Medicaid abortion funding ban a bridge too far for Branstad administration

Opposing all government funding for abortion is settled dogma among Iowa Republican activists and elected officials. For two years in a row, Senate Democrats have blocked attempts to write new restrictions on Medicaid abortion coverage into the budget for the state Department of Human Services. Now DHS Director Chuck Palmer has signaled that taking control of the upper chamber may not give Republicans the power to restrict the choices of low-income women.

Palmer’s action puts Governor Terry Branstad in an awkward position, and a legislature completely under GOP control could create a political nightmare for Branstad, a proud “pro-lifer” throughout his career.

During the 2012 fiscal year, Medicaid paid for 22 abortions in Iowa: “15 for severe fetal anomalies, two for rape and five to save the life of the mother, according to the DHS.” In June, 41 Iowa House Republicans led by State Representative Dawn Pettengill filed a petition for emergency rulemaking with the DHS, seeking to halt all Medicaid abortion funding, or at least the payments for abortion in cases of fetal anomalies.

Palmer informed the lawmakers on August 3 that he denied their petition. Excerpt from his cover letter to Pettengill:

The elimination of Medical Assistance (Medicaid) or IowaCare payment for abortions in cases of rape or incest would violate federal funding requirements under the federal Medicaid program. Eliminating Iowa Medicaid payment for abortions in cases of rape or incest would jeopardize all federal Medicaid funding Iowa receives, approximately 2.1 billion dollars annually. This funding is important to the delivery of vital care to vulnerable Iowans.

The 2011 appropriations language provided funds to the Department of Human Services for Medicaid “consistent with options under federal law and regulations.” Federal law allows for state Medicaid programs to reimburse for abortions of fetuses for fetal anomalies without federal funding. The Department, as required by 2011 appropriations, is requiring the physician certifications in the case of abortions covered based on fetal anomalies, absent a medical emergency. However, there is no clear mandate in the 2011 appropriations to make any further change to the long-standing Iowa policy regarding fetal anomaly abortions. Any such change should be based on a clear directive in legislation.

Palmer explained his decision in an eight-page document citing many provisions in state and federal law as well as federal court rulings relating to Medicaid funding for abortion. Excerpt from page 7:

The rule allowing payment for abortion when the fetus is physically deformed, mentally deficient, or afflicted with a congenital abnormality has been used sparingly. Fifteen abortions were paid for on that basis during fiscal year 2011-2012. These included abortions due to fetal anencephaly (absence of a large portion of the brain or skull) and acrania (absence of the skull). As discussed above, the 2011 appropriations language regarding abortion requires only that in the absence of a medical emergency, a physician providing an abortion must certify that the woman has been given the opportunity to view an ultrasound image of the fetus and has been provided information about the options relative to pregnancy. […] Further, the 2011 appropriations provided funds to the Department for Medical Assistance “consistent with options under federal law and regulations.” […] Those options include the option to cover abortion in the case of serious fetal anomalies (in addition to rape and incest), with state-only funding. Continued state-only funding for such abortions was included in the Department’s budget proposals for 2011-2012 and 2012-2013, and the Department’s appropriation was never adjusted to reflect a change. The Department is requiring the physician certifications mandated by the 2011 appropriations in the case of abortions covered based on fetal anomalies, absent a medical emergency. But there is no clear mandate in the 2011 appropriations to make any further change to the long-standing Iowa policy regarding such abortions. Any such change should be based on clear legislation.

Palmer also noted that the DHS added language about a woman’s opportunity to view an ultrasound to its “Certification Regarding Abortion” form that is “a condition of payment for an abortion.” For that reason, he does not consider it necessary to change the DHS administrative rules in order “to comply with the requirements of the 2011 appropriations.”

Pettengill had claimed only $4 million in Medicaid funding for Iowa was at risk if the state DHS changed its rules. She criticized Palmer when commenting to the Des Moines Register last Friday.

“As a member of the Administrative Rules Review committee and a legislator, I’m disappointed Director Palmer has decided not to implement the law and enforce legislative intent,” she wrote in an e-mail. “As much as I disagree with the logic that brought the director to that conclusion, he knows the tools we have to force (the Department of Human Services) to obey law are extremely limited. As a Rules (Committee) member, I have emptied my toolbox and done everything I could to make the rules match our intent.”

In contrast, Iowa House Democratic Leader Kevin McCarthy gave Branstad full credit for Palmer’s decision.

I’m pleased Governor Branstad put the brakes on this latest attempt by House Republicans to deny health care options to women who are victims of rape or incest. From banning birth control such as the pill to reducing cancer screenings, this effort by Republicans was just the latest attempt in their relentless attack on women’s health care. It’s time for Republicans to put aside their divisive social agenda and focus on growing our economy and putting Iowans back to work.

I am seeking comment from Branstad’s office regarding the governor’s position on changing Medicaid abortion funding rules. I will update this post as needed. Branstad told the Cedar Rapids Gazette last month that he believed Palmer would “do the right thing.”

“I haven’t had a chance to talk to him in detail,” Branstad said Monday, referring to Iowa DHS director Chuck Palmer, “but I have a lot of confidence in him. He’s a problem-solver. He has empathy for the people who receive human services and he has good fiscal management skills.”

For many in the pro-life crowd, “do the right thing” would mean “make sure taxpayers don’t have to cover any abortions for indigent women facing terrible circumstances.” That’s the opposite of how I read Branstad’s comment.

To my ear, “problem-solver” translates to “makes problems go away rather than amplifying them.”

By the same token, “has empathy for the people who receive human services” translates to “won’t put Medicaid funding for hundreds of thousands of Iowans at risk.”

Finally, “good fiscal management skills” equals “won’t blow a $2 billion hole in Iowa’s budget.”

The American Civil Liberties Union of Iowa and Planned Parenthood of the Heartland objected to the House Republicans’ petition for rulemaking and welcomed Palmer’s decision last week. Who’d have thought the Branstad administration would ever be congratulated by Planned Parenthood and the ACLU? I’m sure the governor doesn’t appreciate their praise.

I expect to see Republican pressure on Branstad to replace Palmer as head of the state’s largest department, but I don’t see Branstad ditching Palmer over this issue. He trusted Palmer to do this job during the 1990s and wanted him back for his fifth term as governor.

Another land mine potentially awaits Branstad next year. Not only are Iowa House Republicans against Medicaid funds for abortion, the 24 current Iowa Senate Republicans voted unanimously in April to eliminate all Medicaid funding for abortion. Consequently, if the GOP wins control of the Iowa Senate in November and holds the House, both chambers of the legislature will pass more restrictive language on Medicaid abortion funding in 2013. That would put Branstad in a no-win situation: veto the language and spark a Republican civil war, or approve the language and risk losing all of Iowa’s federal Medicaid funding.

Any relevant comments are welcome in this thread.

P.S.- Here is the full list of Iowa House Republicans who joined Pettengill’s petition for rulemaking: Dwayne Alons, Rich Anderson, Mark Brandenburg, Royd Chambers, Betty De Boef, Cecil Dolecheck, Jack Drake, Greg Forristall, Joel Fry, Julian Garrett, Pat Grassley, Chris Hagenow, Bob Hager, Mary Ann Hanusa, Lee Hein, Erik Helland, Lance Horbach, Stew Iverson, Ron Jorgensen, Jarad Klein, Kevin Koester, Glen Massie, Linda Miller, Ross Paustian, Dan Rasmussen, Walt Rogers, Tom Sands, Jason Schultz, Tom Shaw, Jeff Smith, Chuck Soderberg, Annette Sweeney, Jeremy Taylor, Dave Tjepkes, Linda Upmeyer, Guy Vander Linden, Ralph Watts, Matt Windschitl, and Gary Worthan.

The following 18 Iowa House Republicans did not join Pettengill’s petition: Rich Arnold, Chip Baltimore, Clel Baudler, Josh Byrnes, Peter Cownie, Dave Deyoe, Dave Heaton, Jeff Kaufmann, Mark Lofgren, Brian Moore, Steve Olson, Kraig Paulsen, Kim Pearson, Scott Raecker, Henry Rayhons, Renee Schulte, James Van Engelenhoven, and Nick Wagner. Former State Representative Steve Lukan had just retired from the Iowa House to accept a position in the Branstad administration.

The House Republican leadership was split, with Majority Leader Upmeyer, Majority Whip Helland, and Assistant Majority Leader Windschitl joining Pettengill’s petition while Speaker Paulsen, Speaker Pro-Tem Kaufmann, and Assistant Majority Leaders Deyoe and Schulte stayed on the sidelines.

LATE UPDATE: Here is the joint statement Planned Parenthood of the Heartland and the ACLU of Iowa released on August 2.

Des Moines, IA. – Planned Parenthood of the Heartland and the American Civil Liberties Union (ACLU) of Iowa applaud the state Department of Human Services (DHS) for denying an emergency rule-making petition recently filed by a group of Republican lawmakers.

The petition demanded the state change its rules to immediately cease reimbursing abortions for rape and incest victims through Medicaid. DHS denied the petition as it would violate federal funding requirements and jeopardize more than $2 billion dollars in federal Medicaid funds to the state of Iowa.

“This petition would have put the health of Iowa women and their families at risk,” said Planned Parenthood of the Heartland President and CEO Jill June. “Thousands of Iowans rely on the Medicaid program every year. This decision ensures that those who need access to vital health care can get the services they need at a price they can afford.”

DHS concluded that no rule change will be made.

“DHS made the right decision,” said ACLU of Iowa Legislative Director Rita Bettis. “The petition asked for a procedural run-around that was improper under Iowa law. It sought to withhold abortion coverage from a qualified woman. Only a woman facing those extremely difficult circumstances–not politicians–knows what decision is right for her.”

“A woman who has been through the violent trauma of a rape of incest should not be re-victimized by our political system. We know that these crimes do not discriminate based upon a woman’s financial situation, and because of this decision by the DHS our laws won’t either,” said June.

Maintenance Notice - As of November 14, 2023 we are still seeing issues with replying to comments...Thanks for your patience, this will be restored.

  • not as politically risky

    for Branstad as you imply. The only people crazy enough to want to put Medicaid funds at risk over this are the “Why can’t we be South Dakota?” crowd. This is a free pander for the House Republicans before the election.

    Consequently, if the GOP wins … (lots of spec)

    He’ll take the “civil war.” Ir’s not like the hard-core in the BVP crowd were that crazy about Branstad in 2010.


  • Branstad knows these social issues

    aren’t going to solved.  He’s always been principled focused on smaller gonvernment, lower taxes and criticizing state workers.  Let’s be frank about this.  If you want to keep people on the dole one of the best ways to do that is to take their right to seek an abortion away.  Pro-life voters cannot even deny the statistics that are linked to family planning.  

    • some of them do deny any benefits

      to family planning, but I know what you mean and agree with you. Branstad is anti-abortion the way he’s always been for the death penalty: not motivated to do anything about it as governor. He was president of a university where medical students learned how to perform abortions, and to my knowledge he never tried to remove that from the curriculum.

  • Palmer

    He’s safe…well regarded in the inner circle.