News Law and Policy

Virginia Assembly Closes Without Passing Medicaid Expansion—Or a Budget

Erin Matson

Democratic Gov. Terry McAuliffe has called legislators back for a special session that will begin March 24. If a budget is not adopted by July 1, the state government will shut down.

Unable to reach an agreement on the fate of Medicaid expansion, the Virginia General Assembly closed on schedule on Saturday without passing a budget. If a budget is not adopted by July 1, the state government will shut down.

In response, Democratic Gov. Terry McAuliffe has called legislators back for a special session that will begin March 24. McAuliffe has made Medicaid expansion a top priority for the commonwealth.

Medicaid expansion is a chief difference between the budgets adopted by the Republican-dominated state house and the Democratic-dominated senate. The house budget offered no expansion, whereas the senate version offered something similar to Medicaid expansion called “Marketplace Virginia” that would use the same funding stream to subsidize private insurance purchases for the eligible.

Nearly 400,000 low-income Virginians stand to gain access to health coverage if the measure is implemented. As part of the Affordable Care Act (ACA), the federal government offers full funding for Medicaid expansion for the first three years, and subsequently covers 90 percent of costs.

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The suggestion of a shutdown in Virginia over the ACA is reminiscent of the federal government shutdown of 2013. A study showed that that shutdown affected the commonwealth more than any other state.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

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.

Mid year state restrictions

 

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. Hellerstedt struck 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.

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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.

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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:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • 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.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

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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.

Roundups Politics

The House Freedom Fund Bankrolls Some of Congress’ Most Anti-Choice Candidates

Ally Boguhn

With the 2016 election cycle underway, the political action committee seems to be working tirelessly to ensure the House Freedom Caucus maintains a radical anti-choice legacy.

In its short existence, the House Freedom Caucus (HFC) has made a name for itself through endless efforts to push Congress further to the right, particularly when it comes to reproductive health. Now with the 2016 election cycle underway, the caucus’ political action committee, the House Freedom Fund, seems to be working just as tirelessly to ensure the caucus maintains a radical anti-choice legacy.

Since its founding by Rep. Jim Jordan (R-OH) in January 2015, the group of ultra-conservative lawmakers that make up the caucus has ballooned from just nine members to at least 36 members, as of October 2015, who have confirmed their own inclusion—though the group keeps its official roster secret. These numbers may seem small, but they pack a punch in the House, where they have enough votes to block major legislation pushed by other parts of the Republican party.

And now, the group is seeking to add to its ranks in order to wield even more power in Congress.

“The goal is to grow it by, and I think it’s realistic, to grow it by 20 to 30 members,” Rep. Matt Salmon (R-AZ), one of HFC’s founding members, told Politico in April. “All new members.”

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While the caucus itself reportedly does not endorse candidates, its unofficial PAC has already thrown money behind defending the seats of some of the group’s most notoriously anti-choice members, as well as a few new faces.

According to OpenSecrets.org, the Center for Responsive Politics’ campaign finance database, thus far in 2016, the House Freedom Fund has invested in seven congressional candidates currently vying to keep a seat in the House of Representatives: Rep. Rod Blum (R-IA), Rep. Dave Brat (R-VA), Rep. Tim Huelskamp (R-KS), Rep. Mark Meadows (R-NC), Rep. Scott Desjarlais (R-TN), Rep. Scott Garrett (R-NJ), and Rep. Paul Gosar (R-AZ). The PAC’s website also highlights two candidates hoping to move from their state legislatures to the House: Republican Indiana state senator Jim Banks and Georgia state Senator Mike Crane. The PAC is also backing the Republican candidate for Florida’s 2nd Congressional District, Mary Thomas; and Republican candidate for North Carolina’s 13th Congressional District, Ted Budd.

Rep. Warren Davidson (R-OH), who won a special election in early June to replace former House speaker John Boehner, also received funding from the PAC. He joined the House Freedom Caucus that same week.

The Republican Party actively works to deny access to virtually all forms of reproductive health care, so it is not surprising that the candidates supported by the House Freedom Fund, whose confirmed members are all members of the GOP, share similarly radical views on reproductive rights and health.

Here are some of the House Freedom Fund’s most alarming candidates:

Rep. Rod Blum

Rep. Blum, a freshman congressman from Iowa, considers his opposition to reproductive choice one of the “cornerstones” of his campaign. “It is unconscionable that government would aid in the taking of innocent life. I strongly oppose any federal funding for abortion and I will vote against any of our tax dollars flowing to groups who perform or advocate abortions on demand,” asserts Blum’s campaign site. The Hyde Amendment already bans most federal funding for abortion care.

Blum spent much of his first year in the House attempting to push through a series of anti-choice bills. The representative co-sponsored the medically unsupported Pain-Capable Unborn Child Protection Act, which would have enacted a federal ban on abortion at or beyond 20 weeks of pregnancy, in January 2015. He signed on as a co-sponsor for the failed Life at Conception Act, a so-called personhood measure that would have granted legal rights to fetuses and zygotes, thus potentially outlawing abortion and many forms of contraception, in March of that year. That July, Blum co-sponsored the Defund Planned Parenthood Act of 2015, which would have stripped the reproductive health organization of all federal funding for one year so that Congress could investigate it in the wake of the Center for Medical Progress’ (CMP) discredited videos smearing the provider. 

Blum’s co-sponsorship of anti-choice legislation was accompanied by a long series of like-minded votes throughout 2015, such as a January vote in favor of the No Taxpayer Funding for Abortion Act and Abortion Insurance Full Disclosure Act of 2015, which, among other things, would have made the Hyde Amendment’s annually renewed ban on most federal funding for abortion care permanent. He also voted to block Washington, D.C.’s Reproductive Health non-discrimination law, and in favor of a measure allowing states to exclude from Medicaid funding any health provider that provided abortions, as well as other anti-choice measures.

Blum’s brief time in Congress has been marked by such extremism that Emily’s List, an organization that works to elect pro-choice women, put Blum on their “On Notice” list in July 2015, signaling their intention to prioritize unseating the Iowa Representative. “In less than five months into the 114th Congress, we have seen Representative Blum lead the crusade to restrict women’s access to healthcare, most notably when he cosponsored a national abortion ban,” explained the organization in a press release on its decision to target Blum. “It’s clear that Congressman Blum is more focused on prioritizing an extreme ideological agenda over enacting policies that benefit more women and families in Iowa’s First Congressional District.”

Rep. Dave Brat

Rep. Dave Brat gained notoriety for his win against incumbent representative and then-House Majority Leader Eric Cantor in 2014, a victory considered one of “the biggest political upset[s] in recent memory.” Like many of his HFC colleagues, Brat has co-sponsored several pieces of anti-choice legislation, including the Pain-Capable Unborn Child Protection Act in 2015 and the Conscience Protection Act of 2016, which claimed to “protect” against “governmental discrimination against providers of health services” who refuse to provide abortion care. Brat’s voting record in Congress earned him a 100 percent rating from the National Right to Life Committee.

In April of this year, the Virginia representative signed on to a letter with Senator Ted Cruz (R-TX) and other anti-choice legislators, such as House Freedom Fund candidate Rep. Meadows expressing “serious concerns” about the Food and Drug Administration’s decision to update the label of abortion drug mifepristone to bring it in line with scientific research and evidence-based medicine. Though medication abortions are safe and result in complications in fewer than 0.4 percent of patients, the lawmakers nonetheless claimed that the regulation change could be dangerous, noting that the drug was originally approved during the Clinton administration and demanding a list of information about it.

In the wake of the deadly shooting at a Colorado Springs Planned Parenthood facility in November, when the alleged shooter parroted the same violent rhetoric about the reproductive health organization popularized by the CMP’s discredited videos, many in Congress called for the panel investigating Planned Parenthood to be disbanded and for lawmakers to distance themselves from the videos. Brat, however, saw no reason the anti-choice violence should affect the conservative crusade to shut down access to reproductive health care. “Principles are principles,” Brat said at the time according to the Huffington Post. “They don’t change on a news cycle.”

Rep. Tim Huelskamp

Kansas Rep. Tim Huelskamp has been an anti-choice advocate since graduate school, when, according to the biography provided on his website, he was “active in assisting women in crisis pregnancies” while working toward a doctoral degree at American University. His advocacy continued as he made his way to Congress, eventually leading him to become the congressional “Pro-Life Caucus” whip.

Though he has cast plenty of anti-choice votes, the congressman’s most notable moment when it comes to reproductive rights may be a 2012 speech on the House floor, in when he compared abortion to slavery and accused Planned Parenthood and the Obama administration of being racist. “Perhaps the biggest war against our liberties is the war that is being waged against those that are not here today, the unborn,” claimed Huelskamp. “Besides slavery, abortion is the other darkest stain on our nation’s character and this president is looking for every way possible to make abortion more available and more frequent. And he wants you to pay for it. Even if you disagree with it.”

Huelskamp went on to falsely accuse Planned Parenthood of targeting people of color. “I am the adoptive father of four children, each of them either Black, Hispanic, Native American, and I am incensed that this president pays money to an entity that was created for the sole purpose of killing children that look like mine; a racist organization and it continues to target minorities for abortion destruction,” said the congressman. “Shame on this president and shame on that party.”

It wouldn’t be the last time Huelskamp exploited race in order to promote his anti-choice agenda. In 2015, the Kansas Representative lashed out at those who accepted awards from Planned Parenthood, tweeting that they were supporting a “racist” agenda.

Rep. Mark Meadows

Rep. Mark Meadows, who has a 100 percent rating from the National Right to Life Committee, co-sponsored anti-choice measures such as the House’s 2015 fetal pain bill, the 2015 Life at Conception Act, and the Prenatal Nondiscrimination Act of 2016 (PRENDA). He also once badgered a pregnant doctor testifying during a House committee hearing about the importance of offering maternity coverage through the Affordable Care Act. However, the congressman’s recent vendetta against Planned Parenthood stands out the most.

In July 2015, in the wake of CMP’s deceptively edited videos, Meadows latched onto the discredited films in order to justify defunding Planned Parenthood. “In addition to cutting funding for abortion providers, I strongly urge Congress to investigate the legality of the practices engaged in by Planned Parenthood,” said Meadows at the time.

In September, as Congress faced the looming threat of a possible government shutdown if they didn’t pass a budget bill, Meadows exploited the opportunity to push for Planned Parenthood to be defunded, no matter the cost. With the South Carolina congressman leading the charge, pressure from conservatives to pull funding for the reproductive health-care provider played a role in prompting then-House Speaker John Boehner to resign his position. Meadows was a co-sponsor of the Defund Planned Parenthood Act of 2015, which passed in the House as part of a compromise to narrowly escape the shutdown. 

But Meadows’ quest to attack Planned Parenthood didn’t end there. In September, the congressman also participated in the House Oversight and Government Reform Committee’s hearing to “examine the use of taxpayer funding” by Planned Parenthood and its affiliates, a sham hearing used by the GOP to repeatedly push misinformation about the organization.

Rep. Scott Desjarlais

Rep. Scott Desjarlais, a medical doctor, is perhaps best known for his attempt to pressure his patient, with whom he was having an affair, into having an abortion when she became pregnant. While the congressman has repeatedly run on his anti-abortion credentials, his divorce papers also revealed he had supported his wife in having two abortions. Politico‘s Chas Sisk labeled DeJarlais  “the biggest hypocrite in Congress.”

Desjarlais made headlines again in 2015 for voting for a later abortion ban. A spokesperson for the Tennessee Republican told the Times Free Press that the vote was in accordance with the congressman’s record:

“Congressman DesJarlais was proud to vote in favor of this legislation,” said his spokesman Robert Jameson, who added that DesJarlais has maintained a “100 percent pro-life voting record” during his five years in Congress and “has always advocated for pro-life values.”

Indiana State Sen. Jim Banks

Indiana state Sen. Jim Banks (R-Columbia City) is one of the few candidates backed by the House Freedom Fund that has yet to win federal office, but his time in the state legislature has given him more than ample opportunity to demonstrate his opposition to reproductive health and rights.

Banks’ campaign website highlights the candidate’s “pro-life” position as a key issue for his race for the House, providing an extensive record of his anti-choice credentials and claiming that he is “running for Congress so that northeast Indiana continues to have a strong voice for innocent lives in Washington, D.C.” That page includes a laundry list of campaign promises, including amending the U.S. Constitution to give a fetus legal human rights, which could outlaw abortion and many forms of contraception; banning federal funding for abortion, though such a ban already exists; eliminating federal funding for any organization that performs abortions domestically or abroad; and opposing any change to the Republican platform on abortion.

The state senator’s site goes on to suggest that “it has been far too long since the Supreme Court discovered that women have a ‘right’ to have an abortion,” lamenting that much of the anti-choice movement’s work to shutter access to abortion in state legislatures hasn’t been replicated on a federal level and promising to address the issue if elected.

Included in his anti-choice resumé is a note that both Banks and his wife have been working in the movement to oppose choice since graduating college, when the two joined Focus on the Family, an organization that has spent millions of dollars promoting its extreme agenda, even devoting $2.5 million to run an anti-abortion ad during the 2010 Super Bowl. The two also worked together on the Allen County Right to Life Board of Directors, and Banks’ wife, Amanda, remains the board’s vice president.

But most extreme of all was the legislation Banks spearheaded while in the state legislature, which included several targeted regulation of abortion providers (TRAP) measures. Most recently the state senator sponsored Indiana’s SB 144, a bill that would modify the state’s 20-week abortion ban to outlaw the procedure once a fetal heartbeat could be detected, typically around six weeks’ gestation. In a statement on the bill, Banks claimed the law was needed because it “would protect unborn Hoosiers’ right to life and also includes important women’s health protections.”