​​This article was co-published with The Advocate as part of The 19th News Network’s Abortion on the Ballot series.

Just two months before the Supreme Court would overturn Roe v. Wade, eliminating the federal right to an abortion, Mike Bonanza launched Elevated Access. 

The nonprofit dedicated to helping patients receive reproductive health care would soon find its services more crucial than ever. Since its beginnings in April 2022, Republican-run legislatures have passed near-total abortion bans in 13 states. Conservatives also began pushing bans on gender-affirming care for minors alongside other anti-transgender laws, culminating in 26 states that now prohibit this widely-supported medical treatment, according to the Movement Advancement Project. 

As the need has grown, so has Elevated Access. The organization has continued to enlist volunteer pilots and offer free flights to patients who need reproductive health care, such as abortions and gender-affirming care, but who don’t have access to it where they live, whether due to bans or lack of resources. Elevated Access completed 400 flights in its first 18 months, according to Bonanza. In the past 12 months, it’s completed 1,200. 

Now, Bonanza and his few staff members are preparing for the results of the November elections, which could have an impact on their work. For Bonanza, there is a “best-case” scenario that sees Vice President Kamala Harris ascend to the presidency, and a “worst-case” that sees former President Donald Trump return to office. But no matter the outcome, there will still be plenty of work for Elevated Access. 

“Trump winning alone doesn’t necessarily do all the bad things that could happen. Harris winning doesn’t mean all the good things will happen,” Bonanza said. “So, a likely scenario really is some form of what we see today, where it’s going to vary wildly between states no matter who wins, at least for probably the first year to 18 months [of the next administration].”

While Trump’s campaign has attempted to distance itself from the unpopular idea of a national ban — even claiming recently that he would veto one if it made it to his desk — his running mate, JD Vance, previously expressed the desire to restrict abortion federally, and a road map to implement such a policy is outlined in Project 2025, the blueprint for a second Trump presidency crafted by conservative organization the Heritage Foundation.

Bonanza isn’t quite sure what will happen to Elevated Access in the longshot event of a national ban. While the organization currently enlists its volunteer pilots and other allies through aviation conferences and media coverage, their efforts have remained domestic. He insists that if abortion is somehow outlawed nationally or otherwise restricted, his group will continue to do what they’ve done in the face of increasing state bans, which is “get creative.” 

“When I think about what the worst case scenarios are of the future — short of having to shut down because there’s just no legal space for us to operate in — we’ll find a way to help people, whatever that looks like,” Bonanza asserted. “We’re really creative and really nimble, and always ready to find solutions to new challenges.”

While Harris is “certainly” the “better” option, according to Bonanza, the rollback of rights seen at the state level over the past two years has happened under a Democratic president and can continue to happen under another one. There are unlikely pathways a Harris administration could take to solidify access to reproductive health care, such as by expanding the Supreme Court or championing legislation through a Democrat-controlled Congress — which is currently not in place.

Even under Harris, Bonanza explained that “there’s always going to be people that don’t have transportation, don’t have the funds they need to pay for the care they need, don’t have housing and other things they might need in order to get care from the right provider.” Part of this is due to “the state of the American health care system” and lack of universal health care, but “that’s not something we’re gonna fix in the next two to four or even eight years — it’s going to be a long process.”

“The problems that people are facing today are not new. Some of our partners have existed for a decade helping people travel to get access to abortion in particular. That’s because you can’t just walk to any medical provider and get that care, because some providers don’t do it,” Bonanza said. “So, even if President Harris is able to [legally protect] abortion, gender-affirming care, and all the possible scenarios that we would support, legalization does not equal access.”

Ten states will be voting on abortion directly: Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York and South Dakota each have a referendum on the ballot that would enshrine abortion access in their state constitutions. So far, every abortion protection referendum that’s previously been brought to vote has passed.

But regardless of whether the ballot measures pass, Bonanza predicts that legal challenges to abortion laws will continue. In Georgia, a six-week ban was recently overturned before the state Supreme Court almost immediately reinstated it. Bonanza said that while providers were “ready to start providing abortions again” in the state, it’s the constant back-and-forth that leaves health care suspended in legal limbo. 

“The providers that have been under a state ban the shortest amount of time are going to have the most capability to get up and running again. But there are certainly providers out there that relocated from one state to another after their bans were passed,” Bonanza explained. “I know a provider that relocated both his practice and himself from Ohio to Illinois. I don’t see a scenario where he moves back to Ohio and starts a new clinic again.”

Beyond the election, Elevated Access is preparing for the U.S. Supreme Court’s impending ruling on gender-affirming care and the constitutionality of state restrictions for youth. Bonanza, who is not just the executive director but also a pilot, has personally flown both transgender adults and youth to receive treatment. 

He emphasized that there’s “a very broad spectrum of what gender-affirming care looks like,” from altering one’s hair and wardrobe to puberty blocker and hormones. For the transgender youth Bonanza has served, the gender-affirming care they receive is often “as simple as just going to see a talk therapist.” For the adults he serves, many “are traveling just to get access to care because they don’t have a provider locally.”

Surgeries on minors are incredibly rare — a recent study published in JAMA found that there were only 151 breast reductions performed on American minors in 2019, and 146 (97 percent) were performed on cisgender males. 

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults but minors as well. 

The American Medical Association, American College of Obstetricians and Gynecologists, National Library of Medicine, and World Health Organization, all agree that abortion is an essential component of reproductive health care which requires legal and safe access. A large majority of the U.S. — 63 percent — also believe that abortion should be legal in most or all cases, according to the most recent data from Pew Research. 

But, Bonanza said, facts and data are no match for “dehumanizing language” from politicians and public figures, which is why he has issued a call to voters ahead of November: “Let’s rehumanize people that have been attacked from certain parts of the spectrum, especially immigrants, trans people, and others that have been targeted by people in politics today.”

“If you listen to the rhetoric of people that are running — and whether they’re in the same party or from one person — you hear the people that use dehumanizing language,” Bonanza continued. “What it comes down to is: If that person in your family, that neighbor that you have, might be experiencing some of these things, do you want them to suffer under these oppressive policies? Or do you want them to be able to live their lives and get access to health care that they need?”