Medicaid coverage of abortion has been a contentious issue in the Iowa legislature since 2011 and will be on lawmakers' agenda during next year's session. I was surprised to learn that Iowa is already more restrictive than most other states when it comes to Medicaid coverage of abortion in cases of rape.
Dylan Matthews wrote a good post about rape exceptions to the ban on public funding for abortion. In theory, the Hyde Amendment dating from the 1970s provides for Medicaid to cover abortions if the pregnancy resulted from rape or incest, or if continuing the pregnancy would risk the woman's life.
How does the Hyde exemption work? Not as intended, for one thing. A recent study (pdf) from Ibis Reproductive Health found that over half of eligible abortions - that is, of pregnancies due to rape or incest or in cases where continuing the pregnancy would threaten the mother's life - conducted for Medicaid beneficiaries were not reimbursed by the program. [...]
Stephanie Poggi is the executive director of the National Network of Abortion Funds, which coordinates groups that subsidize abortions for low-income women. She tells me that many states require that women submit police reports. In Iowa, for example, women must submit a police report of a rape within 45 days of it occurring and give the report to their abortion provider so she can include it in the Medicaid claim; you can see the specific paperwork here (pdf). Given that most rapes - 54 percent, according to the Rape, Abuse, and Incest National Network (RAINN) - are never reported to police, that rules out funding for a majority of women right off the bat.
Other states, such as Pennsylvania, only require a doctor's certification that the patient was raped (some require such a judgment from two doctors). Pennsylvania used to require a police report and two doctors' certifications until it lost a court case forcing it to drop those requirements. I went through the policies of all 33 states (plus D.C.) that only cover abortions in the case of rape, incest or life of the mother, and found that 21 (Alabama, Arkansas, Colorado, D.C., Florida, Georgia, Kansas, Maine, Michigan, Mississippi, Missouri, New Hampshire, Nevada, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas and Wisconsin) only require a doctor's note, while 11 (Delaware, Indiana, Idaho, Iowa, Louisiana, Montana, Ohio, Tennessee, Utah, Virginia and Wyoming ) require a police report or social services agency report.
During the 2012 fiscal year, Iowa's Medicaid program paid for only two abortions resulting from rape, plus five abortions to save the life of the mother and 15 abortions in cases of severe fetal abnormalities.
Many Republican legislators seek even tighter restrictions on Medicaid coverage of abortion. This summer, Iowa Department of Human Services Director Chuck Palmer denied their request for emergency rulemaking to address the issue. Palmer informed lawmakers that prohibiting Medicaid coverage for abortions in the case of rape or incest could jeopardize nearly $2 billion in federal funding for Iowa. He also found "no clear mandate" in Iowa law "to make any further change to the long-standing Iowa policy regarding fetal anomaly abortions."
Iowa is one of just three states that permit Medicaid reimbursement for terminating a pregnancy in case of severe fetal anomalies. A representative of the Guttmacher Institute told me by telephone this morning that Mississippi and Virginia are the two other states that provide Medicaid coverage "in cases of fetal impairment."
Governor Terry Branstad seems inclined not to pick a fight with the federal government over Medicaid abortion coverage. He has not made clear whether he would sign new legislation explicitly prohibiting Medicaid from covering abortions in the case of rape, incest, or severe fetal abnormalities. He won't have to take a stand on this issue if Democrats hold their Iowa Senate majority, but if Republicans gain control over the Iowa Senate and hold the Iowa House, Branstad may need to choose a side. Currently only South Dakota flouts federal law by banning Medicaid coverage of abortions in all cases other than to save the life of the mother.