Analysis Abortion

State Policy Trends: More Supportive Legislation, Even as Attacks on Abortion Rights Continue

Elizabeth Nash & Rachel Benson Gold

Some 64 provisions have been introduced so far this year to expand or protect access to abortion, more than had been introduced in any year in the last quarter-century.

The 2014 legislative session got off to a fast start, with legislators introducing a combined 733 provisions related to sexual and reproductive health and rights in nearly all the states that have legislative sessions this year (legislatures in Montana, Nevada, North Dakota, and Texas will not meet in 2014). See here for the full analysis of the first quarter of 2014.

Significantly, legislators quickly showed a clear interest in protecting or expanding access to sexual and reproductive health care. Some 64 provisions have been introduced so far this year to expand or protect access to abortion, more than had been introduced in any year in the last quarter-century. And only three months into the year, two new provisions protecting abortion rights have been enacted, and three others have passed one legislative chamber. Similarly, seven measures designed to expand access to other sexual and reproductive health services have passed at least one legislative body in six states and the District of Columbia.

As in recent years, however, state legislatures continued to take aim at abortion rights. Legislators in 38 states introduced 303 provisions seeking to limit women’s access to care. By March 31, three new abortion restrictions had been enacted, and 36 had passed one legislative chamber.

Expanding Access to Sexual and Reproductive Health Care

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In 2013, California and Colorado enacted the first state laws since 2006 to protect and expand access to abortion services. The California law allows appropriately trained nurse-practitioners, physician assistants, and certified nurse midwives to provide first-trimester abortion services, while Colorado repealed its pre-Roe abortion ban. Building on that momentum, governors in two other states have already signed measures protecting abortion rights into law this year. Vermont repealed its pre-Roe abortion ban and Utah waived its counseling and ultrasound requirements when an abortion is necessary to protect the woman’s life or health or in cases of severe fetal impairment.

In addition, proactive measures have passed at least one legislative chamber in three additional states, including bills that would establish a 25-foot buffer zone around abortion clinics (NH); permit abortions until 24 weeks of pregnancy when the woman’s life or health is at risk (NY); and require insurance plans to cover abortion services if they cover maternity care (WA). Legislators in other states have also taken steps to expand access to sexually transmitted infection (STI) and family planning services (see the full analysis for details).

Restricting Access to Sexual and Reproductive Health Care

In sharp contrast, but mirroring the trend in recent years, legislators moved quickly to reduce abortion access as this year’s sessions opened: three laws were enacted in the first three months. Indiana accounted for two of these measures, banning nearly all abortion coverage in private insurance plans and also requiring inspections of abortion clinics at least once a year; South Dakota banned abortion for the purpose of sex-selection (see the full analysis for details).

Legislators in 16 states have introduced provisions that would conflict with U.S. Supreme Court holdings by banning at least some abortions prior to viability. Five of these measures have passed at least one legislative chamber. One of these five, a measure in West Virginia that would have banned abortion at 20 weeks post-fertilization (the equivalent of 22 weeks past the woman’s last menstrual period) was approved by the legislature only to be vetoed by Gov. Earl Ray Tomblin (D). This runs counter to the recent trend of signing so-called 20-week bans into law, which has occurred in 12 states over the last four years.

Several states have continued their attempts to enact burdensome and unnecessary requirements aimed at shutting down abortion providers (known as TRAP [targeted regulation of abortion providers] laws), which would require an abortion provider to have admitting privileges at a hospital within 30 miles and direct the state to develop standards for abortion clinics (OK).

In addition, five measures to expand existing counseling and waiting period requirements have passed at least one legislative chamber so far this year. These measures would lengthen existing waiting periods (AL and MO); mandate that pre-abortion counseling take place in person at least 24 hours in advance of the procedure, meaning that a woman would have to make two separate trips to obtain an abortion (KY); and require counseling about perinatal hospice care for women who are seeking an abortion because of a diagnosed fetal impairment (AL and OK). In addition, legislative chambers in three states that already require parental consent approved measures designed to make it even more difficult for a minor to obtain an abortion (AL, AZ, and MO).

Legislators have sought to limit access to abortion services in other ways by attempting to reduce access to medication abortion (OK and IA); banning abortion coverage in plans sold on the insurance exchange (GA); and requiring an ultrasound before a woman may obtain an abortion (KY).

Finally, legislators in several states have moved to impede access to other sexual and reproductive health services; some examples include measures that would: disqualify independent family planning clinics, such as those operated by Planned Parenthood, from receiving any family planning funds that flow through the state, including federal Medicaid reimbursement (MO); require minors younger than 17 to have a prescription to obtain emergency contraception (OK); and expand the ability of health-care providers to refuse to provide services (AL and MO).

See the full analysis for additional details.

Gwendolyn Rathbun and Yana Vierboom also contributed to this analysis.

For more information:

Guttmacher State Center
State Policies in Brief
State Policy Developments in 2013
Analysis: A Surge of State Abortion Restrictions Puts Providers—and the Women They Serve—in the Crosshairs

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.

News Politics

Sen. Tim Kaine Focuses on Reproductive Rights Amid Clinton’s Looming Decision on Vice President

Ally Boguhn

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 order to 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 on last 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 Hill noted 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.