6-week ban. However, the state's law is not in effect after a county judge put it on hold over a lawsuit brought by the National Association of Social Workers and the Abortion Fund of Ohio. The legal fight could reach the Ohio State Supreme Court.

Ohio will also be closely watched nationally. Sen. Sherrod Brown, a Democrat, is seeking a fourth term and is one of a handful of incumbents that Republicans want to pick off. Democrats haven't carried the state in a presidential race since 2012, but having abortion access on the ballot could draw more Democratic voters to the polls.

Two abortion rights groups are teaming up to put the question before voters in 2023. Ohio Right to Life President Mike Gonidakis told the Cincinnati Enquirer in February that his organization enlisted national support, foretelling a potentially expensive fight.

Ohio Gov. Mike DeWine, a Republican, has urged the state legislature to get ahead of a ballot measure by clarifying that when the 6-week ban goes into effect, doctors can intervene to save a mother's life, the Enquirer reported.

"The legislature also needs to look at a very basic fact and that is in Ohio, we have an ability of people to take something to the ballot box for the people to vote on," DeWine told reporters. "I am pro-life, and I think saving lives is very, very, very important. We need a bill that we can pass...that is sustainable, and that will not be overturned by the voters when they go to the polls."

Nebraska

At first glance, putting Nebraska on this list might appear odd. A Democrat hasn't won the statewide presidential race since LBJ in 1964. No Democrats currently hold elected statewide office, and the last time one was sent to Congress was just over six years ago.

Nebraska is different, though. It is the only state with a one-house state legislature, which is why it remains a hold-out among its conservative neighbors in passing abortion restrictions. Like Maine, it also awards Electoral College votes by congressional district, which is why both Biden and Barack Obama paid close attention to the Omaha-based 2nd Congressional District.

Per PRRI's polling, a slim majority — 54% of Nebraskans — favor abortion being legal in most or all cases.

If Democrats want to retake the House, ousting Rep. Don Bacon, one of the 18 House Republicans representing a district Biden won, will be high on their list. The ballot box might also be abortion rights advocates' best hope as the unicameral legislature appears to be on the verge of breaking a filibuster to pass a 6-week abortion ban.

The fight could even go to the local level. Anti-abortion activists are pushing a local measure in Bellevue, an Omaha suburb next to Offutt Air Force Base, home of US Strategic Air Command. If successful, their efforts to restrict abortion access within city limits would effectively shut down the only clinic in Nebraska that is performing abortions up to 16 weeks, Straight Arrow News previously reported.

Correction: February 28, 2023 — A previous version of this article misstated the year for an Ohio anti-abortion ballot initiative. It will be decided in 2023, not 2024.