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Abortion rights groups are amassing millions in donations, recruiting volunteers to help people travel across state lines for the procedure, and developing a grey market to deliver abortion pills straight to patients’ doorsteps — even in states that have banned them.

Clinics in Democratic-controlled states are also staffing up, anticipating a flood of new patients from Republican-led states, which have been tightening access for years and are likely to waste little time in fully banning the procedure should Roe fall.

Conservative groups are equally busy: drafting model legislation that will prohibit abortion, spending hundreds of thousands of dollars lobbying lawmakers to enact new bans, and sending an army of door-to-door canvassers to key swing states to blunt any political backlash the decision could cause.

“We’ve had a post-Roe strategy for the last 15 years,” said Kristan Hawkins, the president of the group anti-abortion group Students for Life of America. “Now is when the rubber will meet the road.”

While a ruling limiting or overturning Roe v. Wade wouldn’t outlaw the procedure nationwide, it would further fray the country’s current patchwork of access. A dozen states have “trigger” laws that will automatically prohibit abortion should the court overturn the 50-year old precedent, while other conservative-led states are expected to move swiftly to ban abortion in the wake of such a ruling. A smaller group of progressive states have abortion rights protected in state law.

But many states neither ban nor protect the procedure and a final ruling, expected to come just a few months ahead of the midterms, could shape the 2022 election, as both sides jockey for votes with the understanding that the right to an abortion may be determined by which party prevails.

“Dozens of states are likely or certain to ban abortion if Roe falls. Do people in those states know that?” asked Kristin Ford with NARAL, which is supporting candidates who back abortion rights. “How are we communicating the gravity and significance of this moment to voters and reminding them who is to blame — who confirmed these justices and how do we hold those elected officials to account?”

Texas, which has had a near-total abortion ban in place for the last three months that the Supreme Court has allowed to stand, offers a preview of what the nation could look life if Roe falls: people with means traveling across state and national borders or going outside the law to terminate a pregnancy while those unable or unwilling to do so carry unwanted pregnancies to term.

And in the five states that have just one remaining clinic, the right to an abortion may still exist on paper, but access is so limited that organizers on the ground say they’ve been readying for a “post-Roe scenario” for years.

“We still have a clinic, but it’s just one, they can only do procedures a few times a week, and they have to fly all their doctors in from out of state,” said Michelle Colón, the executive director of the Mississippi-based group SHERO, which stands for Sisters Helping Every Woman Rise and Organize. “They can’t even see everyone who needs an abortion in Mississippi, let alone serve people coming in from Alabama, Louisiana and other neighboring states.”

SHERO is part of a loose network of abortion rights groups bracing for an end to Roe and scrambling to get information, medication and resources into the hands of people in states most likely to prohibit abortions. These groups are distributing emergency contraception and offering workshops on how to use it, recruiting volunteers to drive patients to clinics in other states, and fundraising to cover the cost of travel, housing and childcare — as well as the cost of the procedure itself, which is rarely covered by insurance when patients go out of state.

Abortion funds around the country — the largely volunteer-run non-profits that field calls from people who can’t afford the procedure or the travel — dispensed $9 million in 2020, up from $4 million in 2018, according to the National Network of Abortion Funds. The vast majority of the money comes from individual small donations, with a fraction coming from charitable foundations. But the groups fear they won’t have nearly enough to meet the demand if Roe is significantly curtailed or reversed.

Meanwhile, clinics in states with fewer restrictions on abortion — such as Illinois and California — are adding staff and hours while petitioning lawmakers to make the procedure even more accessible. Advocates in California are pushing for the state’s Medicaid program to more easily reimburse providers for treating patients from out of state, while groups in Michigan are looking at a ballot initiative to ensure access to abortion pills.

Their prep work was put to the test in September when the Supreme Court allowed Texas’ six-week ban to take effect, and in some parts of the country, clinics’ limited resources are now nearly overwhelmed.

“Prior to Texas, our system was already taxed,” said Colleen McNicholas, the chief medical officer of one of Planned Parenthood’s Midwest affiliates, which operates a clinic on the Illinois-Missouri border and serves patients from many surrounding states. “We are now on the verge of not being able to uphold it.”

Anti-abortion groups are also working to shape a post-Roe world.

Students for Life, an anti-abortion group that focuses primarily on college campuses, is lobbying more than 30 state legislatures to enact abortion restrictions. The organization also recently launched a $5 million dollar campaign in 20 cities — from Jackson, Mississippi to Tacoma, Washington — to have volunteers and staff knock on more than 77,000 doors, put up billboards, phone bank and run digital ads to convince people to oppose abortion.

And Americans United for Life, one of the largest anti-abortion lobbying groups, plans to unveil a new database this January, when state legislatures go back into session. The resource will explain current state law and what steps would be needed to ban abortion if Roe is reversed, Katie Glenn, the group’s government affairs counsel, told POLITICO.

“We’re also developing model bills we think are constitutionally sound and that make sure the woman is not penalized — that’s in every piece of legislation we’re working on,” she said.

Anti-abortion groups, anticipating an increase in unwanted pregnancies, are also promoting faith-based crisis pregnancy centers, petitioning college campuses to provide better housing and services for pregnant and parenting students, and lobbying state governments to allocate funds for parenting classes, adoption services and other anticipated needs.

“We realize this will mean there will be women who need more resources and help and we want to step up and provide that,” Glenn said. “This is the kind of thinking we’re pushing all states to do.”

Another battlefront is emerging over abortion pills. Students for Life, along with several other groups, are working with Republicans in Congress — primarily Reps. Bob Good (R-Va.) and Chip Roy (R-Texas) — to ban online sales of abortion pills and distribution on college campuses.

Eight red states have already enacted restrictions on the pills in anticipation of the Biden administration easing federal restrictions on the drug and allowing it to be prescribed via telemedicine and mailed to homes — a decision the FDA will make later this month. And 16 other Republican-controlled states have introduced bills to limit access.

“Our post-Roe strategy is mainly an offensive strategy,” Hawkins told POLITICO. “But our defensive strategy is fighting chemical abortion.”

Progressive groups have also zeroed in on abortion pills, which they’re counting on to be one of main ways people who live in states that may prohibit surgical abortions can still terminate a pregnancy if Roe falls. Colón described the medication as a key differentiator from the pre-Roe era when many people were forced to turn to unlicensed providers for risky procedures.

“So much of our mandate as a movement fighting for reproductive freedom right now is helping people understand what medication abortion care is, how it works and how to access it,” said NARAL’s Ford.

The two-drug regimen is far cheaper than a surgical abortion, can be ordered online and taken at home and carries a less than half-a-percent risk of major complications.

Yet the pills can only be taken during the first 10 weeks of pregnancy. By the time a person realizes they are pregnant and finds out how to obtain them, it may be too late. Abortion rights groups also worry misinformation and fear will prevent people from using the pills or deter them from seeking follow-up care if needed, particularly as more states move to ban them.

“I can’t stress enough that states are criminalizing this — putting people in jail who self-manage their abortions and going after those who help them do so,” Colón said. “If Roe is overturned, I expect that will only get worse.”