BUFFALO, N.Y. -- A leaked opinion and a conservative court meant it wasn't necessarily a surprise when justices overturned Roe v. Wade a year ago.

However, Planned Parenthood of Central and Western New York President Michelle Casey said there was still a difference between expectation and reality.

"It's been a very, very, very difficult year and we're in New York. It's just been horrible the number of attacks we've seen, the implications with patients and it's just not stopping," Casey said.

She said the New York state Legislature has taken positive steps to protect women's reproductive health rights since the decision but congressional conversations about a national abortion ban and federal litigation about abortion pills still stokes fear for advocates.

"When this first passed, they started talking about states' rights and how it's really up to the states and that lasted for a good 10 minutes," Casey said.

In the first few months, Casey said upstate clinics saw a huge influx of patients from other more restrictive states. She said it leveled off a bit after a court enjoined Ohio's ban of abortions for pregnancies longer than six weeks.

"We are still seeing a lot of patients from Pennsylvania and Ohio, even as far away as Texas," Casey said. "Abortion care is legal in Pennsylvania but there's a waiting period and there's more strict minor consent laws so even in a state where it appears abortion is legal, there a lot of barriers there."

The regional Planned Parenthood president said New York state Medicaid increases for family planning and in-clinic abortion services have helped the organization significantly. It is working on increasing staffing, recently expanded greater Buffalo facilities, is in the progress of expanding its Rochester area health center and has increased hours in Central New York.

"We've definitely done a lot to try to improve access and that's our main point is to really make sure people have access to the health care that they need regardless of their ability to pay," she said.

Casey said while numbers and statistics about the impact of the Supreme Court decision are important, she believes its also vital advocates continue to focus on the human cost.

"There's a story behind every single person who wants an abortion and can't get one or somebody who wants one and ends up getting one but has to go to ridiculous lengths to obtain that," she said.