SALT LAKE CITY (AP) — Utah’s Republican Gov. Spencer Cox signed legislation Wednesday that will effectively ban clinics from providing abortions, setting off a rush of confusion among clinics, hospitals and prospective patients in the deeply Republican state.

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

With the law set to start taking effect May 3, both the Planned Parenthood Association of Utah and the Utah Hospital Association declined to detail how the increasingly fraught legal landscape for abortion providers in Utah will affect how facilities provide abortion.

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

The Utah lawmakers behind the legislation have said removing clinics from state law would help protect lives and serve as a necessary update given the new restrictions allowed to go into effect in Utah after the overturning of a constitutional right to abortion.

While lobbying against the legislation, Planned Parenthood, which runs three out of the four clinics in Utah, said it would dramatically hamper the organization’s ability to provide abortions as soon as it went into effect. Jason Stevenson, the association’s lobbyist, said Wednesday the organization would now further examine the wording, implications and whether other provisions of the bill allowed clinics to apply for a new kind of license 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 STI testing, pregnancy testing, cancer screenings and vasectomies. Stevenson said they were “looking closely” at other “hospital equivalent” licensing options laid out in the legislation, but would not say whether the clinics would apply at this point.

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 say they are concerned hospitals’ comparatively higher cost of care and staffing shortages will make it harder to get a legal abortion 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 more than 50 years. Historically, patients with low-complication pregnancies have 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, Joffe said, both in terms of recruitment and getting personnel to provide abortions. Especially in states where anti-abortion sentiment runs strong, many physicians or nurses at hospitals may not want to provide them, she added.

“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 included in the legislation. It prohibits clinics from obtaining new licenses as of May 2 and institutes a full ban on Jan. 1, 2024. However, advocates are worried about a separate provision in the 1,446-line bill that specifies under state law that abortions may only be performed in hospitals, rendering the licensing dates irrelevant.

The clinic-focused legislation has also raised questions about which cross-sections of the population would be most affected and which kinds of facilities are best equipped to provide specialty care to patients regardless of their income or location.

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

The Utah Hospital Association said no hospitals provided elective abortions in the state last year. It declined to answer questions about whether plans were in place to accommodate additional patients likely to seek care if clinics close.

The new restrictions are most likely to affect those seeking to terminate low-complication 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 provided via telemedicine.

In Utah, clinicians at three locations run by Planned Parenthood and a fourth by the independent Wasatch Women’s Center in South Salt Lake City provide the majority of abortions. 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 from zero to 18 weeks of pregnancy.

The law also clarifies the definition of abortion to address legal liability concerns providers voiced about the way exceptions are worded in state law — a provision that the governor and Republican lawmakers called a compromise.

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