News Law and Policy

In Alaska, a Woman Would Need to Be in a Coma to Get State-Funded Abortion Care

Nicole Knight

The State of Alaska is appealing a court ruling that found its definition of "medically necessary" abortion unduly restrictive by limiting Medicaid funding to women with a serious medical condition.

The State of Alaska is appealing a state Superior Court ruling that found its definition of “medically necessary” abortion unduly restrictive by limiting Medicaid funding of the procedure to women with a serious medical condition, like a coma.

In its appeal, Senior Assistant Attorney General Stuart Goering said the state will argue that it can enact standards to distinguish between medically necessary abortions and elective abortions, so that state Medicaid money pays only for those deemed medically necessary.

The appeal marks the latest attempt by Republican lawmakers and the governor to strip the procedure of state funding. A decision in favor of the state could jeopardize abortion coverage for hundreds of low-income women annually.

In 2013, the former Planned Parenthood of the Great Northwest (now called Planned Parenthood of the Great Northwest and the Hawaiian Islands), among others, sued to block a regulation that limited Medicaid coverage to women who could demonstrate their abortion was “medically necessary,” meaning it met at least one of 21 conditions deemed a serious health risk, such as seizures, congestive heart failure, or diabetes “with acute metabolic derangement.”

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The regulation was temporarily blocked by a judge, but Republicans soon after pushed through a similarly restrictive bill, SB 49, which passed in 2014 on a near party-line vote. That law was also temporarily halted.

“It was tantamount to a ban on Medicaid paying for abortion,” Laura Einstein, chief legal counsel for Planned Parenthood of the Great Northwest and the Hawaiian Islands, said of the restrictions in an interview with Rewire.

Superior Court Judge John Suddock in August ruled in favor of Planned Parenthood, saying the regulation and law violated the state constitution. Suddock said in a 53-page ruling that the state’s limits failed to address “less-than-catastrophic” situations and imposed a “higher barrier” to funding abortion compared to other “non-pregnancy medical needs.”

In Alaska, state money in the Medicaid program pays for low-income women’s abortions, unlike most states, according to the Guttmacher Institute. Between January 2013 and July 2014, Planned Parenthood performed 1,633 abortions, and of those, 769 were covered by Medicaid, Einstein said.

The August decision underscores a longstanding clash in the nation’s northernmost state over the definition of medically necessary abortion. Since the 1994 state law had defined medically necessary abortion as one to “ameliorate the physical or emotional health of a woman,” Einstein said.

State Republican lawmakers have increasingly acted to limit Medicaid-funded abortions to cases of rape and incest or to save the life of the mother, in a fashion similar to the federal Hyde Amendment. Planned Parenthood has argued the state’s regulation restricting Medicaid abortions puts a burden on pregnant low-income women who already have the least access to health care.

The Alaska Supreme Court ruled in 2001 that the state must pay for medically necessary abortions if it pays for other procedures deemed medically necessary. In that decision, the court ruled that medication needed by women with conditions like bipolar disorder and epilepsy “can be highly dangerous to a developing fetus.”

Goering described the notice of appeal filed November 6 as routine and not ideologically motivated.

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