As the new year progresses, both states and the Trump administration are continuing their involvement in issues involving abortion and contraception.
In Tennessee, a law that took effect Jan. 1 requires women who are considering abortions and who have had an ultrasound of their fetus be given an opportunity to see the ultrasound results. In Arizona, a new law requires providers to ask women who seek abortions whether they have been coerced into getting the procedure and whether they are victims of sexual assault or sex trafficking; however, women are not required to answer the questions. And in Kansas, a new law bans so-called telemedicine abortions, in which women seeking to have a medical abortion receive consultations via telemedicine.
On the other side of the abortion issue, a new law in Washington state requires private insurers in that state who cover maternity care to also cover abortion. The law also requires all health insurers to cover contraception.
The American College of Obstetricians and Gynecologists (ACOG) was unable to provide someone to comment on the new laws; however, a spokesperson sent a policy statement from May 2013 regarding government interference in the physician-patient relationship. “Efforts to legislate elements of patient care and counseling can drive a wedge between a patient and her health care provider, be that a physician, certified nurse-midwife, certified midwife, nurse practitioner, or physician assistant,” the statement said. “Laws should not interfere with the ability of physicians to determine appropriate treatment options and have open, honest, and confidential communications with their patients.”
In particular, “laws that require physicians to give, or withhold, specific information when counseling patients, or that mandate which tests, procedures, treatment alternatives or medicines physicians can perform, prescribe, or administer are ill-advised,” the statement continued. “Examples of such problematic legislation include laws that prohibit physicians from speaking to their patients about firearms and gun safety; laws that require medically unnecessary ultrasounds before abortion and force a patient to view the ultrasound image; [and] laws that mandate an outdated treatment protocol for medical abortion.”
The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), on the other hand, praised the new laws in Tennessee and Arizona. “The American Association of Pro-Life Obstetricians and Gynecologists strongly supports full informed consent laws such as the Tennessee law which requires women to be shown the ultrasound of their fetus prior to the decision to abort,” AAPLOG executive director Donna Harrison, MD, said in an email. “Only with full information, including what their unborn child looks like, will women be empowered to make an informed choice.”
“AAPLOG also strongly supports the Kansas ban on telemedicine abortions, as medical abortion is four times riskier than surgical abortion, and the dispensing of abortion drugs without examining a patient and without ruling out contraindications, and without the ability to administer RhoGAM [to prevent Rh immunization], is bordering on medical malpractice,” she continued. “AAPLOG also strongly supports the Arizona law which requires screening for abuse and trafficking, situations which put a woman at very high risk for death, and for which an abortion serves to maintain and cover the continued abuse of women.”
These state laws come at a time of action on both abortion and contraception at the federal level. The Department of Health and Human Services (HHS) issued a proposed rule in November that would require insurers on the Affordable Care Act’s health insurance exchanges to send a separate bill and collect separate payments for the portion of the consumer’s premium that pays for abortion — a service that, under the federal Hyde Amendment, cannot be paid for with public funds except in very limited circumstances.
Health plans “must segregate funds for … abortion services collected from consumers into a separate allocation account that is to be used exclusively to pay for non-Hyde abortion services,” the proposed rule notes. “Thus, if a [plan] disburses funds for [an] abortion on behalf of a consumer, it must draw those funds from the segregated allocation account.”
On Jan. 8, more than 170 House Democrats sent a letter to the Trump administration objecting to the proposed rule; 34 senators sent a similar letter. “The cost of abortion alone is often times prohibitive for many women,” the House members wrote. “We are deeply concerned that the proposed rule would further push abortion out of reach for many … This rule would turn a once simple and concise billing procedure into an arduous and costly process that would result in reduced access to healthcare for women.”
The rule also has its supporters; for example, AAPLOG “applauds the effort of HHS to increase transparency for taxpayers, many of whom don’t want to be purchasing insurance products which are supporting the abortion industry,” Harrison said in her email.
HHS also is tangled up in court over another set of rules it issued in November on contraceptive coverage. The Affordable Care Act requires insurers to cover contraception at no charge to patients, but under these rules — which were to take effect Monday — would allow most employers to refuse to cover contraceptives for their employees on the basis of religious or “moral” objection not tied to an organized religion.
However, those rules were blocked by a federal judge in Philadelphia, who issued a nationwide injunction on Monday. District Judge Wendy Beetlestone, presiding over a case filed by attorney generals in Pennsylvania and New Jersey, granted their motion for a preliminary injunction. The government, she wrote, is “enjoined from enforcing the … Final Rules across the Nation, pending further order of this court.”
On Sunday, another federal judge in California handling a similar lawsuit had issued an injunction blocking the moral-exemption rules as well. But that judge only applied it to the 13 states and District of Columbia that filed the suit.