Iowa House votes to ban "telemedicine" abortions (updated)

Although Iowa House Republicans sought to restrict abortion rights after regaining the majority in the lower chamber in 2011, anti-choice bills were never a high priority for leadership. In fact, House leaders sometimes put the brakes on conservative efforts to bring anti-abortion legislation to the floor. During the 2013 legislative session, not a single bill restricting abortions even made it out of a committee in the Republican-controlled Iowa House.

House leaders must have gotten some flack from their caucus or outside advocacy groups, because even though restricting abortion isn’t a top agenda item for House Speaker Kraig Paulsen or Majority Leader Linda Upmeyer, they made sure to move an anti-abortion bill quickly during this year’s session. Yesterday the Iowa House approved House File 2175, which would ban the use of telecommunications technology for the purpose of terminating a pregnancy. (A similar bill died in the funnel last year.)

Follow me after the jump for background and details on the roll call.

Planned Parenthood of the Heartland (formerly Planned Parenthood of Greater Iowa) began using telemedicine in some of its small-town clinics several years ago. Click here for a brief explanation of the system. The technology made medical abortions available in some clinics that previously had provided only contraception services, STD testing, and well-woman care. Only a few Planned Parenthood clinics in Iowa provide surgical abortions.

Telemedicine allows Iowa doctors in many fields to see and speak with patients through a video connection. After the consultation, a doctor can then prescribe medication for any number of health problems. In 2010, the Iowa Board of Medicine reviewed state rules on telemedicine and approved Planned Parenthood’s use of the technology after researching the issue. But last year, board members appointed by Governor Terry Branstad adopted an administrative rule change to ban telemedicine for termination of pregnancy. That rule is on hold pending a District Court ruling in Planned Parenthood’s lawsuit challenging the Iowa Board of Medicine’s rule.

Enter the Iowa House. Nineteen House Republicans co-sponsored a bill banning telemedicine abortions this year: Matt Windschitl, Dean Fisher, Mark Costello, Mary Ann Hanusa, John Landon, Tedd Gassman, Dan Huseman, Mark Brandenburg, Jarad Klein, Walt Rogers, Megan Hess, Ron Jorgensen, David Maxwell, Chuck Soderberg, Sandy Salmon, Larry Sheets, Dawn Pettengill, Greg Heartsill, and Jason Schultz. After going through a Human Resources subcommittee, the bill number was changed to House File 2175.

House Republican Kevin Koester floor-managed the bill yesterday. He depicted the legislation as targeting an “unsafe practice.” As usual with anti-choice activists, Koester did not explain why he is only concerned about this procedure, when Iowa doctors use the same technology to prescribe many other medications, some with potentially harmful side effects.

During the floor debate, House Democrats including State Representatives Beth Wessel-Kroeschell, Lisa Heddens, Marti Anderson, Bruce Hunter, Mary Mascher, and Anesa Kajtazovic denounced efforts to limit women’s health care options in rural Iowa.

Only one Republican spoke against House File 2175. Retiring State Representative Tom Shaw opposed the bill because it does not “protect all life.” For the same reason, Shaw voted against the 2011 bill banning all abortions after the 20th week of pregnancy.

The House Journal (pdf) for February 11 includes the roll call on this bill. It passed by 55 votes to 42. Three Democrats (Nancy Dunkel, Dan Muhlbauer, and Phyllis Thede) joined every Republican except Shaw to approve House File 2175. Shaw and 41 Democrats voted no. Three Democrats were absent (Ruth Ann Gaines, Mary Wolfe, and Jerry Kearns), but based on past behavior, they all would have opposed the bill if they had been present.

The Iowa Senate blocked efforts to ban late-term abortions in 2011 and will certainly not send House File 2175 to Governor Branstad’s desk. However, Iowa law on telemedicine could change next year if Democrats lose their 26-24 majority in the midterm elections.

Any relevant comments are welcome in this thread. I enclose a statement released by State Representative Anesa Kajtazovic, who is one of five candidates seeking the Democratic nomination in Iowa’s first Congressional district:

Anesa Kajtazovic defends telemedicine on House floor

Waterloo-Representative Anesa Kajtazovic defended telemedicine, including for abortion, during today’s debate of House File 2175 in the Iowa House. House File 2175 is a bill aiming to ban the use of telecommunications technology in the termination of pregnancy. Kajtazovic noted that telemedicine is practiced in much of the medical field and in rural Iowa it has been used to deliver lifesaving medical services to those in need.

“This bill before us today and the bills I’ve seen in this chamber the past few years, will take women’s health decades back and endanger the lives of women,” said Kajtazovic, “We don’t need to go back to the days when thousands of women died seeking health care services.”

“I hope we won’t see any more of these bills targeting women’s health care this session. This GOP obsession with women’s health care choices needs stop,” Kajtazovic urged the legislative body, “Instead; let’s focus on ensuring that a woman has the resources and healthcare options available to make the best and safest decision for her and her family.”

UPDATE: Lynda Waddington wrote an excellent post for Essential Estrogen about this bill. She cites evidence that medical abortions are safe and points out that this bill “does nothing to stop medical abortions in the state.” Its only purpose is to reduce access.

Over the past few years, women who are lower income or who live outside of or on the fringes of urban centers have been denied access to health care not because of any new laws, but because they have been geographically prevented or limited in their access to that care. There are only so many doctors willing to place themselves into the (literal) line of fire by providing abortion services, and those doctors can’t be in all 99 Iowa counties at once – at least not without the use of teleconferencing.

Since medication abortion drugs were approved by the U.S. government, use has been on the rise – even as overall abortions in the country are on the decline. As the graph from Guttmacher shows, medication abortions were 23 percent of all abortions during 2011, a significant increase from 10 years before.

For those who have mobilized in hopes of reducing access to abortion services, telemedicine abortion is a game changer. In the future it could allow rural physicians to partner with abortion providers anywhere in the country, just as they partner with behavioral health and surgical specialists today.

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  • Isn't telemedicine used in Iowa prisons?

    I didn’t get to listen to this debate, but I seem to remember a discussion years ago in the legislature about the advantages of using telemedicine in the prison system (it didn’t require transporting prisoners, enabled specialists to more easily see patient/prisoners, etc.).  I doubt any of that is in written form (and was probably before video).  I don’t know what the current use of telemedicine is within state government, but its documented use would certainly argue against the allegation that it is “dangerous”.  Maybe the next time a bill like this comes up for debate, someone could look into that.

    • it's used in many settings

      and access to health care in rural Iowa would be much more limited without it. I have not seen any evidence that it’s more dangerous than in-person doctor’s visits for any kind of health concern.