News Abortion

New York Lawmakers Introduce Legislation to Require Inspections of Abortion Clinics

Teddy Wilson

The bill is in response to documents released in April that purport to show that clinics that provide abortion services in New York state are not being regularly inspected by the state health department.

A bill introduced in the New York legislature would require the state health commissioner to inspect abortion clinics a minimum of once every two years.

Sponsored by Assembly members Nicole Malliotakis (R-East Shore) and Jane Corwin (R-Clarence), A 9538 would also require that a written report of the results of each inspection be delivered to the governor and members of the state legislature.

The bill is in response to documents released in April that purport to show that clinics that provide abortion services in New York state are not being regularly inspected by the state health department. The Chiaroscuro Group claims that of the 25 clinics directly overseen by the health department, only 17 were inspected and only 45 routine inspections were conducted from 2000 to 2012.

Andrea Miller, president of NARAL Pro-Choice New York, told Rewire that the legislation stems from the selective release of records received by the Chiaroscuro Group, which she calls a “leading anti-choice organization in the state.”

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The Chiaroscuro Group is the organization behind a campaign against a policy requiring that New York City public schools provide evidence-based comprehensive sex education curricula. According to Miller, the group is not just opposed to sex education, but also opposes basic protections of reproductive rights. “They’ve been trying for a very long time to gain inroads in undermining access to reproductive health care including abortion,” said Miller.

Malliotakis told the Staten Island Advance that the legislation is about the health and safety of women. “This legislation deals with the critical concern of women’s health—real women’s health issues that could potentially mean life or death for a young woman visiting one of these clinics,” said Malliotakis.

Miller took issue with the claim that the legislation is intended to improve the health and safety for women, specifically citing the Chiaroscuro Group and supporters’ ideological agenda. “They have an explicit ideological agenda, which is to limit access to reproductive health care,” Miller told Rewire. “We know when you limit access to reproductive health care you harm women’s health.”

The legislation is similar to bills introduced and passed into law around the country that increase regulations on abortion clinics, that reproductive rights advocates claim are unnecessary and are used to specifically target abortion providers. “There isn’t any medical justification for creating extra different requirements for medical and surgical abortion providers that are separate and different and more onerous than those for any other medical facility that is engaged in similar serves,” said Miller. 

“They are trying to single out abortion because they are opposed to abortion—even though it is one of the safest and most common medical procedures in this country,” said Miller. “They are trying to use the guise of protecting women’s health to actually undercut women’s health.”

Commentary Politics

Pennsylvania Lawmakers Square Off Over Abortion Law, New Bill

Tara Murtha

Anti-choice legislators in Pennsylvania recently pulled out all the stops when debating a bill that would be one of the nation's harshest abortion laws if passed. But in the wake of a recent Supreme Court ruling, other state lawmakers are trying to stop that bill and change existing policy.

With the new U.S. Supreme Court abortion ruling, some Pennsylvania lawmakers want to roll back provisions similar to those struck down in Texas—and to head off any new restrictions in a bill debated on the house floor in late June.

Several legislators have called for repeal of Act 122, which was enacted in 2012 and mandates that Pennsylvania abortion clinics meet the standards of ambulatory surgical centers.

The U.S. Supreme Court struck down Texas’ ambulatory surgical center provision in the 5-3 Whole Woman’s Health v. Hellerstedt decision. Justice Stephen Breyer concluded in the opinion that the provision represented a “substantial obstacle in the path of women seeking a previability abortion” and was unconstitutional.

Soon after the decision, Sen. Daylin Leach (D-Montgomery/Delaware), a member of the bipartisan Women’s Health Caucus of the Pennsylvania legislature, wrote a memo recommending repeal of Act 122. And at a June 30 press conference organized by the caucus, Rep. Steven Santarsiero (D-Bucks) introduced legislation to do just that. He weighed in on another bill, HB 1948, discussed in the house on June 21.

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During that debate, “[anti-choice lawmakers] were exposed, they were unmasked,” Rep. Santarsiero said. “They stood one person after another after another in support of [HB 1948], and they came right out and said this is all about the anti-choice movement. They were exposed. They tried 20 years ago to claim it was not about that, but they’re not making any pretense at this point.”

Like Act 122, HB 1948 is an urgent matter. Anti-choice lawmaker Rep. Kathy Rapp (R-Warren) introduced the latter legislation in April, which would be one of the most severe laws in the country if enacted. HB 1948 would ban abortion beginning at 20 weeksIt also includes a “method ban” provision, which would criminalize dilation and evacuation (D and E), often used after miscarriages and for abortions earlier than 20 weeks.

Currently, HB 1948 is still on the schedule of the Pennsylvania Senate Judiciary committee. Though the senate may reconvene this summer, it’s unclear when or whether HB 1948 will move forward.

But advocates must not lose sight of this bill. 

A ‘Dangerous Precedent’

HB 1948 inserts the legislature into the doctor-patient relationship, forcing medical professionals, ordinary Pennsylvanians, and even some legislators out of the process. In April, lawmakers twice rejected requests for input on HB 1948 from both medical professionals and the public. When Rep. Dan Frankel (D-Allegheny) spoke out against the bill, his microphone was reportedly cut off.

Struggling to be heard, doctors and relevant medical associations sent open letters and wrote op-eds against the bill. “We are highly concerned that the bill sets a dangerous precedent by legislating specific treatment protocols,” wrote Scott E. Shapiro, president of the Pennsylvania Medical Society, in an April letter sent to legislators.

They are right to be concerned. Around the country, lawmakers with no medical training frequently propose method bans to criminalize the safest, medically proven procedures. They then threaten to imprison doctors if they don’t provide less-than-optimal care for their patients. This kind of legislative coercion brings to mind Donald Trump’s March statement that women who seek abortion should suffer “some form of punishment” for having an abortion.

Punishment, indeed. Under HB 1948, the punishment can go one of two ways: Either women receive less-than-optimal care, or doctors must be incarcerated. While considering the potential fiscal impact of HB 1948, lawmakers discussed how much it would cost to imprison doctors: $35,000 a year, the annual expense to care for an inmate in Pennsylvania.

My colleagues here at the Women’s Law Project, who co-authored a brief cited by Justice Ruth Bader Ginsburg in her Whole Woman’s Health v. Hellerstedt concurrence, have sent an open letter to senate leadership asking them to remove HB 1948 from further consideration.

The letter said:

If enacted, HB 1948 would inflict even greater harm on the health of Pennsylvania women than House Bill 2 would have inflicted on Texas women. Relevant medical experts such as the Pennsylvania section of the American Congress of Obstetricians and Gynecologists (ACOG) and the Pennsylvania Medical Society strongly oppose this bill.

Under well-established constitutional standards, HB 1948 is quite clearly unconstitutional.

The Strange Debate About HB 1948

For a while, HB 1948 seemed to have stalled—like much business in the legislature. It took more than 270 days to finalize the 2015 budget—an impasse that forced dozens of nonprofit organizations serving rape survivors, domestic violence victims, hungry children, and the elderly to lay off workers and turn away clients.

But in April, Pennsylvania lawmakers whisked HB 1948 to the floor within 24 hours. Then, on June 21, the bill suddenly sailed through the appropriations committee and was rushed to the house floor for third consideration.

HB 1948 passed the house after the kind of bizarre, cringe-worthy debate that makes “Pennsylvania House of Representatives” feel like an insult to the good people of the state. Surely, Pennsylvanians can represent themselves better than elected officials who want to punish abortion providers, liken abortions to leeches, ignore science, and compare abortion regulations to laws restricting pigeon shooting. Surely, they can do better than the legislators who hosted the June 21 farce of a debate about a bill designed to force women to carry unviable pregnancies to term.

At that debate, primary sponsor Rep. Rapp stood for questions about HB 1948. But when Rep. Leanne Krueger-Braneky (D-Delaware County) began the debate by asking Rapp about what doctors, if any, were consulted during the drafting of the bill, Speaker of the House Mike Turzai (R-Allegheny) halted proceedings to consider if such a question is permissible. Also a co-sponsor of the bill, he concluded it was not, offering the explanation that legislators can inquire about the content of the bill, but not its source or development.

Rapp eventually stated she had many meetings while drafting the bill, but refused to answer with whom. She invoked “legislator’s privilege” and insisted the meetings were “private.” Legislator’s privilege is an esoteric provision in the state constitution intended to protect the process from undue influence of lobbyists, not shield lobbyists from public inquiry.

The bill’s language—referring to D and E by the nonmedical term “dismemberment abortion”—echoes legislation promoted by the National Right to Life Committee (NRLC). The NRLC has also drafted boilerplate 20-week bans, along with Americans United for Life, an anti-choice organization and a leading architect of the incremental strategy for building barriers to access safe and legal reproductive health care.

Next, Rep. Madeleine Dean (D-Montgomery) asked Rapp if similar bills have been deemed unconstitutional in other states.

Indeed, they have. According to Elizabeth Nash, senior state issues advocate at the Guttmacher Institute, similar D and E bans have been blocked in Oklahoma and Kansas, and 20-week bans have been struck down in Arizona and Idaho. HB 1948 is one of the first pieces of legislation to combine both provisions into one bill; at the Women’s Law Project, we call it a “double abortion ban.”

But no one in the chambers would know that these anti-abortion restrictions have been obstructed because, once again, Speaker Turzai halted the proceedings over these questions. This time, he stopped the debate citing the house rule that lawmakers cannot ask a question if they already know, or the speaker suspects they know, the answer.

In any case, so it went. Pro-choice lawmakers of the Women’s Health Caucus of the Pennsylvania Legislature spoke out against the bill, reading letters from physicians and sharing tragic stories of family members who died after being denied abortion care during severe pregnancy complications.

When Rep. Rapp was asked if she knew that many severe fetal abnormalities were not diagnosed until or after the 20th week of pregnancy, she responded that many were not diagnosed until birth, which misses the point: HB 1948 is designed to deprive women who receive a diagnosis of a severe fetal anomaly, even unviable pregnancy, at 20 weeks or later of safe and legal abortion.

That’s alright with Rapp and others pushing HB 1948; the bill contains no exemptions for fetal anomalies or pregnancies that were a result of rape.

The bill’s supporters didn’t refute allegations that if passed into law, it would negatively affect health care. They argued their case by invoking metaphors instead. They compared abortion regulations to laws about pigeon shoots. They compared fetuses to bald eagles and abortion to leeches. A white male legislator, a description unfortunately almost synonymous with “Pennsylvania legislator,” compared abortion to slavery, drawing the ire of Rep. Jordan Harris (D-Philadelphia).

“We use slavery references when it benefits, but won’t do anything about the systems that negatively affect their descendants,” tweeted Rep. Harris.

Democratic Rep. Dan Frankel, co-chair of the Women’s Health Caucus, attempted to put the bill into context by noting the barrage of abortion restrictions passed in Pennsylvania already. In addition to the ambulatory surgical facility requirement, the state already has a ban prohibiting women from purchasing affordable health insurance that covers abortion through the exchange; an arbitrary 24-hour mandated waiting period; and a Medicaid ban that allows federal funding of abortions only in cases of rape, incest, or life endangerment.

The house voted 132-65 in favor of the bill, mostly among party lines, though 25 Democrats voted for it and nine Republicans voted against it. Gov. Wolf has promised he will veto it if passes, while HB 1948 proponents are working to gather enough votes for an override if necessary.

Analysis Abortion

Data Shows Surge in Texans Traveling Out of State to Get an Abortion

Teddy Wilson

A Rewire analysis has found that while Texas data shows there has been a decline in the number of abortions in the state, data from other neighboring states suggests there has been a dramatic increase in the number of Texans traveling out of state to access abortion care since the passage of HB 2 in 2013.

Last week, the Texas Department of State Health Services (DSHS) was accused by the American Civil Liberties Union (ACLU) of Texas of deliberately attempting to conceal abortion statistics from 2014, the first full year provisions of the state’s omnibus abortion law were in effect.

DSHS has yet to respond to a letter from the ACLU of Texas demanding that the agency make those statistics available to the public.

The news comes as the Supreme Court is set to issue a ruling on Whole Woman’s Health v. Hellerstedt, which challenges provisions of the abortion law, HB 2, which lawyers of the abortion clinics argue place an undue burden on patients and providers in the state, impeding their ability to provide or access constitutionally protected health care.

DSHS officials finalized the statistics in March, according to the ACLU in a statement, but they have yet to release the full statistics to the public.

“The details are being reviewed for accuracy,” Carrie Williams, director of media relations for DSHS, told Rewire. “We did release the provisional total several months ago but can’t release the underlying details until they are final.”

Even without those details, a Rewire analysis has found that while DSHS data shows there has been a decline in the number of abortions in the state, data from other neighboring states suggests there has been a dramatic increase in the number of Texans traveling out of state to access abortion care since the passage of HB 2 in 2013.

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The number of abortions in Texas has been steadily decreasing since 2008, according to data from DSHS: Over the six-year period, the number has declined by nearly 22 percent. There were 81,591 abortions in 2008, 77,850 in 2009, 77,592 in 2010, 72,470 in 2011, 68,298 in 2012, and 63,849 in 2013.

Around that time, the number of Texans who traveled out of state to have abortions also steadily decreased, by nearly 57 percent from 2008 to 2012. There were 225 patients who had abortions out of state in 2008, 220 in 2009, 129 in 2010, 138 in 2011, and 97 in 2012, according to DSHS.

In 2013, the year Gov. Rick Perry (R) signed HB 2 into law, the number of Texans who traveled out of state to have an abortion increased to 681more than the previous four years combined. Prior to the implementation of HB 2, there were 41 facilities providing abortion services in the state, and 16 of those facilities had either closed or stopped providing abortion services by the end of 2013.

Trisha Trigilio, staff attorney at the ACLU of Texas, told Rewire that the statistics for out-of-state abortions for Texans are concerning. “This is more evidence of what was already proven in court: Texas’ onerous regulations unnecessarily block access to safe, legal abortion in our state,” Trigilio said in an email to Rewire.

Specifically, a study from the Texas Policy Evaluation Project showed the implementation of HB 2 has increased travel distances to clinics, out-of-pocket costs, and overnight stays.

At least 400 more patients traveled outside of Texas to have an abortion in 2014 than did in 2013, according to Rewire‘s analysis. Data collected by the state health departments of Arkansas, Kansas, Oklahoma, and Louisiana shows that at least 1,086 patients traveled to those states from Texas to obtain an abortion after portions of HB 2 took effect.

“Based on this [analysis from Rewire], it’s clear that this law doesn’t make women safer, it forces them to travel across the Texas border to get the care they need—and for women who can’t afford to leave the state, Texas law may prevent them from seeing a doctor at all,” Trigilio continued.

Texas Patients Seeking Out-of-State Abortions

In the wake of HB 2, more than half of the clinics that provide abortion services in Texas have been forced to close, leaving large swaths of the state without access to legal abortion care. The majority of the clinics that have remained open are located in major metropolitan areas: Austin, Dallas/Fort Worth, Houston, and San Antonio.

As clinics that once served rural areas have closed, patients have been forced to drive hundreds of miles away from their homes to one of the state’s major cities or cross the border into neighboring states. 

Arkansas has seen a slight increase since the passage of HB 2 in the number of patients from Texas seeking abortion care.

Arkansas’ Health Statistics Branch of the state health department tracks the number of patients from out of state who have abortions. There were 21 from Texas in 2012, 25 in 2013, 41 in 2014, and 33 in 2015.

Kansas has also seen a slight increase in the number of Texas patients seeking abortion care, according to statistics published by the Kansas Department of Health and Environment. There were two patients from Texas who traveled to Kansas to obtain an abortion during 2012, 13 in 2013,  23 in 2014, and 24 in 2015.

Oklahoma saw a noticeable increase in the number of patients from Texas seeking abortion care there after the passage of HB 2, according to data from the Oklahoma State Department of Health annual abortion surveillance report.

There were 21 patients from Texas who had an abortion during 2012 in Oklahoma, 59 in 2013, 136 in 2014, and 131 in 2015.

Based on Rewire‘s analysis, it seems as if no other state has seen a larger increase in patients from Texas seeking abortion care than Louisiana.

The Louisiana Department of Health and Hospitals (DHH) publishes data on abortions performed there collected by the State Center for Health Statistics (SCHS), but has typically not published data on the number of patients who live outside the state who have an abortion in Louisiana.

Preliminary SCHS figures for 2015 provided to Louisiana Right to Life, a state affiliate of the anti-choice organization National Right to Life Committee, included data on patients from out of state who obtained abortions in Louisiana.

There were 9,311 abortions performed in Louisiana during 2015, and patients from out of state accounted for 1,362 of all abortions performed in the state, according to DHH data published by Louisiana Right to Life.

The data did not include the states of residency for the patients from out of state, which the organization noted is “not available at this time.”

However, preliminary SCHS figures for 2014 provided to the Louisiana Right to Life did include details on the states of residency for patients who had an abortion in Louisiana. There were 10,211 abortions performed in Louisiana during 2014, and patients from out of state accounted for 1,432 of all abortions performed in the state.

Out of the 1,432 abortions had by residents from out of state, 886 were from Texas.

More and more pregnant people are traveling to New Mexico to access abortion care. About 20 percent of the roughly 4,500 abortions performed there in 2014 involved out-of-state patients, according to state health department data reported by the Albuquerque Journal.

Brittany Defeo, program manager with the aid group New Mexico Religious Coalition for Reproductive Choice, previously told Rewire that the people she assists represent a wide range of ages and backgrounds. “They’re ages 18 to 40. It’s all walks of life,” Defeo said.

Defeo estimates that approximately one third of those seeking abortion services in New Mexico from out of state are from Texas. If estimates are correct, that would suggest that approximately 300 patients traveled from Texas to New Mexico to obtain abortion care in 2014. 

Natalie St. Clair, who assists patients seeking abortion care with nonprofit Fund Texas Choice, told the Texas Observer that she helps about ten clients per month travel to New Mexico to access abortion care. St. Clair explained to the Observer that clients often express shock over the barriers in Texas to accessing  abortion care.

“I hear a lot of ‘I had no idea that the laws were this way. I have to go out of state?’ There’s a lot of shame and guilt because people think it’s their fault, or they weren’t prepared enough,” St. Clair said. “I explain that [Texas laws] are set up this way on purpose … [They’re] making abortion inaccessible on purpose.”

Trigilio told Rewire that this data shows that HB 2 was never about protecting patients’s health and safety as proponents have claimed. “When a woman makes the deeply personal decision to have an abortion, she needs access to safe medical care and respect for the decision she has made. HB 2 impedes that,” the ACLU of Texas staff attorney said.