Analysis Law and Policy

Missouri Republicans Introduce Dozens of Anti-Choice Bills While Rejecting Medicaid Expansion

Teddy Wilson

No state has seen as many anti-choice bills introduced this year as Missouri, where Republican lawmakers are simultaneously resisting an expansion of Medicaid that could improve health outcomes for hundreds of thousands of residents.

In Republican-controlled state legislatures across the country, more than 100 anti-choice bills have been introduced this year. But no state has seen as many of these bills as Missouri, where Republican lawmakers are simultaneously resisting an expansion of Medicaid expansion that could improve health outcomes for hundreds of thousands of residents.

Republican lawmakers in the state have introduced at least 32 bills this year that would restrict access to reproductive health care, often justifying the regulations as protecting women’s health. The bills appear to be part of a coordinated strategy between GOP legislators and anti-choice organizations. “We’re looking to pass at least a couple [bills], if not more,” Susan Klein, the top lobbyist for Missouri Right to Life, told the Washington Post earlier this month. According to Klein, the lawmakers’ plan is to introduce individual bills with specific regulations, as opposed to omnibus bills, like the one passed last summer in Texas.

Angie Postal, director of public policy at Planned Parenthood of the St. Louis Region and Southwest Missouri, told Rewire that the amount of anti-choice legislation in the state is troubling. “What’s concerning is that they have already done so much this session, and the session is only really now half over,” she said. “They’ve spent so much time already debating abortion on the floor of both chambers that it’s hard to say which ones are going to pass, because there are so many options for [the lawmakers].”

The anti-choice legislation that’s progressed the furthest this session would require women to wait 72 hours before receiving an abortion, up from the 24 hours they are already required to wait. HB 1307 and HB 1313, sponsored by Reps. Kevin Elmer (R-Nixa) and Keith Frederick (R-Rolla), were both passed by committee, but HB 1307 has been passed by the house and introduced into the senate. SB 519, sponsored by Sen. David Sater (R-Cassville), has already passed committee and awaits a floor vote.

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“This bills are going to make it harder for women to access safe abortion,” said Postal, who noted that the extended waiting period would create a barrier to abortion access for many women, not just in Missouri, but in surrounding states. “Many of our patients come, not just from all over Missouri, but from states surrounding Missouri. Some women are traveling hundreds of miles to get here,” she said. “Essentially we’re seeing women who are facing challenges accessing abortion care due to travel considerations, scheduling child care, and taking time off work. Doing that over a three-day period is just going to force the procedure later in pregnancy, and that poses a senseless risk to women’s health.”

Increasing the waiting period for abortions is a priority for Republicans in the state, who appear ready to use unconventional tactics to pass the legislation. The Republican leader in the senate, Ron Richard, reportedly said members of his party would attempt to use procedural legislative tactics to force a vote on extending the waiting period. 

Another bill that has reproductive rights advocates concerned would force women to view an ultrasound before having an abortion. It is already required that women receive an ultrasound at least 24 hours prior to terminating a pregnancy. HB 1148 and HB 1379, sponsored by Reps. Ron Hicks (R-St. Charles County) and Chuck Gatschenberger (R-Lake St. Louis), require the abortion provider to “review the ultrasound with the woman.” If the woman views the ultrasound in another facility, she must provide the abortion provider with written verification that it was conducted and viewed. The legislation does include exceptions for victims of rape or incest. Both bills are currently pending in the house Health Care Policy Committee. 

“We believe a woman should be informed of all her options, and given accurate medical and science based information about all those options,” said Postal. “That information should be given to a woman to help her make the best decision for herself, and not to coerce her into having an abortion or not having an abortion.”

There are a litany of other bills making their way through the legislature that would regulate reproductive health care in the state, which already has a highly restrictive regulatory regime on abortion care. For instance, lawmakers are considering a ban on the use of telemedicine to prescribe medication abortion, and restricting both private and public health insurance plans from covering abortions except in cases of medical emergencies. 

There are two bills, one that has passed committee and one awaiting a committee hearing, that would change the definition of medical emergency, removing “psychological or emotional conditions.” A ban on sex-selective abortions, much like the bill that was recently passed by the South Dakota legislature, is awaiting a committee hearing. Another bill awaiting a committee hearing would ban abortions performed for the purpose of providing fetal organs or tissue for medical transplantation. In addition, there are two bills, one of which passed committee and another that has passed the house and been introduced in the senate, that would change the parental notification requirement for minors seeking an abortion requiring that both parents be notified (with an exception for parents who have been convicted of abuse or who currently are restrained by a protective order).

Postal says Republicans have spent so much time attempting to restrict abortion in the state that measures that could expand access to health care for all state residents have been neglected. “We think they should spend time trying to pass a Medicaid expansion, something that would actually improve the health of people in Missouri,” she said.

Missouri Republicans have blocked the expansion of Medicaid under the Affordable Care Act. In February, the state senate voted 23 to 9 against expanding Medicaid, which would have reportedly extended health care coverage to 300,000 residents. This week, Republicans in the senate reaffirmed their opposition to expanding Medicaid, even as the Missouri Hospital Association and business leaders called for the expansion.

A study release by the Commonwealth Fund this week finds that many of the states that have refused to expand Medicaid coverage, mostly with Republican-controlled legislatures, would stand to benefit the most from expanded access.

And a report from the Missouri Health Advocacy Alliance predicts that Medicaid expansion would “improve access to health care and health outcomes for nearly 260,000 low-income Missourians who are currently left out of Missouri Medicaid.”

Postal says that some of the same lawmakers who are pushing anti-choice legislation are also blocking the expansion of Medicaid in the state. “These are the same people that really really don’t want to talk about Medicaid expansion, which the people now really want in Missouri,” she said. “They think that maybe if they talk about abortion, some more people won’t notice that we’re leaving behind more than 260,000 Missourians who need health care.”

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

News Abortion

Anti-Choice Group Wants National Abortion Data Reporting Law

Teddy Wilson

Anti-choice activists claim that despite the evidence, the number of complications from abortion is higher than is being reported. States that track abortion care data have shown the procedure to be exceedingly safe.

A leading anti-choice organization is calling for a national database of abortion statistics and increased reporting requirements for states—proposals seen as part of a strategy to justify laws restricting access to abortion care.

The U.S. Supreme Court in June struck down provisions of Texas’ omnibus anti-choice law known as HB 2. The ruling relied heavily on research that showed abortion care was a safe and well regulated procedure. Anti-choice activists have long disputed those claims.

Clarke Forsythe, acting president of Americans United for Life (AUL), told Politico that there is not enough data on abortion. “The abortion advocates like to talk in vague terms about abortion but we need specifics,” Forsythe said. “We don’t have a national abortion data collection and reporting law.”

The Centers for Disease Control and Prevention (CDC) has collected “abortion surveillance” data since 1969. The CDC published the most recent report on abortion statistics in 2012.

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Abortion surveillance reports are created by compiling data from health agencies, provided voluntarily to the CDC, in all 50 states as well as the District of Columbia and New York City. The data includes deaths from abortion related complications, but does not include the number of complications that don’t result in deaths.

Reporting requirements for abortion statistics vary from state to state, with 46 states requiring that abortion providers submit regular reports, according to the Guttmacher Institute. Most states report the number of abortion procedures performed as well as the type of procedure, the gestation of the pregnancy, and demographic data of the patient.

There are 27 states that require providers to report the number of complications from abortion procedures.

The self-described “legal architect” of the anti-choice movement, AUL has been heavily involved in lobbying for state and federal laws that restrict access to abortion. The organization creates copycat legislation and distributes anti-choice proposals to state lawmakers, who then push the measures through legislatures.

Forsythe took a victory lap Monday for the organization’s role in promoting bills from the AUL’s “playbook of pro-life legislation” that were introduced this year in state legislatures. “AUL continued to assist states considering health and safety standards to protect women in abortion clinics,” Forsythe said in a statement.

Dozens of bills to increase reporting requirements have been introduced in state legislatures over the past several years. These proposals include several types of reporting requirements for abortion providers, and many of the provisions are similar to those found in AUL model legislation.

Arizona legislators in 2010 passed SB 1304, which required abortion providers to submit annual reports to the state and required the state Department of Health Services (DHS) to publish an annual report.

The Republican-backed legislation is similar to copycat legislation drafted that same year by AUL.

Since the law’s passage there have been very few complications resulting from abortion procedures reported in the state: from 2011-2014, less than 1 percent of abortions procedures in the state resulted in complications.

Arizona reported that 137 patients experienced complications out of 12,747 abortion procedures in 2014; 102 patients experienced complications out of 13,254 abortion procedures in 2013; 76 patients had complications out of 13,129 abortion procedures in 2012; 60 patients experienced complications out of 14,401 abortion procedures in 2011.

Dr. Daniel Grossman, a physician at the University of California, San Francisco who studied the impact of HB 2 for the Texas Policy Evaluation Project (TxPEP), told Politico that abortion has been shown to be exceptionally safe medical procedure.

“There’s already a lot of data that have been published documenting how safe abortion is in the U.S.,” Grossman said.“The abortion complication rate is exceedingly low.”

Anti-choice activists claim that despite the evidence, the number of complications from abortion is higher than is being reported. Joe Pojman, the executive director of the Texas Alliance for Life, told Politico that “better data” is needed.

Texas has required reporting of the number of complications from abortion procedures since 2013, and the data has shown that abortion complications are exceedingly rare. There were 447 complications out of 63,849 procedures in 2013 and 777 complications out of 54,902 procedures in 2014.

Pojman said that the Texas data “defies common sense” and that the complications are “are much smaller than what one would expect.”

The Texas abortion statistics reveal that it is safer to have an abortion than to carry a pregnancy to term in the state. Between 2008 and 2013, the most recent years for which data is available, there were 691 maternal deaths in Texas, compared to one death due to abortion complications between 2008 and 2014.

“There’s no sign that there’s a hidden safety problem happening in Texas,” Grossman said.

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