As a public charity, the group “legally cannot consider the partisan implications on any set of candidate elections” in funding decisions, she said. It will fund only ballot measures that would allow abortions at least until fetal viability — generally about 24 weeks — the standard under Roe v. Wade. A proposed initiative in Arkansas is off the table because access would go to 20 weeks.

“We are not interested in policies that do less than reestablish Roe,” Huang said.

In South Dakota, Dakotans for Health wants to reinstate abortion rights in the state. But an anti-abortion campaign says out-of-state money pays for signature drives that pressure people to sign the petitions without providing sufficient information on the measure. The Republican-dominated legislature passed a bill to let people remove their signatures from such ballot petitions. An emergency clause would put the bill into effect immediately if the governor signs it — ahead of the deadline to place the abortion question on the November ballot.

Critics of other states’ measures see other avenues for defeat.

Gregg Keller, a St. Louis-based Republican political strategist, said Missouri’s proposed amendment goes further than the measure passed last year in Ohio. For example, abortions could be allowed after fetal viability to protect the mental health of a pregnant person.

If opponents can get out the word that this goes further than what was done in Ohio and other states, “we have a chance of actually beating this thing,” Keller said. “If they are able to raise money. That’s a big if.”

Ballot supporters here raised $4.2 million as of March 12, according to campaign finance records. Money has come from national groups including the American Civil Liberties Union and the Fairness Project, which has supported ballot efforts on various progressive causes. Kansas City-based Health Forward Foundation has also donated.

So far opponents of the Missouri measure have raised $55,000, nearly half of which comes from the Catholic Church, according to campaign finance records.

“We went into this knowing that we were going to be outspent,” said Missouri Catholic Conference Executive Director Jamie Morris, who said he didn’t know whether the church would spend more. “We’re still going to be out trying to educate the faithful as best as we can, with the resources we have.”

Abortion Action Missouri Executive Director Mallory Schwarz said the coalition backing the state’s abortion measure is confident it will hit the signature goal by the May deadline.

If that happens, it will be up to outgoing Republican Gov. Mike Parson, who supports Missouri’s near-total abortion ban, to decide whether to put the measure before voters in the state’s August primary or the November general election.

Keller, the GOP strategist, said the governor will face tremendous pressure to put it on the August ballot. Five of six statewide offices are on the November ballot, as is Republican Josh Hawley’s U.S. Senate seat. An abortion ballot measure could overshadow those campaigns — just based on the war chests in play: Hawley’s 2018 campaign spent about $11.5 million, for example, while the three political action committees backing Ohio’s abortion amendment last year spent over $50 million.

“I am telling anyone who is running as a Republican this year that if you want to be able to make your case about how and why you deserve to be elected, and you want to be able to get your story out,” Keller said, “then clearly you would not want to have a $50 million ballot initiative on in November.”

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KFF Health News rural health care correspondent Arielle Zionts and Mountain States editor Matt Volz contributed to this report.

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