News Abortion

Alaska Health Commissioner Proposes New Form to Reimburse Providers for Medicaid Patient Abortion Procedure

Robin Marty

The form would reduce the number of ways in which an abortion can be considered “medically necessary” in Alaska, and some doctors predict it could make it more difficult for Medicaid patients to access abortions and for medical professionals to receive funding for such procedures.

During its 2013 legislative session, the Alaska legislature failed to pass a bill meant to limit the conditions under which a pregnant person enrolled in Medicaid can obtain a Medicaid-funded abortion. Now, state health commissioner William Streur, an appointee of Republican Gov. Sean Parnell, has proposed a new certificate form for doctors to fill out when requesting reimbursement for an abortion performed on a Medicaid patient. The form would reduce the number of ways in which an abortion can be considered “medically necessary” in Alaska, and some doctors predict it could make it more difficult for Medicaid patients to access abortions and for medical professionals to receive funding for such procedures. 

Streur told the Associated Press that he chose to revamp the form after deciding that the Alaska Department of Health and Social Services was seeing physicians’ requests for reimbursements for abortion procedures at a “considerably faster pace,” rather than at a slower pace, as hoped, compared to the same time period last year.

With Steur’s form, pregnant people enrolled in Medicaid whose lives are in danger as a result of their pregnancy or who are victims of rape or incest could have the cost of their abortion procedure reimbursed by the federal government under allowances in the Hyde Amendment. But the checklist of acceptable conditions for reimbursement would reduce access by no longer allowing doctors to just say that an abortion was necessary for a patient’s health, instead creating a list of specific conditions under which a doctor can claim an abortion was done for health reasons. The change also eliminates general health concerns, including mental health, as a reason to fund an abortion. The end result would be exactly what the state board of health and the legislature have been trying to accomplish since 2012

Much like the 2013 bill that failed in session, the checklist of allowable health conditions redefines “medically necessary abortion” for pregnant people on Medicaid. Included as reasons the government will support a termination of pregnancy are those that pose “threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function” and range from diabetes to cancer to “severe infection exacerbated by the pregnancy” or dilation of more than 6 centimeters prior to 22 weeks’ gestation. Mental health as a reason for termination is narrowed explicitly to “a psychiatric disorder that places the woman in imminent danger of medical impairment of a major bodily function if an abortion is not performed.”

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Some doctors have expressed concerns that not only will women on Medicaid find it more difficult to access abortion services, but that the medical professionals who provide the service could be dissuaded from doing so as a result of the form, which would make it harder for them to receive abortion payments from the government. “This actually happened to me about 15 years ago,” one doctor told Alaska Public Media. “But if someone from the enforcement branch basically said, ‘I don’t think you’re exercising due clinical oversight, and you’re essentially billing the state for things they shouldn’t be paying for, and you’re breaking the law.’ So from that practical point, that’s chilling to me.”

Planned Parenthood, which opposes the proposal, calls it unnecessary. “The Department of Health and Human Services just did rule making on this last year and instituted a certificate process to ensure that any abortions in Alaska provide with public funding were compliant with existing state law,” Jennifer Allen, public policy director for Planned Parenthood Votes Northwest, told Rewire. “Now, suddenly, not even a year later, they are looking at revising that rule making in a very extreme way.”

Although the commission said that he believes the certification process could better ensure those abortions eligible for federal reimbursement are paid while eliminating situations where state funds are being wasted, Allen finds it difficult to believe that’s the true impetus for the review. “The state of Alaska’s stated reasons for doing this don’t seem to amount to much,” she said. “Their idea is that they will somehow get the federal Medicaid office to pay for more abortions provided in Alaska. Since we know that the federal Medicaid program under the Hyde amendment only pays for abortions for rape or incest, or if the woman’s life is at risk, and studies across the country show that is only 1 percent of abortions, it looks like this rule making process might save the state of Alaska about $1500 a year. Obviously it would cost the state a lot more to do the rule making than the savings it would generate. It seems like that can’t possibly be the real reason behind this rule.”

Like the last health department rule change, Streur’s proposal is up for public comment, and feedback will be accepted through September 27. Even if the changes are approved, pro-choice groups believe a state supreme court challenge would be likely.

“From our perspective this is blatantly unconstitutional based on previous supreme court rulings saying women’s pregnancy decisions need to be given equal protection under the law,” said Allen. “It says all pregnancy decisions [need equal protection], whether it is a decision to terminate or to carry to term.”

Jean Mischel of the state Legislative Affairs Agency says the new proposal is likely unconstitutional, writing in a memo that the proposed changes “create a new and restrictive state standard for determining when abortion services are ‘medically necessary’ without applying this same standard to coverage for other types of medical care services.”

Roundups Law and Policy

Gavel Drop: The Fight Over Voter ID Laws Heats Up in the Courts

Jessica Mason Pieklo & Imani Gandy

Texas and North Carolina both have cases that could bring the constitutionality of Voter ID laws back before the U.S. Supreme Court as soon as this term.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts

Texas Attorney General Ken Paxton intends to ask the U.S. Supreme Court to reinstate the state’s voter ID law.

Meanwhile, according to Politifact, North Carolina attorney general and gubernatorial challenger Roy Cooper is actually saving taxpayers money by refusing to appeal the Fourth Circuit’s ruling on the state’s voter ID law, so Gov. Pat McCrory (R) should stop complaining about it.

And in other North Carolina news, Ian Millhiser writes that the state has hired high-powered conservative attorney Paul Clement to defend its indefensible voter ID law.

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Alex Thompson writes in Vice that the Zika virus is about to hit states with the most restrictive abortion laws in the United States, including Alabama, Louisiana, Mississippi, and Texas. So if you’re pregnant, stay away. No one has yet offered advice for those pregnant people who can’t leave Zika-prone areas.

Robin Marty writes on Care2 about Americans United for Life’s (AUL) latest Mad Lib-style model bill, the “National Abortion Data Reporting Law.” Attacking abortion rights: It’s what AUL does.

The Washington Post profiled Cecile Richards, president of the Planned Parenthood Federation of America. Given this Congress, that will likely spur another round of hearings. (It did get a response from Richards herself.)

Kimberly Strawbridge Robinson writes in Bloomberg BNA that Stanford Law Professor Pamela Karlan thinks the Supreme Court’s clarification of the undue burden standard in Whole Woman’s Health v. Hellerstedt will have ramifications for voting rights cases.

This must-read New York Times piece reminds us that we still have a long way to go in accommodating breastfeeding parents on the job.

Commentary Politics

Milwaukee Officials: Black Youth, Single Mothers Are Not Responsible for Systemic Failings—You Are

Charmaine Lang

Milwaukee has multiple problems: poverty, a school system that throws out Black children at high rates, and lack of investment in all citizens' quality of life. But there's another challenge: politicians and law enforcement who act as if Black youth, single mothers, and families are the "real" reasons for the recent uprising and say so publicly.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

On the day 23-year-old Sylville Smith was killed by a Milwaukee police officer, the city’s mayor, Tom Barrett, pleaded publicly with parents to tell their children to come home and leave protests erupting in the city.

In a August 13 press conference, Barrett said: “If you love your son, if you love your daughter, text them, call them, pull them by the ears, and get them home. Get them home right now before more damage is done. Because we don’t want to see more loss of life, we don’t want to see any more injuries.”

Barrett’s statement suggests that parents are not on the side of their sons and daughters. That parents, too, are not tired of the inequality they experience and witness in Milwaukee, and that youth are not capable of having their own political ideologies or moving their values into action.

It also suggests how much work Milwaukee’s elected officials and law enforcement need to do before they open their mouths.

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Barrett’s comments came after Smith fled a traffic stop and was shot by authorities on Milwaukee’s northwest side. The young Black man’s death sparked an urban uprising in the Sherman Park neighborhood, an area known for its racial and religious diversity. Businesses were burnt down, and the National Guard was activated in a city plagued by racism and poverty.

But Milwaukee parents and families need more than a directive thinly disguised as a plea. And Mayor Barrett, who was re-elected to a fourth term in April, should know well that Milwaukee, the nation’s most racially stratified city, needs racial equity in order for there to be peace and prosperity.

I live in Milwaukee, so I know that its residents, especially its Black parents, do love their children. We want more for them than city-enforced curfews and a simplistic solution of returning to their homes as a way to restore calm. We will have calm when we have greater investment in the public school system and youth services; easy access to healthy food; and green spaces, parks, and neighborhoods that are free from police harassment.

In fact, according to staggering statistics about Milwaukee and Wisconsin as a whole, Black people have been consistently denied their basic human rights and health. Wisconsin has the highest rate of incarceration of Black men nationwide; the Annie E. Casey Foundation has found it is the worst state for racial disparities affecting Black childrenand infant mortality rates are highest among Black women in the state.

What we absolutely don’t need are public officials whitewashing the facts: that Milwaukee’s young people have much to protest, including Wisconsin’s suspending Black high-school students more than any other state in the country.

Nor do we need incendiary comments like those coming from Milwaukee County Sheriff David Clarke, who drew national attention for his “blue lives matter” speech at the Republican National Convention and who is a regular guest on CNN and Fox News. In an August 15 op-ed published by the Hill, Clarke has called the civil unrest “the rule of the jungle,” “tribalism,” and a byproduct of “bullies on the left.”

He went even further, citing “father-absent homes” as a source of what he calls “urban pathologies”—leaning on old tropes used to stigmatize Black women, families, and the poor.

Single mothers are not to be blamed for young people’s responses to a city that ignores or criminalizes them. They should not be shamed for having children, their family structure, or for public policy that has made the city unsafe for parenting.

Creating justice—including reproductive justice—in Milwaukee will take much more than parents texting their teens to come home. The National Guard must leave immediately. Our leaders must identify anti-Black racism as a root cause of the uprisings. And, lastly, creating justice must start with an end to harmful rhetoric from officials who lead the way in ignoring and dehumanizing Milwaukee residents.

Sheriff Clarke has continued his outrageous comments. In another interview, he added he wouldn’t “be satisfied until these creeps crawl back into their holes so that the good law-abiding people that live in the Milwaukee ghetto can return to at least a calm quality of life.”

Many of Milwaukee’s Black families have never experienced calm. They have not experienced a city that centers their needs and voices. Black youth fed up with their treatment are not creeps.

And what hole do you think they should crawl back into? The hole where they face unemployment, underemployment, police brutality, and racism—and face it without complaint? If that’s the case, you may never be satisfied again, Sheriff.

Our leaders shouldn’t be content with Milwaukee’s status quo. And asking the citizens you serve to be quiet in the ghetto is an insidious expectation.


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