State health officials are refusing to answer questions about a proposal that critics fear could restrict abortions for low-income women in Alaska. Whether that would actually be the result is unclear. People on both sides of the abortion debate say it's difficult to determine what the proposed rule really means.
The state Department of Health and Social Services proposed the new regulation for "abortion payment conditions" in late June and is inviting public comment through July 30. Officials say it's not appropriate for them to discuss it until then.
At issue is coverage for abortions through Medicaid and Denali KidCare, the state-federal health insurance programs for low-income Alaskans.
The state wants to require physicians who perform abortions to certify on paper whether an abortion is medically necessary. If it's not, or doesn't meet federal criteria, the state won't pay for it.
In a written statement, deputy health commissioner Kimberli Poppe-Smart said the changes are needed "to avoid payment errors" and "to verify that medical assistance funds are being used in accord with the law."
Planned Parenthood of the Great Northwest, which provides the majority of abortions in Alaska, says a shift in wording of what constitutes a medically necessary abortion is the biggest of several problems with the proposal.
A rule now on the books defines a medically necessary abortion as one that improves "a condition harmful to the woman's physical or psychological health." The proposed change says an abortion can be eligible for payment if "the health of the mother is endangered by the pregnancy."
The elimination of the reference to "psychological health" appears to be a significant change that could rule out abortion coverage for many women, said Clover Simon, Planned Parenthood spokeswoman.
"You have to be suspicious, because there have been so many attacks on a woman's right to obtain an abortion, especially poor women, in Alaska. So we have to be extra vigilant," she said.
Health and Social Services Commissioner William Streur assured Planned Parenthood the new rule won't affect the kinds of cases covered under an Alaska Supreme Court decision, and the organization said it hopes that is true. But the measure is so vague that the effect won't be certain until it's enacted, Simon said.
Sen. Hollis French, a Democrat from Anchorage who chairs the legislative Administrative Regulations Review Committee, said he's concerned by the proposal and is looking into what's behind it.
"It really is hard to understand why they are doing this," French said.
Rep. Wes Keller, a Republican from Wasilla, at first applauded the state proposal, thinking it mirrored legislation he proposed this year to sharply limit what qualified for state funding. But after a closer look, he's backing off that assessment.
"All this does is require the provider to certify the abortion is not elective," Keller said. His bill ran into a procedural problem and died.
Besides the big worry over whether the change could impede poor women from getting an abortion, Planned Parenthood has concerns about privacy. The paper form will be sent through the mail and will include the women's name, the date of the abortion, and whether there had been a rape or incest, as well as whether her life or health would be at risk without an abortion. While billing forms already include the patient's name, they use codes to identify the medical procedure and aren't as vulnerable to the information slipping out, Simon said.
Members of the Legislature have tried for decades to cut back or eliminate state funding for abortion. But the state Supreme Court ruled in 2001 the state had to fund medically necessary abortions if it funded maternity care, to avoid discriminating among pregnant women who choose different paths.
Gov. Sean Parnell, an anti-abortion Republican, two years ago vetoed an expansion of the Denali KidCare program after learning it paid for abortions. The governor did not push for the change in rules now under debate, but supports the proposal, his spokeswoman, Sharon Leighow, said. He is not discussing the matter further until the close of the public comment period, Leighow said. Neither are his top health aides, including the commissioner, Streur. State lawyers did not explain why officials cannot talk at this stage.
In the written statement, health officials said they are trying to make sure the state complies with the federal Hyde Amendment, which limits federal funding for abortion to cases of rape, incest or those in which the mother's life is in danger. They also say the state hasn't had a way to verify that state-paid abortions meet the criteria in the 2001 state Supreme Court decision. They didn't explain why they are tweaking the payment rules now. The Hyde Amendment has appeared in federal budgets in one form or another since 1976.
Under the court decision, the state has to pay for abortions beyond Hyde, if they meet the "medically necessary" standard. Streur told Keller's Health and Social Services Committee in March that the state wanted to minimize paying for elective abortions but that ultimately, the decision on whether the procedure is medically necessary rests with the doctor.
The federal government paid for no abortions in Alaska last year and may not have covered any for several years before that, according to Keller's office.
The state spent just over one-half million dollars in general funds on abortions and related services in 2011 for 901 individuals, though all may not have gotten abortions, health officials told Keller. According to the state's annual report on abortion, based on information from medical providers, out of 1,627 abortions performed in 2011, 623 were covered by Medicaid.
Alaska is among 17 states that cover medically necessary abortions, Planned Parenthood says. Six have certification procedures.
An abortion costs $650 in Alaska, according to Planned Parenthood.
The proposed regulation still has to go through several steps before becoming finalized and could be changed or withdrawn entirely.
Reach Lisa Demer at firstname.lastname@example.org or 257-4390.