Analysis | The Health 202: Blue states move to expand abortion access in rebuttal to bans in Republican-led states – The Washington Post

THE PROGNOSIS

Democratic-led states are pushing forward a flurry of bills to expand access to abortions in a rebuttal to Republican states that pushed to severely restrict the procedure this spring.

Two of the most recent examples are in Nevada and Illinois, which recently approved bills repealing criminal penalties around abortion and easing some restrictions to make it easier for women to get the procedure. Maine this week also enacted a measure that would allow medical professionals other than doctors to perform abortions. In all, there are 25 state legislatures that introduced dozens of bills just this year that would expand abortion access as other states looked to limit it, according to the Guttmacher Institute, which supports abortion rights.

This momentum on both sides is pushing red and blue states further apart. And state legislatures are poised to continue their push into the election year. All this virtually ensures 2020 will be one of the most contentious years ever in the abortion debate as candidates at both the state and national level face pressure to stake out a position.

The emerging factions, says Maya Manian, a law professor at the University of San Francisco, represent a clear “bifurcation” across the country. 

“Republican-controlled states are enacting their hostility toward abortion rights and reproductive rights by passing outright bans and shoving those cases in the pipeline so they can reach the Supreme Court and overturn Roe v. Wade,” she said. “At the same time, we have haven states that want to ensure women continue to have reproductive freedom, preparing a way to ensure that even if the Supreme Court overturns the federal constitutional right, that states will continue to protect these rights.”

Consider Maine, where Gov. Janet Mills (D) just signed a bill that will allow physician assistants and advanced practice registered nurses to perform the procedure in addition to doctors. Contrast that with Alabama: Gov. Kay Ivey (R) signed a bill last month that could punish doctors who perform abortions — including in cases of rape or incest — with felony charges and up to 99 years in prison.

In Nevada, Gov. Steve Sisolak (D) signed the Trust Nevada Women Act at the end of May, which got rid of criminal penalties for anyone who provides or administers abortion medication without a doctor’s advice. It also eliminated a requirement that physicians tell patients about the “emotional implications” of getting an abortion and know a woman’s marital status before performing the procedure. It also aims to expand access by ensuring women can get information about the procedure and give consent in the language they understand.

In Illinois, Gov. J.B. Pritzker (D) has signaled he will sign the Reproductive Health Act passed by state lawmakers late last month. The bill repeals a 1975 state law that included criminal penalties for physicians who perform abortions, as well as provisions requiring spousal consent and waiting periods. The new bill also requires that private health insurance plans in the state cover abortions.

But the legislation — which Pritzker said makes Illinois the “most progressive state in the nation for reproductive healthcare” — may not have passed this year without the bans in red states such as Alabama, Ohio and Georgia.

Elizabeth Nash, a state issues manager at Guttmacher, said the confirmation of Brett M. Kavanaugh to the Supreme Court in October initially sparked state-level efforts to protect abortion rights, as advocates worried his ascension to the high court meant the landmark Roe v. Wade abortion ruling would be in jeopardy. New York passed a law to protect abortion rights early in 2019, followed by a similar effort in Vermont.

Lawmakers in Illinois introduced the Reproductive Health Act back in February. But it only started to move forward after the wave of abortion bans in other states, Nash said.

The bill’s sponsor, Democratic state Sen. Melinda Bush, said that “certainly made it clear the moment was now for Illinois to stand up and say, ‘Not on our watch. This won’t happen in Illinois.’ ”

But on the flip side, Mallory Quigley, the vice president of communications for antiabortion group Susan B. Anthony List, said New York’s early move to loosen abortion restrictions sparked outrage among antiabortion lawmakers and “gave the pro-life movement more momentum.” She also noted efforts to protect abortion access in Rhode Island and New Mexico failed in those Democratic-led states — which she referenced as victories for the antiabortion movement. 

“All of this unrest and all of this activity at the state level and federal level underscores the reality that Roe is not settled in the hearts and minds of the American people,” Quigley said. “We are seeing activists at the state and federal level work to push for a change regarding the status quo in this country. States ought to be able to decide this and to pass bills reflective of the values of people in that state.”

Both sides agreed the momentum for state-level abortion measures will continue into next year.

Bush, the Illinois state senator, called on “every other state that hasn’t passed a Reproductive Health Act [to] get busy.”

“I realize most states are coming to the end of their sessions — Illinois was in a position to move this forward because we had this bill filed,” she said. “But I think you’re going to see them getting ready over the summer.”

Traditionally, Nash said, states usually opt not to introduce controversial social policy during an election year. They might not be as reticent this time. “That said, the outcry is very strong among abortion rights supporters, and that could make protecting abortion rights an issue in the 2020 legislative session,” Nash said.

And abortion politics are changing quickly. Manian pointed to the firestorm that prompted former vice president Joe Biden to suddenly reverse his support for the Hyde Amendment, which bans taxpayer funding for abortion in most circumstances. We’re already seeing changes,” she said. “It used to be the case that Democrats wouldn’t touch the Hyde amendment — it wasn’t a politically useful issue.”

AHH, OOF and OUCH

AHH: As states have passed measures restricting abortion, more women are seeking help from a network of nonprofit groups and volunteers who help individuals who want to get the procedure. These groups help women in need to work out things like the cost and logistics of travel, stay or child care as well as the procedure itself and they’ve seen a resurgence amid the recent efforts to approve severe abortion restrictions, pushing women to cross state lines or experience other hurdles in getting the procedure, my Post colleague Lenny Bernstein reports.

One group, Midwest Action Coalition, says it will help 240 to 360 women this year, up from 185 in 2018 and 35 in 2015.

Some groups also say they’re receiving a surge in donations to help low-income women who make up the majority of their clients. Lindsay Rodriguez, a spokeswoman for the National Network of Abortion Funds, an umbrella organization representing 76 groups in 41 states, told Lenny the groups have gotten $1.07 million in donations since Alabama passed the nation’s most restrictive law.

“Nevertheless, some women are finding it difficult to end unwanted pregnancies as new restrictions increase the cost of abortions as well as the travel time and distance,” Lenny adds. “The support groups’ costs are also increasing as more states impose obstacles to abortion. Some organizations cannot meet the demand.”

OOF: Abortion rights advocates including Planned Parenthood and the American Civil Liberties Union have filed separate lawsuits against the Trump administration over the new federal rule that allows health-care providers to refuse services such as abortion, sterilization or assisted suicide because of religious or moral objections.

The lawsuits are the latest brought against the Trump administration to challenge what the rule’s advocates call “conscience protections.”

“The two lawsuits filed in Manhattan federal court said enforcing the ‘conscience’ rule would encourage discrimination against women, minorities, the poor, the uninsured, and lesbian, gay, bisexual, transgender and queer people by curbing access to legal healthcare procedures, including life-saving treatments,” Reuters’s Jonathan Stempel reports. “HHS pledged to defend the rule vigorously. Planned Parenthood said the rule might affect more than 613,000 hospitals, health clinics, doctors’ offices and nonprofits.”

OUCH: Ivey, Alabama’s governor, signed a bill this week to require some sex offenders to undergo a “chemical castration,” in an effort to prevent offenders from committing similar crimes, my Post colleague Marisa Iati reports.

The enacted law will apply to perpetrators who commit sex offenses after Sept. 1 and will require judges to order individuals convicted of a sex offense involving a child younger than 13 to start receiving testosterone-inhibiting medication as a condition of their parole one month before they are released from prison.

“Most offenders will have to pay for their treatment, which will be administered by the Department of Public Health, until a judge decides the medication is no longer necessary,” Marisa writes. “Under the law, a judge — and not a doctor — will tell the offender about the effects of the treatment. Offenders can choose at any time to stop getting the medication and return to prison to serve the remainder of their term.”

Marisa also explains that unlike what the name suggests, a “chemical castration” is reversible, leaves the testes intact and doesn’t prevent a man from reproducing. There’s also no guarantee that it eliminates sexual urge: Some studies of the treatment show success in sexual offenders who show desire toward children while others did not see a marked effect.

STATE SCAN

— Maryland has experienced its first decline in the rate of fatal opioid overdoses in a decade: In the first quarter of the year, fewer people died of heroin and fentanyl compared to the same time last year, my Post colleague Erin Cox reports. Additionally, 16 of the 24 jurisdictions in Maryland reported fewer overdose deaths in the first quarter compared to last year.

“Though the data represents a 14 percent decline, or 85 fewer deaths, Maryland public health officials were quick to point out that the opioid epidemic continues at a historic pace, killing more than 500 people in the first three months of this year,” Erin writes.

The data, which are still preliminary, also shows the potent synthetic opioid fentanyl was involved in 92 percent of all opioid overdoses.

While the data shows the crisis is ongoing, the downtick in overdoses signals the epidemic in Maryland may be slowing down.

— Florida Gov. Ron DeSantis signed a bill yesterday to allow his state to move toward importing cheaper prescription drugs from other countries such as Canada.

“This will have the potential to save the state a lot of money,” the Republican told supporters as he signed the bill, the Tampa Bay Times’s Elizabeth Koh reports. “I’m just glad that we’re here today and able to say we’re listening to the people who have concerns about these costs and we’re taking action to help get people relief.”

The measure will “open up three pathways for bringing medication in from different countries, including Canada, through a 2003 federal law that tasks federal officials with authorizing state plans to import prescription drugs,” Elizabeth writes. “No state has received such approval in the 16 years since the bill was passed, but DeSantis…said he is confident Florida will clear those hurdles when the state asks for the approval likely next year.”

DeSantis has said he has spoken to President Trump about his support for importing lower-cost prescriptions. “I’ve been in the Oval Office arguing the case when almost everyone else in his administration has been saying don’t do it,” he said yesterday. “I don’t think we would have been able to get this done or have a pathway to get this done were it not for the president’s willingness to do it.”

MEDICAL MISSIVES

— Ugandan health officials and the World Health Organization confirmed the first case of Ebola outside of Congo, where a massive outbreak of the deadly virus has continued for nearly a year.

Until now, the Ebola outbreak had been mostly concentrated to a densely populated area in Congo’s North Kivu province. A 5-year-old Congolese boy was diagnosed with Ebola after traveling with his family and crossing into Uganda, where he sought medical treatment, my Post colleague Max Bearak reports.

“The boy and his family crossed the border Sunday, and the case was confirmed at a rural hospital,” Max writes. “The boy was then put in isolated care, and ‘rapid response teams’ have been sent to the surrounding area to follow up with potential contacts of the boy and his family.”

“In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4,700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease,” the World Health Organization and Uganda’s Health Ministry  said in a joint statement yesterday.

— And here are a few more good reads: 

AGENCY ALERT

The American Medical Association will remain opposed to proposals for the U.S. to create a single-payer healthcare system. The group voted narrowly to maintain its stance on Tuesday at its annual House of Delegates meeting.

Modern Healthcare

HEALTH ON THE HILL

REPRODUCTIVE WARS

DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Health holds a hearing on surprise medical bills.
  • The House Science Committee holds a hearing on combating sexual harassment in science.
  • The House Ways and Means Committee holds a hearing on pathways to universal health coverage.

SUGAR RUSH

Antiabortion protesters interrupt Joe Biden’s Iowa speech:

Author: crh9e