As more states prepare to put into effect the new state health exchanges mandated under the Affordable Care Act, many Republican governors have been using the opportunity not just to ensure that abortion coverage is eliminated from state plans, but to force it out of private insurance plans in the state as well. Now, Virginia Governor Bob McDonnell may be the latest to jump on the bandwagon.
According to The Virginian-Pilot, Gov. McDonnell is crafting a restrictive abortion coverage ban for the state exchange, but some legislators believe that the wording could be used to go beyond just the exchange, banning coverage in private insurance, too. Sen. John Watkins, R-Powhatan County told The Pilot he was concerned that “an amendment drawn too broadly could restrict abortions in private insurance plans, something that would go ‘way too far.'”
So what is “too far?” NARAL Pro-Choice Virginia notes that Gov. McDonnell’s 2011 plan would not only forbid any private insurer that participated in the state exchange from providing abortion coverage, but it would also forbid women from purchasing separate riders, even with their own personal money.
“It is unacceptable that Governor McDonnell is attempting to hold health care legislation hostage in order to further his agenda of intruding in Virginia women’s personal medical decisions,” said Caroline O’Shea, deputy director of NARAL Pro-Choice Virginia, via statement. “Despite the governor’s outward focus on other issues this session, it is obvious that his attacks on reproductive rights and health-care access are alive and well behind the scenes. With this latest action, Governor McDonnell and his anti-choice allies once again reveal their true political intentions: intrude in personal medical decisions and erode access to vital reproductive-health care in our state. It is outrageous that Governor McDonnell would jeopardize women’s health in the name of an ideological crusade.”
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So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.
So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.
Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.
Signs of Progress
The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedtstruck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear.
Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.
More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.
As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.
But the Assault Continues
Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:
Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.
The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:
South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.
Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.
Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in order to fight Zika. "The uniform focus for members of Congress should be, 'Let's solve the problem,'" Kaine reportedly said at a meeting in Richmond, according to Roll Call.
Sen. Tim Kaine (D-VA) appears to be rebranding himself as a more staunch pro-choice advocate after news that the senator was one of at least three potential candidates being vetted by presumptive Democratic nominee Hillary Clinton’s campaign to join her presidential ticket.
Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in orderto fight the Zika virus. “The uniform focus for members of Congress should be, ‘Let’s solve the problem,'” Kaine reportedly said at a meeting in Richmond, according to Roll Call. “That is [the] challenge right now between the Senate and House.”
Kaine went on to add that “Planned Parenthood is a primary health provider. This is really at the core of dealing with the population that has been most at risk of Zika,” he continued.
As Laura Bassett and Ryan Grim reported for the Huffington Post Tuesday, “now that Clinton … is vetting him for vice president, Kaine needs to bring his record more in line with hers” when it comes to reproductive rights. While on the campaign trail this election cycle, Clinton has repeatedly spoken out against restrictions on abortion access and funding—though she has stated that she still supports some restrictions, such as a ban on later abortions, as long as they have exceptions.
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In what is seemingly an effort to address the issue, as Bassett and Grim suggested, Kaine signed onlast week as a co-sponsor of the Women’s Health Protection Act, which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services. As previously reported by Rewire, the measure would effectively stop “TRAP (targeted regulation of abortion provider) laws, forced ultrasounds, waiting periods, or restrictions on medication abortion.” TRAP laws have led to unprecedented barriers in access to abortion care.
Just one day before endorsing the legislation, Kaine issued a statement explicitly expressing his support for abortion rights after the Supreme Court struck down two provisions of Texas’ omnibus anti-choice law HB 2.
“I applaud the Supreme Court for seeing the Texas law for what it is—an attempt to effectively ban abortion and undermine a woman’s right to make her own health care choices,” said Kaine in the press release. “This ruling is a major win for women and families across the country, as well as the fight to expand reproductive freedom for all.”
The Virginia senator went on to use the opportunity to frame himself as a defender of those rights during his tenure as governor of his state. “The Texas law is quite similar to arbitrary and unnecessary rules that were imposed on Virginia women after I left office as Governor,” said Kaine. “I’m proud that we were able to successfully fight off such ‘TRAP’ regulations during my time in state office. I have always believed these sort of rules are an unwarranted effort to deprive women of their constitutionally protected right to terminate a pregnancy.”
Kaine also spoke out during his run for the Senate in 2012 when then-Gov. Bob McDonnell (R) signed a law requiring those who seek abortions to undergo an ultrasound prior to receiving care, calling the law “bad for Virginia’s image, bad for Virginia’s businesses and bad for Virginia’s women.”
Kaine’s record on abortion has of late been a hot topic among those speculating he could be a contender for vice president on the Clinton ticket. While Kaine’s website says that he “support[s] the right of women to make their own health and reproductive decisions” and that he opposes efforts to overturn Roe v. Wade, the senator recently spoke out about his personal opposition to abortion.
When host Chuck Todd asked Kaine during a recent interview on NBC’s Meet the Press about Kaine previously being “classified as a pro-life Democrat” while lieutenant governor of Virginia, Kaine described himself as a “traditional Catholic” who is “opposed to abortion.”
Kaine went on to affirm that he nonetheless still believed that the government should not intrude on the matter. “I deeply believe, and not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm,” Kaine continued. “They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”
As the Hillnoted in a profile on Kaine’s abortion stance, as a senator Kaine has “a 100 percent rating from Planned Parenthood’s scorecard, and has consistently voted against measures like defunding Planned Parenthood and a ban on abortions after the 20th week of pregnancy.”
While running for governor of Virginia in 2005, however, Kaine promised that if elected he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”
After taking office, Kaine supported some existing restrictions on abortion, such as Virginia’s parental consent law and a so-called informed consent law, which in 2008 he claimed gave “women information about a whole series of things, the health consequences, et cetera, and information about adoption.” In truth, the information such laws mandate giving out is often “irrelevant or misleading,” according to the the Guttmacher Institute.
In 2009 he also signed a measure that allowed the state to create “Choose Life” license plates and give a percentage of the proceeds to a crisis pregnancy network, though such organizations routinely lie to women to persuade them not to have an abortion.