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.

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