Political reaction in Canada to the draft Supreme Court opinion has been swift, with no shortage of posturing. Americans have always been free to travel to Canada for medical care, for example.

“If an American wanted a medical procedure, they could get one, they would just have to pay for it out of pocket,” Minister of Families, Children and Social Development Minister Karina Gould told reporters Wednesday on her way into a Liberal caucus meeting. “There’s no reason why we would turn anyone away to receive that procedure here.”

But the reality on the ground in Canada is far more complicated.

Anyone who travels north for health care will discover that the system is stretched and waiting lists are long for many types of medical care. Abortion services are no different.

“They’re going to be in for a little bit of a rude awakening in terms of the lack of access in this country,” Mohini Datta-Ray, executive director of Planned Parenthood Toronto, told POLITICO when asked about the prospect of an American influx.

“I think Canada is often seen as a utopia in the U.S.”

Foreigners are free to use services provided by Canada’s public health care system as long as they pay their own costs or they are covered by insurance.

If the U.S. Supreme Court were to adopt the draft majority decision, the step could immediately restrict access to abortion in at least 23 states, including the border states of Michigan, Idaho and North Dakota. While access to the procedures would likely be maintained in other U.S. states, the changes could encourage some Americans to consider Canada as a friendly option for reproductive services.

But access to abortion services, which have been decriminalized in Canada, can be a challenge, especially for Canadians outside of urban areas. Some must travel for hours, often across provincial boundaries, to the nearest clinic.

In Canada’s big cities, where services are easier to find, landing an appointment — and quickly — is not always as simple.

“Wait lists are through the roof,” said Datta-Ray, whose organization has partnerships with clinics across the Toronto region. “The places that do provide abortion or reproductive care in this country are overwhelmed.”

Abortion Rights Coalition of Canada executive director Joyce Arthur says while there are barriers for Americans — like travel expenses, the need for a passport and fees for the procedure itself — she expects future changes in the U.S. will boost demand at Canadian clinics.

“That could impact everyone up here looking for services as well, in terms of waiting times and being able to get in,” Arthur said this week. “It’s a very time-sensitive procedure, and once you’ve decided to have an abortion, staying pregnant is very psychologically taxing.”

Datta-Ray said medical abortions cost between C$875 and C$971 at the Toronto-area clinics, while surgical abortions can cost between C$531 and C$2,400. In most parts of Canada, these fees are covered by the health care system.

Meghan Doherty, director of global policy and advocacy for Action Canada for Sexual Health and Rights, said in an interview that services offered in Canada are not designed to absorb a great number of patients from outside the country.

“But there will be a lot of people who will be working day and night to provide care that is needed,” she said.

In 2020, more than 74,000 abortion procedures were done in Canada, according to figures from the Canadian Institute for Health Information.

The availability of services across the provinces and territories is uneven, even though the Canada Health Act is supposed to ensure equitable access to health care services. In New Brunswick, for instance, surgical abortions are only offered in a few hospitals.

Doherty said Canadians could feel the effects of Roe v. Wade being overturned in another way: the potential loss of access to critical U.S. abortion procedures later in pregnancy. The availability of abortions for pregnancies more than 24 weeks is limited in Canada, she said.

“The impact of Roe v. Wade potentially being struck down will have ripple effects here for sure,” Doherty said. “It does put an onus on the provincial and federal governments to make sure that those services are available in people’s own communities, so that they don’t actually have to travel and they don’t need to be reliant on a country that is trying at every step of the way to restrict access to abortion.”

While Canada’s political discourse on abortion is far more subdued than the bare-knuckle public debates in the U.S., the issue remains especially sensitive for the Conservatives, who draw considerable support from voters opposed to abortion.

After the leak of the Supreme Court draft decision, interim Conservative leader Candice Bergen’s office instructed the party’s MPs and senators to avoid discussing the matter.

The challenge for Conservatives is that polls have shown a clear majority of Canadians believe people should be able to have an abortion regardless of the reason.

Prime Minister Justin Trudeau’s Liberals have long tried to brand themselves as strong supporters of abortion rights — and have done their best to needle their Conservative rivals about it. Trudeau’s Liberals have also promised to fight for more access to abortion procedures.

During last fall’s election, the Liberals made several commitments to improve access to abortion services.

The pledges included establishing regulations under the Canada Health Act to ensure “that no matter where someone lives, that they have access to publicly available sexual and reproductive health services.” If a province failed to comply, the Liberals said they would empower Ottawa to withhold federal health-care transfers to the province.

Pressed Wednesday about the government’s lack of progress on the abortion access file, Health Minister Jean-Yves Duclos promised announcements soon.

He told reporters the government has been advancing a C$45-million program to increase access and information about abortion services. He promised more work to step up enforcement measures for provinces who fail to offer an adequate level of service.

“Every year, there are provinces and territories whose funding from the federal government is cut because they don’t provide abortion and reproductive services in the way that they should,” he said.