Change in Iowa Medicaid policy hasn't reduced abortion access

A year after Iowa law changed to require the governor to approve all Medicaid reimbursements for abortions, the new policy does not appear to have limited low-income women's access to abortions in cases of rape, incest, threat to the mother's life or severe fetal abnormality.

On the other hand, the policy has in effect ended Medicaid coverage of abortion in Iowa, which was already among the most restrictive states in this area.  

Since the late 1970s, federal law has called for Medicaid to cover abortions in cases of rape, incest or a threat to the mother's life. In Iowa, Medicaid has also covered a small number of abortions each year in cases of severe fetal abnormalities.

For many years that policy was uncontroversial. But ever since Republicans regained the Iowa House majority in the 2010 elections, Medicaid coverage of abortions has been a flashpoint in state budget negotiations. A dispute over this issue forced the 2011 legislative session to go all the way to the final day of the fiscal year. The following year, Iowa House Republicans sought unsuccessfully to end Medicaid coverage of abortions through the rulemaking process.

Whether Iowa would expand Medicaid coverage, as foreseen in the 2010 federal health care reform law, became the one of the most contentious issues of the state legislature's 2013 session. As Bleeding Heartland discussed here, the eventual compromise on an alternative to Medicaid expansion gave the governor the power to approve reimbursement for each abortion under Medicaid before money can be allocated for that purpose.

Iowa's largest abortion provider, Planned Parenthood of the Heartland, does not bill Medicaid for abortions. For the most part, Medicaid recipients whose abortions qualify for coverage are treated at the University of Iowa Hospitals and Clinics in Iowa City. Last fall, that facility announced that it would no longer bill Medicaid for any abortions, to avoid the politics of having Governor Terry Branstad sign off on reimbursement.

A few days ago, Jacob Luplow followed up on this issue for the Iowa Center for Public Affairs Journalism.

Last year, the Legislature gave the governor the power to decide whether or not to approve or decline reimbursement for Medicaid-funded abortions.

But in the slightly more than 12 months the law has been in effect, the governor hasn't had to make these decisions. UI Hospitals and Clinics, where low-income abortions are performed most often, decided not to bill the state the $41,378.06 for the 20 abortions performed by doctors there from July 1, 2013, through July 7, 2014.

"The reason was just to keep us out of the politics of this issue," university spokesman Tom Moore said.

I haven't been able to find figures going back more than a couple of years on how many abortions were covered by Medicaid in Iowa. It doesn't seem that the new policy is limiting access for women who otherwise would have qualified for a Medicaid-funded procedure, though. During the 2012 fiscal year, Medicaid was billed for 22 abortions in Iowa. The figure dropped slightly during the 2013 fiscal year.

I agree with State Senator and gubernatorial nominee Jack Hatch, State Senator Joe Bolkcom, and others who have argued that Medicaid should be billed for qualifying abortion services provided in Iowa City. Under a new governor and Democratic-controlled state legislature, I would expect and hope for this policy to be overturned. On the other hand, it's reassuring that women in need are not being turned away because of fears that Governor Branstad would not approve Medicaid reimbursement.

Anti-choice politicians and activists seem satisfied by the new policy's outcome, although there's no sign it has reduced the number of abortions performed in Iowa. From Luplow's story:

Jenifer Bowen, executive director of Iowa Right to Life, said she supports Branstad's views but also the decision by UI Hospitals and Clinics officials to refrain from billing the state for the Medicaid-eligible abortions that were performed.

"We were optimistic that it would help stop taxpayer funding of abortion, and ... we've seen it actually work," Bowen said.

I don't see the logic, since the University of Iowa is a state-funded institution. Republican State Representative Matt Windschitl, an advocate of a total ban on abortion through "personhood" legislation, split the hairs this way last year:

The Missouri Valley Republican, who opposes abortion in general, acknowledged that abortions done at the U of I still will be financed with the state's money, because the state owns the university. But he noted that much of the hospital's revenue comes from other sources, such as private insurance. By forcing the hospital to use those sources for abortion, he said, "we are not directly appropriating taxpayer dollars to end human life."

Any relevant comments are welcome in this thread.

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