What this bill would do is codify the existing abortion landscape in Montana, which at the top level is the right to access an abortion under a 1999 state Supreme Court ruling called Armstrong. And that found that Montana's state Constitution has the right to privacy and that Constitution protects access to an abortion.

House Bill 432, brought by Rep. Laurie Bishop, D-Livingston, would align Montana’s code with past court rulings and existing constitutional rights that protect private medical choice, the sponsor said during Tuesday’s hearing before the House Judiciary Committee.

“This bill reflects where we are at this moment and is intended to clarify the current legal landscape in Montana,” Bishop said in her opening statement. “It codifies statutory protection for abortion that is consistent with the current state constitutional protection for abortion rights.”

Getting an abortion has long been extremely difficult for Native Americans like Matson. It has become even tougher since the Supreme Court overturned Roe v. Wade.

New, restrictive state laws add to existing hurdles: a decades-old ban on most abortions at clinics and hospitals run by the federal Indian Health Service, fewer nearby health centers offering abortions, vast rural expanses for many to travel, and poverty afflicting more than a quarter of the Native population.

“That’s a lot of barriers,” said Matson, who lives in Sioux Falls and is Sicangu Lakota. “We’re already an oppressed community, and then we have this oppression on top of that oppression.”

Republican lawmakers have introduced at least four constitutional amendment bills so far in the legislative session that began in January, but none has dealt with abortion. That may be due to the uncertainty over how Montanans and even Republican lawmakers would react to such a proposal after voters in other states sided with abortion rights advocates on ballot issues in last year's elections.

Nearly 40 people spoke during the meeting, with the majority against the ordinance. Many questioned why the council was considering the ordinance when other issues, like Manhattan’s infrastructure, needed attention.

The ordinance’s enforcement mechanism was also a point of contention. Opponents of the ordinance stated that the proposed local law would turn neighbors into vigilantes, and have people spying on one another.

Dr. Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists, said in a written statement in January that “restricting access to mifepristone interferes with the ability of obstetrician–gynecologists and other clinicians to deliver the highest-quality evidence-based care for their patients.”

For one thing, he said the town attorney advised the council that the sample ordinance as written would violate the Montana Constitution’s right to privacy along with case law dealing with abortion.

In response to a question, the lawyer also said an ordinance written to try to comply with Montana law would essentially be meaningless, Clements said.

The eight-page draft ordinance says that a person may sue someone who receives an abortion pill by mail up to six years after it happens. It says the accuser could receive at least $100,000 in statutory damages.

“This isn’t just about health care and counseling for transgender youth, as critical as that is,” said Sen. Christopher Pope, D-Bozeman. “It’s about health care for 300,000 Montana citizens paid in large part by the federal government in multi-billions of dollars … which is being put at risk by this unconstitutional, and in my opinion, misguided law.”

Zephyr said Regier’s characterization the bill was focused on procedures and not people doesn’t accurately reflect its broad language, including definitions for health care service that span from research to any service performed or provided by a medical practitioner.

Rep. Alice Buckley, a Democrat from Bozeman, is carrying House Bill 302 that would in some cases quadruple the maximum number of months of birth control supply a patient could pick up at one time – whether that be a pill, patch or ring.

Industry opponents included the Montana Medical Association, Montana Hospital Association, Montana chapter of the American Academy of Pediatrics, the Montana Nurses Association, the Montana Primary Care Association, Planned Parenthood of Montana and Blue Mountain Clinic, all of whom said the bill would undermine the medical profession’s obligation to act in the best interest of patients. The ACLU of Montana and the Montana Human Rights Network lodged additional opponent testimony, saying HB 303 would lead to patients being denied care “with impunity.”

For abortion rights groups, state constitutions are a critical part of a strategy to overturn bans that have cut off access to abortion in a wide swath of the country. Those documents provide much longer and more generous enumerations of rights than the United States Constitution, and history is full of examples of state courts using them to lead the way to establish broad rights — as well as to strike down restrictions on abortion. They offer a way around gerrymandered state legislatures that are pushing stricter laws.

Roughly 150 people gave passionate testimony Friday morning on Senate Bill 99, a proposal to ban gender-affirming care for transgender minors and restrict the use of public resources for medical and social transitions. After more than five hours of commentary, opponents outnumbered proponents by more than two-to-one.

Under the health department’s new proposal, abortions would be determined to be medically necessary only when a physician — not another type of provider — certifies a patient suffers from an illness, condition, or injury that threatens their life or has a physical or psychological condition that would be “significantly aggravated” by pregnancy.

Elsewhere, courts have rejected some states’ attempts to create a definition for medically necessary abortions apart from existing Medicaid standards as constitutional violations of equal protection.

“If the proposed rules take effect, they will have an immediate, grave, and irreparable impact on the health of patients in Montana seeking abortion care and their constitutional rights,” the letter said.

The letter warns that “should the rules become effective as proposed, Planned Parenthood of Montana and other providers intend to seek declaratory and injunctive relief against the new laws.”