The Kentucky General Assembly voted Thursday to update the state’s strict restrictions on abortion in a way that supporters say will help reassure health care institutions and providers they can legally end a patient’s pregnancy when they’re diagnosed with certain life-threatening conditions.

The proposal cleared the legislature the day after it was introduced, and it wasn’t just regular Kentuckians who had little chance to learn about the bill before lawmakers approved it. Democratic legislators said they, too, didn’t get enough time to review it and talk to lawyers and other experts about how the bill’s changes to the abortion ban could impact women.

During Thursday’s debate, Rep. Adrielle Camuel of Lexington asked why Democratic representatives weren’t invited to offer input on the bill and said “the voices of those that we represent were silenced in this critical discussion.”

GOP Rep. Jason Nemes of Middletown, one of the bill’s architects, disagreed, saying they held public discussions about the proposal in legislative committee meetings Wednesday and during Thursday’s votes.

Several Democratic lawmakers said they welcomed an effort to make the state’s abortion ban less dangerous for patients. But they expressed concern that the specific language of the bill could have the opposite impact of its stated intent and actually make doctors wait until patients are in more danger, not less, from hemorrhaging or sepsis before providing an abortion.

And Democrats said a bill like this – clarifying when women can legally receive a life-saving abortion – wouldn’t be necessary if the legislature’s Republican majorities hadn’t passed a ban in the first place.

“This (legislative) body is the reason these women are in danger,” said Democratic Rep. Matthew Lehman of Newport. “You know, we don't give credit to firemen when they put out a fire that they start.”

Until now, Republican leaders generally have resisted calls to revisit and amend the restrictions they’ve placed on abortions.

Nearly all abortions were outlawed by Kentucky law starting in 2022 after the U.S. Supreme Court’s own conservative majority struck down a constitutional right to abortion.

Since then, Kentucky voters rejected an anti-abortion amendment to the state constitution. And reporting by various news outlets revealed how abortion bans have endangered women’s lives and led to preventable deaths.

The Kentucky Center for Investigative Reporting recently detailed how the commonwealth’s abortion restrictions contribute to making an effective medication for miscarriage practically inaccessible.

What the new bill does, and what’s controversial about it

The bill legislators passed Thursday will update state law to allow doctors to provide an abortion under the following circumstances:

• To remove an ectopic or molar pregnancy.
• As “lifesaving miscarriage management,” including for “unavoidable” but incomplete miscarriages.
• To treat sepsis or hemorrhaging when an impending or completed miscarriage causes a “life-threatening infection or excessive bleeding.”
• To remove an embryo or fetus after a miscarriage as long as fetal cardiac activity isn’t detected.

Lawmakers who worked on the bill said it doesn’t add new exceptions to Kentucky’s abortion ban, which outlaws abortion in all instances unless there’s a life-threatening health risk.

They also said a health condition doesn’t have to be specifically listed in the bill to qualify for treatment with a legal abortion.

“It's not meant to be an exhaustive list,” said Republican Rep. Kimberly Poore Moser of Taylor Mill. “But it is the most common issues that physicians and mothers … are facing.”

The bill classifies abortions given under these conditions not as abortions but instead as “actions that require separating the pregnant woman from her unborn child.” However, under broadly accepted medical terminology, an abortion is an abortion regardless of the reason it’s provided.

Nemes said that’s quibbling over “small semantics” and doctors understand what is meant.

Kentucky-based reproductive rights advocates contend the bill’s redefining of abortion does matter. Tamarra Wieder, of Planned Parenthood Alliance Advocates, told KyCIR it mirrors language used by “anti-abortion extremist groups.”

Democratic Rep. Rachel Roarx of Louisville said she’d vote for the legislation, despite her concerns about its use of language that isn’t medically accurate. Because, she said, if it does give someone the opportunity to have life-saving care, then it’s needed – especially under the circumstances the current ban has created.

“And it is terrifying to be someone who can become pregnant in this state,” Roarx said. “I’ve had to look at my own family members, in the course of my own family planning, and say things like, ‘Would you get me the care that I need if I were dying? Promise me that you would.’”

How the bill rushed through the legislature

Three Republican lawmakers, Moser, Nemes and Rep. Nancy Tate of Brandenburg, developed the unexpected proposal alongside an OB-GYN, Dr. Jeff Goldberg, and the head of the anti-abortion group Kentucky Right to Life, Addia Wuchner.

They introduced the legislation at a House committee meeting early Wednesday afternoon, amending a different proposal – House Bill 414 – to include their changes to the abortion ban. But procedural technicalities would prevent the legislature from passing HB 414 by Friday, which is necessary to ensure it can withstand a potential veto from Democratic Gov. Andy Beshear.

So, on Wednesday evening, a Senate committee stuffed the new abortion ban language into a different proposal, House Bill 90. Then the full Senate, followed quickly by the House, approved it Thursday morning.

When the House gave the legislation the final vote, the legislature’s website didn’t have a copy of the updated bill with the abortion ban changes available on its main webpage for HB 90, although the new language was available on HB 414’s page.

The Senate voted 29-0 to approve the bill, with five Democrats giving it a pass instead of voting yes or no. The House approved it 74-17, with a handful of Democrats voting yes, a couple Republicans voting no and several lawmakers not casting a vote.

Beshear indicated Thursday he isn’t sure if he’ll veto the bill or not.

He told reporters it doesn’t go far enough to help Kentuckians because the state has “one of the most restrictive, draconian abortion laws in the country.”

“When this one reaches my desk, I’m going to have some questions,” he said. “So one question I’m going to have is: Is it more or less restrictive than the current understanding in the medical community that we have right now?”

If Beshear does veto it, the legislature’s Republican leadership should have enough votes to overturn that veto and ensure the bill becomes law.

Reporters Sylvia Goodman and Joe Sonka contributed to this story.