Biden got the vote of abortion rights advocates. Getting them results will be harder.

WASHINGTON – Allowing federal funds to flow again to international groups that provide or refer patients for abortion services is the easy part of President Joe Biden’s promise to reverse Trump administration policies on reproductive health issues.

Biden did that with a stroke of a pen Thursday.

Undoing restrictions on U.S. clinics that provide abortion counseling or services will take more time, as would changing when employers can decline to include birth control in workers’ health care plans.

Passing legislation to codify the right to an abortion and allowing low-income women to get government-funded abortions – which Biden backed during his presidential campaign – face roadblocks in a closely divided Congress.

Biden’s promise to appoint federal judges who support the Supreme Court’s 1973 Roe v. Wade decision establishing abortion rights is a long-term effort that may not be as successful as President Donald Trump’s judicial accomplishments.

Advocates are eager for action, particularly after women played a crucial role in Biden’s victory. If only men had voted, Trump would have won.

“We really are pushing this administration, not just to undo the harm of the Trump administration but to move us forward in really important ways,” said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center.

Biden, who took a more expansive position on reproductive health issues during the campaign than he had in the past, frames his views in the context of one of his top priorities: creating a more equitable society for people of color and other marginalized groups.

“We are deeply committed to making sure everyone has access to care – including reproductive health care – regardless of income, race, zip code, health insurance status, or immigration status,” Biden said in a joint statement with Vice President Kamala Harris recognizing the 48th anniversary of Roe v. Wade last week.

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Biden’s emphasis is appropriate, said Amanda Roberti, a political science professor at San Francisco State University who studies reproductive justice issues.

“When we look at the communities that are most affected by restrictive reproductive policies, you’re talking about the most marginalized communities,” she said.

Anthony Fauci, Biden’s top medical adviser, told the World Health Organization last week that the United States would revoke the Mexico City Policy – which blocked funding to groups that include abortion services or information in their family planning programs – as part of a "broader commitment to protect women's health and advance gender equality at home and around the world."

Trump restored and expanded the Mexico City Policy, which was started by the Reagan administration and has been turned off and on again, depending on whether a Democrat or Republican held the White House.

Title X funding

In addition to signing an order rescinding that policy Thursday, Biden began the process of undoing a similar restriction on domestic groups.

Trump effectively blocked clinics from receiving federal family planning grants through Title X if they offered abortion services with other funds. Trump changed the rules on counseling, including barring referrals for abortion services. Since those changes, about one-quarter of clinics and other providers that had received federal grants to help the uninsured or low-income patients no longer participate, according to the nonpartisan Kaiser Family Foundation.

Six states withdrew entirely from the Title X network: Hawaii, Maine, Oregon, Utah, Vermont and Washington.

Most of the Title X clinics in seven other states – Alaska, Connecticut, Illinois, Maryland, Minnesota, New York and New Hampshire – left the program.

The number of clients served by the program dropped by about 840,000 – or 21%.

Though clinics didn’t close because they had other funding sources, services were curtailed, said Alina Salganicoff, director of Women’s Health Policy for the Kaiser Family Foundation.

“Hours are often restricted so that it is much harder to get an appointment,” she said. “The waits are longer.”

Restoring the funding will require a months-long rules-writing process and new funding announcement.

"This will likely be step one on a long road to rebuild the provider network," said Audrey Sandusky, a spokeswoman for the National Family Planning & Reproductive Health Association.

Contraception on health care plans

Biden will need to use the regulatory process to simplify payment for abortion coverage that is part of health plans under the Affordable Care Act and to make it harder for employers to opt out of including contraceptive services in their health plans for workers.

Without insurance, women can expect to pay $600 to $1,000 annually for oral contraception and more for longer-acting methods such as IUDs.

Trump allowed any employer with religious objections – and many with moral concerns – to bypass the Affordable Care Act’s requirement that insurance plans include birth control coverage.

There were multiple legal challenges to the ACA’s original workaround for religious organizations. The Supreme Court ruled in July that religious nonprofit groups, such as the Little Sisters of the Poor, can keep contraceptive coverage off their plans instead of having insurers offer it directly to their employees.

Biden called that ruling a disappointment and promised, if elected, to “restore the Obama-Biden policy” that existed before the court challenges.

Biden withdrew his support for the Hyde Amendment, which blocks federal funding for abortion in most cases. He backed codifying the right to an abortion as a backstop in case the newly reconfigured Supreme Court overturns or eviscerates Roe v. Wade.

Anti-abortion groups put the pressure on

Anti-abortion groups, which lauded Trump as the “most pro-life president” in the nation’s history, have started to fight back.

“Now is no time to give in, not when we’re this close,” Marjorie Dannenfelser, president of the Susan B. Anthony List, wrote in a Fox News opinion piece last week.

Though Democrats control both chambers of Congress, they have the narrowest of majorities in the Senate and don’t have enough votes to overcome a filibuster.

The Susan B. Anthony group spent $200,000 on radio ads pressuring West Virginia Sen. Joe Manchin – one of the few anti-abortion Democrats in Congress – to continue supporting the Hyde Amendment and opposing eliminating the filibuster.

“The Senate filibuster is the only thing standing between us and the pro-abortion agenda of the Washington liberals,” an announcer says in the West Virginia ads. “Thankfully, Sen. Joe Manchin is standing strong for life.”

Borchelt, of the National Women’s Law Center, said reproductive rights advocates “have to be realistic about the numbers that we have in Congress,” but lawmakers can lay the groundwork for changes by introducing legislation and holding hearings.

As for whether Biden can catch up to Trump on judicial appointments, that remains to be seen.

“It's certainly true that we're facing a federal judiciary that Trump was able to transform,” Borchelt said. “And that damage is going to be long-lasting.”

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This article originally appeared on USA TODAY: Joe Biden taking first steps on abortion to undo Trump restrictions