No Insurance Coverage Through Health Exchanges
By June, at least four states had taken advantage of a provision of the 2010 Affordable Care Act known as the "Nelson Amendment," which specifically allows states to ban abortion from the state health insurance exchanges created by the law.
While a range of bills were either proposed or considered in 15 states this year, so far those bans have only been enacted in Alabama, South Carolina, South Dakota and Wisconsin. Those exchange bans contain limited exceptions in situations where a woman's life is in immediate danger and for victims of rape or incest (although Wisconsin's law, SB 92, specifically states those victims can only be covered if they have reported those crimes to authorities, and the South Dakota legislation only includes exceptions for women facing imminent death or serious health risks.)
Targeted Restrictions of Abortion Providers (TRAP)
Legislators in at least 17 states have proposed bills that would limit the availability of abortion services by placing increased regulations on abortion providers that do not apply to other medical care professionals.
So far, both Mississippi and Tennessee have passed TRAP legislation that says that any physician who provides abortion services must have admitting privileges at a local hospital. Some lawmakers say the admitting privileges requirement -- referring to an arrangement with a hospital that allows doctors to refer patients to the facility for further treatment -- can often be difficult to obtain because religious-affiliated hospitals in those states will often refuse to grant those privileges to physicians who perform abortions.
Opponents of Mississippi's TRAP law, HB 1390, insist the legislation was specifically crafted to shut down the state's only abortion clinic, which was recently allowed to keep its doors open after suing to avoid closure. Some say that sentiment was reinforced by comments made by Gov. Phil Byrant as he signed the bill, professing it was an important step toward the goal of "making Mississippi abortion-free."
As states continue to enact laws that restrict access to legal abortion, some women who live in rural states who cannot feasibly travel hundreds of miles to see a physician have opted for another method: telemedicine.
The way a telemedicine procedure works is straightforward. A woman seeking an abortion will undergo an ultrasound from a trained technician at a local clinic, where she will also receive information about the medication abortion procedure -- an operation-free process conducted by prescription drugs -- and sign a standard informed consent release. Once that is complete, the patient can consult remotely with a doctor via a teleconference, where the physician will review her medical history, answer questions and then sign off on the medication abortion -- available for pregnancies up to nine weeks -- while an on-site health care professional remains in the room to provide additional care.
As of June, Wisconsin had banned the use of telemedicine for medication abortion, while Oklahoma expanded its existing ban (on the use of telemedicine to prescribe the abortion-inducing drug mifepristone) to prohibit telemedicine for any kind of medically induced abortion. While opponents of abortion telemedicine conferences question the safety of having a remote consultation with a physician -- even referring to it as the "McDonald's drive-through window of abortions service" -- several studies, including one published in the journal Obstetrics and Gynecology, have concluded telemedicine abortions are as safe as medication abortions conducted in person.
'Refusal Clauses' Allowing Doctors to Voice Religious, Moral Objections
Several proposals on the both the state and federal level -- remember the Blunt Amendment? -- have involved either the creation or extension of "refusal clauses," which allow individuals and health care centers to deny care based on their religious or moral beliefs regarding abortion and even contraception.
Only two states -- Arizona and Kansas -- have enacted new refusal clauses into law in 2012, although those have been proposed in at least 14 state legislatures. Arizona's HB 2625 weakens the state's contraceptive equity statute to allow any employer to deny contraception coverage in employee health insurance plans (unless the woman can prove it's necessary to treat medical conditions) as long as that denial is "religiously motivated." It also eliminates existing protections for employees who obtain contraception coverage elsewhere if it is not covered by their employer. Meaning that, in Arizona, a woman can legally be fired for using birth control against her employer's wishes.
Meanwhile, Kansas' SB 62 allows health care providers to refuse to perform an abortion, or even refer that patient to another doctor, if they have religious or moral objections to the procedure. But that's not where the restrictions end. The law also states that individuals and hospitals can even refuse to provide or refer a patient for "any device or drug ... an effect of which the person reasonably believes may result in the termination of a pregnancy," a provision many have interpreted as a potential ban against some forms of contraception, such as the morning-after pill.
Several states have enacted waiting periods and other pre-abortion requirements that opponents say are designed to sway women against following through with a pregnancy termination. This year, Louisiana followed suit with the passage of SB 708, which mandates that a woman seeking an abortion must view an ultrasound image, listen to a description of that image, and then listen to the fetal heartbeat a full 24 hours before she is allowed to have the abortion. Virginia's HB 462 follows suit, although it says women must only be offered the opportunity to see the ultrasound image or listen to the fetal heartbeat.
Similarly, Oklahoma passed a law requiring that patients who are more than eight weeks pregnant be offered a chance to listen to the fetal heartbeat, while both South Carolina and Utah passed legislation reinforcing those states' mandatory 72-hour waiting period before a woman can receive an abortion.
New Hampshire's HB 172 builds on a previous law that requires parental notification when a minor seeks an abortion, unless there is a medical emergency or that minor receives a waiver from a judge. The new law lengthens the amount a time a court can take to rule on such a waiver petition to two "court days" -- which can be as long as four full days -- a change that pro-choice activists say can make it even more difficult for a minor to obtain the procedure, particularly if they fear involving a parent.
Bans on Later-Term Abortion
One of the most prevalent trends of 2012 have been bans on abortion at 20 weeks (post-fertilization), which have already passed in Arizona, Georgia and Louisiana. While pro-choice activists do not typically champion late-term abortions, they say the option should be available for women facing life-threatening conditions, particularly since Roe v. Wade specifically states that abortion is legal up to the point of viability -- typically considered to be about 24 weeks.
The, Arizona, Georgia, and Louisiana laws all contain exceptions for women facing imminent death. However, Georgia's law notably does include a woman's state of mental health as a life-threatening condition, and even contains a provision that prevents doctors from performing an abortion even if they believe the woman is a suicide risk.
And Finally ... Planned Parenthood
Planned Parenthood, the de-facto enemy of conservative Republicans at this point, has been targeted by at least two states in 2012.
Among the slew of abortion restrictions passed in Arizona this year is one preventing Medicaid-eligible women from receiving preventative health care from medical providers who also offer abortions, legislation some say is a veiled attack on Planned Parenthood, one of the most popular providers of reproductive health services for low-income women in the U.S.
Planned Parenthood has filed a lawsuit to block the law from being enacted, which the organization says violates federal Medicaid guidelines.
But Arizona isn't alone. North Carolina's Republican-dominated legislature managed to override a veto by Democratic Gov. Bev Perdue to strip all federal and state funding from Planned Parenthood, which went into effect on July 1. Instead, a new law redirects the funding Planned Parenthood would typically receive from the federal Title X family planning program to county health departments.
Because Planned Parenthood is already banned from using government funding to subsidize abortion services, the organization's North Carolina affiliates say the cut will prevent them from offering basic health care services, such as cancer screenings and pap smears, to low-income women who cannot afford to pay the full rate for that care.
Two other states have recently passed restrictions targeting health care providers. New Hampshire's HB 1679, which bans partial-birth abortion -- a ban many say is unnecessary since federal law already prohibits late-term abortions -- specifies that, in a situation where a woman's life is in danger, the procedure can only occur if two doctors who are not legally or financially affiliated agree the operation is necessary.
In Oklahoma, HB 2561 made it legal to sue abortion providers, or anyone who prescribes abortion-inducing drugs, if they do not abide by a law requiring women to undergo an ultrasound and fetal heartbeat monitoring session prior to the operation. Women can also sue because of complications related to an abortion.
The Oklahoman reports the lawsuits could seek punitive damages equal to those for the wrongful death of a child, including damages for mental anguish and emotional distress.
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