People attend an abortion-rights rally at the Utah State Capitol in Salt Lake City after the U.S. Supreme Court overturned Roe v. Wade in June 2022. Rick Bowmer/Associated Press, file

SALT LAKE CITY — Abortion clinics in Utah could be banned from operating under a law signed by the state’s Republican governor, setting off a rush of confusion among clinics, hospitals and prospective patients in the deeply conservative state.

Administrators from hospitals and clinics have not publicly detailed plans to adapt to the new rules, adding a layer of uncertainty on top of fear that, if clinics close, patients may not be able to access care at hospitals due to staffing and cost concerns.

The law signed by Gov. Spencer Cox on Wednesday takes effect May 3, at which time abortion clinics will not be able to apply to be licensed. It institutes a full ban Jan. 1, 2024. Both the Planned Parenthood Association of Utah and the Utah Hospital Association declined to detail how the increasingly fraught legal landscape for providers in Utah will affect abortion access.

In addition to banning abortion clinics from operating, the law also clarifies the definition of abortion to address liability concerns about how exceptions are worded in state law – a provision Cox called a compromise.

On Thursday, the governor rebuffed critics who’ve equated restricting clinics to a de facto ban on abortion and said the law offered clarity to hospitals providing emergency abortions in the case of threats to maternal health and rape or incest reported to authorities.

“This bill clarifies that so that those abortions can continue. They will continue in a hospital setting, but there’s nothing to prevent those from continuing,” he said at a news conference.

The turmoil mirrors developments in Republican strongholds throughout the United States that have taken shape since the U.S. Supreme Court overturned Roe v. Wade, transformed the legal landscape and prompted a raft of lawsuits in at least 21 states.

Utah lawmakers have previously said the law would protect “the innocent” and “the unborn,” adding that they don’t think the state needs the clinics after the high court overturned the constitutional right to abortion.

Though Planned Parenthood previously warned the law could dramatically hamper its ability to provide abortions, Jason Stevenson, the association’s lobbyist, said Wednesday it would examine the wording of other provisions of the law that could allow clinics to apply for new licenses to perform hospital-equivalent services.

Based on Planned Parenthood’s interpretation, he said in an interview, clinics will no longer be able to provide abortions with their current licenses. They plan to continue, however, to provide the majority of their services such as sexually transmitted disease and cancer screenings and pregnancy testing. Stevenson said they were “looking closely” at the law’s licensing options, but would not say whether the clinics would apply at this point.

Utah’s Department of Health and Human Services did not immediately respond to questions about how it would enact the law, but lawmakers have said Planned Parenthood and other clinics could apply for different licenses under the law’s framework.

Jill Vicory, a spokesperson for the Utah Hospital Association, said in an email that it was “too early to comment” on whether hospitals could soon be the only abortion providers in Utah, noting each “will need to make a determination on how they choose to proceed.”

If clinics stop providing abortions, experts are concerned hospitals’ comparatively higher cost of care and nationwide staffing shortages will make it harder to get legal abortions in Utah, even though the law isn’t explicitly a restriction on those seeking them in the state, where they remain legal up to 18 weeks.

Dr. Carole Joffe, a University of California, San Francisco professor who has written about the societal effects of reproductive health care, said stripping clinics of licenses would upend how abortions have been provided for decades. Historically, patients with low-complication pregnancies have mostly received abortions at outpatient clinics, which on average are able to provide them at a lower cost.

“Everything in a hospital is more expensive than in a clinic. Doing an abortion in a hospital, you need more personnel,” she said, noting hospitals, with teams of anesthesiologists, physicians and surgeons have historically provided them in emergency scenarios.

Another challenge facing already overburdened hospitals is staffing. Especially in states where anti-abortion sentiment runs strong, many physicians or nurses at hospitals may not want to provide them, Joffe said.

“You have to draw from a pool that may or may not be sympathetic to abortion, unlike in a clinic where you don’t go to work at unless you’re committed to abortion being part of health care,” Joffe said.

Abortion advocates say confusion stems from unclear language about the de-licensing process. The law prohibits clinics from obtaining new licenses after May 2 and institutes a full ban on Jan. 1, 2024. However, advocates worry about a separate provision in the 1,446-line bill that specifies under state law that abortions may only be performed in hospitals.

The clinic-focused legislation has also raised questions about which kinds of facilities are best equipped to provide specialty care to patients regardless of their socioeconomic status or location.

If clinics stop providing abortions – as early as May or as late as next year – it could reroute thousands of patients to hospitals and force administrators to devise new policies for elective abortions. To do so would require expanding their services beyond emergency procedures they have previously provided, prompting questions about the shift’s impact on capacity, staffing, waitlists and costs. Roughly 2,800 abortions were provided in Utah last year.

The Utah Hospital Association said no hospitals provided elective abortions in the state last year.

The new restrictions are most likely to affect those seeking to terminate pregnancies via medication, which accounts for the majority of abortions in Utah and the United States. Abortion medication is approved up to 10 weeks of pregnancy, mostly prescribed at clinics and since a pandemic-era FDA rule change, increasingly offered via telemedicine.

The new law takes on added significance amid legal limbo surrounding other abortion laws that have been signed in Utah.

Last year’s Supreme Court ruling triggered two previously passed pieces of legislation– a 2019 ban on abortion after 18 weeks and a 2020 ban on abortions regardless of trimester, with several exceptions including for instances of risk to maternal health as well as rape or incest reported to the police. The Planned Parenthood Association of Utah sued over the 2020 ban, and in July, a state court delayed implementing it until legal challenges could be resolved. The 18-week ban has since been de facto law.

Abortion-access proponents have decried this year’s clinic ban as a back door that anti-abortion lawmakers are using to limit access while courts deliberate. If abortions were restricted regardless of trimester to the exceptional circumstances, closures would have less wide-ranging implications for patients pursuing elective abortions up to 18 weeks of pregnancy.