Editor's Note: (This story has been updated to include the Supreme Court decision to overturn Roe v. Wade and reaction. )
Fairview Heights, Illinois(CNN) On a winding road just off Interstate 64 in southern Illinois, past a Holiday Inn, an antiques mall and a TGI Fridays, the squat brick Planned Parenthood clinic is a window onto a post-Roe v. Wade America.
The clinic's call center -- less than 20 miles from Missouri's lone abortion provider -- had been abuzz since a draft opinion leaked last month suggested that the US Supreme Court could strike down the landmark 1973 decision guaranteeing a constitutional right to abortion.
"Patients immediately were calling, wondering, 'What does this mean? Can I still come to my appointment tomorrow? Is abortion still legal?' " Dr. Colleen McNicholas, Planned Parenthood's chief medical officer for the region, which includes the clinic in Fairview Heights and one just across the Mississippi River in St. Louis, said days after the leak.
On Friday, the country's highest court indeed ruled there is no longer a federal constitutional right to an abortion.
"Today is the worst case scenario for 36 million people of reproductive age who live in 26 states including Missouri where abortion is now poised to be banned," Yamelsie Rodriguez, president and CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region, said in a statement.
"Everything that led to the overturning of Roe should be a stain on our history from which we must learn and do better... We must demand a system that creates abortion access for all people who need it, no matter their identity, insurance status, or zip code."
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At Missouri's only abortion clinic, just across the river, Rep. Cori Bush, a Democrat from St. Louis, wept at news of Friday's decision as she met with clinic staff members, according to social media posts.
Already, more than 75% of the Illinois clinic's patients come from throughout the Midwest and South, Illinois Gov. JB Pritzker, a Democrat, said during a visit to the 18,000-square-foot health center last month. Thousands more are expected to travel for hours from places like Oklahoma, Missouri, Texas and Kentucky after Roe was struck down.
On Friday, Pritzker said he will call the state General Assembly into special session to "address the challenges posed" by the Supreme Court decision. He called the state a "safe haven" for reproductive rights.
"Illinois is going to be ground zero," David S. Cohen, a professor at Drexel University's Thomas R. Kline School of Law in Philadelphia, told CNN last month. "Illinois is just closer to more people who are going to be in states where abortion is going to be banned."
The Fairview Heights clinic -- and a partner facility in nearby Granite City, Illinois -- expect the number of abortion patients in southern Illinois to double to about 14,000 per year with Roe's fall.
In the parking lot of the Fairview Heights clinic there are usually several cars with plates from Southern states. Overall, Illinois could see up to 30,000 out-of-state abortion patients per year, according to McNicholas. The Guttmacher Institute, a reproductive rights think tank, said there were 40 facilities -- including 25 clinics -- providing abortions in the state in 2017.
"Illinois certainly is an island in what will be an incredible abortion access desert," McNicholas said. "An oasis for so much of the country."
At the clinic gates, young people in reflective safety vests try to stop entering cars and hand out pamphlets offering information on parenting support and adoption services in a bid to discourage the patients from getting abortions.
The abortion debate could get more confrontational in the coming weeks. The battle lines have already been drawn by lawmakers in both red and blue states.
In Jefferson City, Missouri's capital, the House in April passed a bill that would ban abortion drugs being sent via mail to people's homes in the state and defund Planned Parenthood clinics in the state. It would also allow family members to file wrongful death lawsuits in cases of a live birth during or after an attempted abortion when the baby is injured or subsequently dies as a result of the abortion.
Roe had affirmed the right to receive an abortion under the 14th Amendment, ruling that the procedure was constitutionally protected up until about 23 weeks of pregnancy when a fetus could be able to live outside the womb.
Many Republican-led state legislatures have already moved to limit abortion access. Others are poised to enforce restrictive laws that have remained unenforced since Roe was passed. In total, an analysis by the Guttmacher Institute finds that 23 states have laws aiming to limit abortion access, including some states with multiple provisions.
And 13 state legislatures -- including Missouri -- have "trigger laws," which are bans that will now go into effect without the landmark Roe ruling in place. In some cases, the law requires an official such as an attorney general to certify that Roe has been struck down before the law can take effect. The bans would kick in almost immediately.
Missouri Attorney General Eric Schmitt, a Republican, tweeted Friday that he had just signed an opinion that made the state the first in the country to effectively end abortion.
Mary Elizabeth Coleman, a Republican state representative, said last month that "the first priority" after Roe is protecting existing state laws.
"For states like Missouri that are largely already operating in a post-Roe environment, it does shift for me my focus from addressing abortion tourism to looking at how do we protect the laws that are on the books in our state courts," Coleman said.
Still, Coleman has been pushing a measure that would allow state residents to file lawsuits against anyone who "aids and abets" a Missourian seeking an abortion out of state.
Cohen, the Drexel University law professor, said he believed others states will pursue similar legislation with the overturn of Roe.
"They're not going to rest knowing that they've banned abortion in their state," he said. "They're going to want to ban it as widely as possible or stop it as widely as possible."
In St. Louis, Missouri's last Planned Parenthood clinic is open from only 8 a.m. to 4 p.m on Wednesdays. State law requires that patients receive counseling -- including information to discourage an abortion -- and then wait 72 hours before the procedure.
"We're telling patients, 'Yes, I can schedule your abortion appointment for Missouri next week. However, although we fully intend to keep that appointment if we can, the truth is that any day now, the landscape may change,' " McNicholas said last month.
Many patients from Missouri and other red states have been calling and traveling to health center in Fairview Heights, where case workers at its Regional Logistics Center coordinate funding for their procedures and other expenses from a vast network of member organizations. The case workers help with transportation costs, including booking flights and hotel rooms, child care services and even rides to and from the airport.
"It's much more than just saying, 'Do you have a car,' right?" McNicholas said. "It's understanding, 'Will your car make it 800 miles here and 800 miles back?' It's really sort of nuanced, individual, deep conversations with patients about what their reality looks like.
"And that not only takes a lot of people power but financial resources that we are going to have to put towards navigating people from across the country in this sort of mass mobilization crisis moment. It's going to be astounding. Right now we're looking at an average of $1,500 per patient we navigate. Some need less, but some need much more."
Abortion providers in other states that have severely restricted abortion access are taking similar steps to connect clients with the necessary services. Three-quarters of US abortion patients are poor or low-income and may not be able to afford gas, hotel rooms or time off work, according to the Guttmacher Institute.
"The people that are hurting the most are low-income people, young people, people of color, specifically from brown and Black communities and those who live in rural areas," Rodriguez, the Planned Parenthood executive, said last month.
Rodriguez said the doctors, nurses and staff at the Fairview Heights clinic have been preparing for the post-Roe era since 2019 -- when Missouri and other states passed a slew of bills restricting abortions. At the time, Missouri was on the verge of becoming the first state in the country with no abortion clinics.
The massive Illinois clinic -- which also provides annual exams, cancer screenings, birth control, testing for sexually transmitted diseases and HIV prevention services -- was practically built in secret across the Mississippi River from St. Louis. It opened in the fall of 2019 -- the same year a federal judge in Missouri blocked a law banning most abortions after eight weeks.
"We needed to make sure that contractors were not going to get harassed by politicians ... that word would get out, and then we would have protesters outside the construction (site)," said Rodriguez, who would not comment on how the construction was kept largely under wraps. "We've seen it before where they go to contractors' homes and protest in front of their homes."
A number of elected officials have visited the Illinois clinic to show support.
"Let's be crystal clear about one point: Abortion is health care," Pritzker said during his visit to the clinic. "By the time many of these out-of-state patients make it to Fairview Heights, Illinois, they have traveled further than anyone should have to, physically and emotionally."
Pritzker in 2019 signed the Reproductive Healthcare Act that declared abortion a "fundamental right" in the state.The law was part of a wave of Democratic states that opted to codify abortion protections in response to steps by a number of Republican states to restrict access.
"People should not have to endure trauma after trauma to be in control of their own bodies," the governor said Wednesday. "But that's exactly the burden this right-wing Supreme Court and anti-choice governors and state legislators increasingly put on the backs of millions of women."
Rep. Bush toured the clinic last month, days after the leaked draft opinion.
As she was greeted outside by McNicholas and Rodriguez, a woman in her early 30s stepped up to a security window and said she hoped she had not missed her appointment.
"I'm not too, too late. But I came all the way from the airport because they don't take my insurance in Missouri. This is a real important procedure," she said before being allowed inside.
Staff members at the clinic have alternated between tears and anger to moments of hope and joy in recent weeks. During Bush's visit, as two or three patients sat with nurses behind curtains in the pre- and postoperative area, the congresswoman, McNicholas, nurses and others shot a TikTok dance video to Dorrough's "Walk That Walk."
"From the front desk to the physicians to the nurses to the case managers to the call center, everyone involved is here for a purpose," Kawanna Shannon, the clinic's director of patient access, said of the moment.
"What we do for a living ... is for the patients, and we're not going to allow anybody to stop that. ...There will be no head hanging. There will only be fight."