A legislator's effort to restrict state-paid abortions in Alaska came under fire Monday during a hearing dominated by testimony from Planned Parenthood and other advocates worried that poor women may resort to dangerous back-room abortions if the state cuts off funding.
Very few pregnant women would qualify under Sen. John Coghill's strict definition of a medically necessary abortion eligible for Medicaid payments, according to Laura Einstein, chief legal counsel for Planned Planned Parenthood of the Great Northwest. The health organization is the primary abortion provider in Alaska.
Maybe women would try to scrounge up the money themselves. Maybe they would get an abortion later in the pregnancy, when it's riskier and, by the second trimester, not available in Alaska. Or maybe, some Alaskans told Coghill's Judiciary Committee, the days of back-alley abortions would return.
Coghill, a Fairbanks Republican, says he's not trying to deny poor woman abortions, but wants to ensure the state only pays for those that are medically necessary, not elective.
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His Senate Bill 49 says the payment would be allowed only if there's "serious risk to the life or physical health of a woman." The bill further describes the risk as "impairment of a major bodily function" because of certain conditions including heart failure, coma or diabetes with severe organ damage.
"The vast majority of women who otherwise would qualify for Medicaid -- they would not meet the standard," Einstein said in response to questions by Sen. Lesil McGuire, R-Anchorage. Most pregnant women just don't get that sick, she said.
McGuire asked how women generally qualify for abortion coverage now.
Without a detailed definition in law, Planned Parenthood turns to the language of court decisions, Einstein said.
In a 2000 ruling upheld by the Alaska Supreme Court, Superior Court Judge Sen Tan wrote that medically necessary abortions are those that prevent death or disability or address "a condition harmful to the women's physical or psychological health, as determined by the treating physician." While the state could audit a doctor's billing practices, it could not second guess the doctor's medical judgment, Tan wrote.
Under a new rule instituted by the Parnell administration, Alaska doctors must certify an abortion is medically necessary in order for Medicaid to cover the bill. Doctors decide what's right themselves.
But by having to reach the high bar set by Coghill's bill, pregnant women seeking abortion won't be treated the same as those who want to give birth, and that violates the Alaska Constitution, Einstein told the committee. When a similar measure was proposed in 2002, the state attorney general's office said it wouldn't hold up, she said.
It's impossible to create a comprehensive list of what conditions might be reason for an abortion, Planned Parenthood says. When Sen. Fred Dyson, R-Eagle River, asked what constituted an elective abortion, Einstein said she didn't know.
On Monday, 15 people besides the Planned Parenthood representatives testified against the proposal. One spoke in favor of it. Former Anchorage Sen. Bettye Davis urged Coghill to drop it.
Medicaid paid for at least 581 of the 1,629 abortions performed in Alaska last year, according to the state Bureau of Vital Statistics.
McGuire asked whether Planned Parenthood ever sees patients who try to abort themselves.
Not that she knows of, Einstein said.
McGuire said her father, a doctor, worked for the U.S. Public Health Service at a time abortions were illegal and doctors saw many women who "had been in a back-alley abortion circumstance or attempted to abort themselves," McGuire said.
As legislators wrangle with a strict definition that may exclude a number of women, they need to consider "would she attempt to do it on her own?" McGuire said.
Many of the Alaskans who testified on Monday worried that could happen.
Myrtle Gohring of Anchorage said she's a great-grandmother turning 90 this month. She testified by phone about the days of illegal abortions that were "often the only family planning for my generation of young, married mothers whose families grew too large, too soon."
She told the committee that she worked more than 30 years as a school teacher and counselor and saw many children who were angry, suffered low esteem and were unwanted.
Elann Moren of Palmer testified by phone that she knows the horrors first hand. She became pregnant after being raped as a teenager, she told the senators. Her mother and other women tried to get her to miscarry through a mix of mistreatment and tricks from old wives' tales. They made her run until her legs gave out, knocked her off a ladder and gave her weird teas that made her throw up. But she didn't lose the baby.
Finally they took her to a woman who ran a daycare center and brought her into a bedroom, where she lay on an ironing board. She could hear voices of children on the other side of the door. She was told to take quinine tablets to complete the abortion but it didn't work right away. Eventually, she said, she miscarried.
The Senate bill discriminates against poor women and may put them in similarly bad situations, she said.
Philip Stewart of Juneau sat in the witness chair and told the three senators at the hearing -- McGuire, Coghill and Dyson -- that he was appalled at what they were considering and warned it will be challenged in court.
"Senate Bill 49 is cruel, it's wrong, and, I believe, merely a grandstanding ploy to appeal to a small but vocal voting bloc," Stewart said. "Drop this bill like a hot rock."
The grandstanding accusation is offensive and insulting, Dyson shot back.
Stewart conceded that he knew Dyson had "profound moral issues" related to abortion.
"No. I have human-rights issues," Dyson, a former foster parent, responded. His voice broke as he talked about raising two dozen children who were not his own.
Coghill is holding another hearing Tuesday on Senate Bill 49, with more opportunity for testimony. He said Monday's hearing was largely intended to give Planned Parenthood and its supporters a chance to make their best case.
Gov. Sean Parnell, another anti-abortion Republican, supports the Legislature providing a definition for medical necessity, his spokeswoman, Sharon Leighow, said Monday.