News Abortion

Another Year, Another Effort to Redefine “Medically-Necessary” Abortion Care in Alaska

Robin Marty

The poor women of Alaska may be in for a drastic change when it comes to using Medicaid to pay for medically necessary abortions or abortions after a sexual assault.

A plan that some believed was intended to provide more restrictions over Medicaid coverage of safe abortion care in Alaska ground to a halt at the end of 2012 when the state department of health announced it would not insist doctors certify an abortion was necessary because the health of the woman was endangered by the pregnancy in order to be reimbursed for the procedure. Instead, doctors can continue to say that it is simply necessary for medical reasons without using the more narrowed “endangered” language.

Last year, Alaska proposed requiring doctors to fill out a certified form that would require them to check off whether the abortion was necessary because of a case of rape, of incest, or if the life of the pregnant woman was in danger. Besides creating additional concerns about violating patient privacy with additional paperwork, the move would also change a doctor’s ability to simply attest that the abortion was medically necessary without delving further into the background of the reason.

However, in December the state agreed to rescind its efforts to narrow the rules, finally adhering to the state Supreme Court’s advice that the move is unconstitutional.

For Planned Parenthood of the Great Northwest, which opposed the potential backdoor abortion access restriction, it was a small victory for women in Alaska who use Medicaid as their insurer. Laura Einstein, an attorney for the health care provider, told the Associated Press that the:

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[R]egulations are a significant improvement over what had been proposed. While she said Planned Parenthood doesn’t consider the certificate requirement to be needed, she said doctors currently make decisions on what is medically necessary, and that won’t be affected.”

“We’re very gratified they’re going to leave this between the physician and patient, and not try to narrow the access” that low-income women have to services, she said.

Of course, a new year means a new onslaught on a woman’s constitutional right to an abortion, and Senate Majority Leader John Coghill is happy to restart the effort in Alaska. Earlier this week, Coghill introduced SB 49, a bill that would limit Medicaid coverage by again seeking to redefine “medically-necessary” by limiting these to such instances in which an abortion is necessary to  avoid “impairment of a major bodily function” due to, say, renal disease that requires dialysis; congestive heart failure; coma; or “another debilitating physical condition.”

As if the narrowing of what constitutes a medically necessary abortion (including removing the allowance for a patient’s mental health) wasn’t enough, Sen. Coghill is also demanding proof that a victim of rape or incest isn’t potentially lying about the crime.

“The department may not pay for abortion services under this chapter unless the abortion services are for a medically necessary abortion or the pregnancy was the result of rape or incest and the rape or incest was promptly reported to law enforcement or public health authorities.”[emphasis added]

Sen. Coghill sees these new rules as a “budgetary issue.” He told the Anchorage Daily News,  “As a right to life guy, I’m interested in that because not only is it a state budget issue, but it really now becomes an issue of when do you actually force somebody from the public to pay for somebody else’s abortion if it’s truly elective. I think that question is a serious question, and it should be asked.”

It may be a “serious question,” but not “serious” enough for Sen. Coghill to be bothered to even put a definition on a wiggly word like “promptly.” Does promptly mean immediately after the incident? Does a woman have a week to report to the police? Just a day? For an attempt to write a new law, the ambiguity would leave hundreds of sexual assault survivors at a total loss as to what their rights would be.

That may well be the entire point.

“Senator John Coghill’s bill is dangerous for Alaskan women,” said Treasure Mackley, Political and Organizing Director at Planned Parenthood Votes Northwest via statement. “In a state where we have some of the highest rates of rape and incest, Coghill would force women in the most vulnerable circumstances to navigate the legal system in order to obtain the medical care they need. With the rate that assaults go unreported in our often small, tight-knit communities, this bill puts a foreboding burden on Alaskan women.”

“Coghill is blatantly inserting politicians and the government into women’s decision making, he’s putting women’s health at risk, and he’s doing this at time when as a Senator he should be focusing on the issues that matter to Alaskans most.”

Sen. Coghill, meanwhile, says he’s unclear why people are so upset that victims need to promptly report assault in order to get an abortion, calling it a matter of the “people’s protection.” Alaska Right to Life agrees, with director Matt Johnson telling the Juneau Empire that, “[I]t seems like if you’re really trying to protect women from men who are predators, those men need to be outed. If you want the state to pay for (abortion), you know, I think the state has an interest in catching predators like this, and the state has an interest in securing its citizens and protecting them against those kind of people.”

So, you can have an abortion, but only if you are willing to potentially put yourself in harm in order to protect the rest of the public.

News Abortion

Parental Notification Law Struck Down in Alaska

Michelle D. Anderson

"The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions," said Janet Crepps, senior counsel at the Center for Reproductive Rights. "This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm."

The Alaska Supreme Court has struck down a state law requiring physicians to give the parents, guardians, or custodians of teenage minors a two-day notice before performing an abortion.

The court ruled that the parental notification law, which applies to teenagers younger than 18, violated the Alaska Constitution’s equal protection guarantee and could not be enforced.

The ruling stems from an Anchorage Superior Court decision that involved the case of Planned Parenthood of the Great Northwest and the Hawaiian Islands and physicians Dr. Jan Whitefield and Dr. Susan Lemagie against the State of Alaska and the notification law’s sponsors.

In the lower court ruling, a judge denied Planned Parenthood’s requested preliminary injunction against the law as a whole and went on to uphold the majority of the notification law.

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Planned Parenthood and the physicians had appealed that superior court ruling and asked for a reversal on both equal protection and privacy grounds.

Meanwhile, the State of Alaska and the notification law’s sponsors appealed the court’s decision to strike some of its provisions and the court’s ruling.

The notification law came about after an initiative approved by voters in August 2010. The law applied to “unemancipated, unmarried minors” younger than 18 seeking to terminate a pregnancy and only makes exceptions in documented cases of abuse and medical emergencies, such as one in which the pregnant person’s life is in danger.

Justice Daniel E. Winfree wrote in the majority opinion that the anti-choice law created “considerable tension between a minor’s fundamental privacy right to reproductive choice and how the State may advance its compelling interests.”

He said the law was discriminatory and that it could unjustifiably burden “the fundamental privacy rights only of minors seeking pregnancy termination, rather than [equally] to all pregnant minors.”

Chief Justice Craig Stowers dissented, arguing that the majority’s opinion “unjustifiably” departed from the Alaska Supreme Court’s prior approval of parental notification.

Stowers said the opinion “misapplies our equal protection case law by comparing two groups that are not similarly situated, and fails to consider how other states have handled similar questions related to parental notification laws.”

Center for Reproductive Rights (CRR) officials praised the court’s ruling, saying that Alaska’s vulnerable teenagers will now be relieved of additional burdensome hurdles in accessing abortion care. Attorneys from the American Civil Liberties Union, CRR, and Planned Parenthood represented plaintiffs in the case.

Janet Crepps, senior counsel at CRR, said in a statement that the “decision provides important protection to the safety and well-being of young women who need to end a pregnancy.”

“The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions. This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm,” Crepps said.

CRR officials also noted that most young women seeking abortion care involve a parent, but some do not because they live an abusive or unsafe home.

The American Medical Association, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine have said minors’ access to confidential reproductive health services should be protected, according to CRR.

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”