A measure that aims to restrict state funding for abortions sought by poor and low-income women cleared the Alaska House on Sunday night on a 23-17 vote without a provision that some said could prevent abortions by ensuring access to birth control.
The bill seeks to define in law a "medically necessary" abortion. Under the measure, the state Medicaid insurance program can only cover those that fit into the new criteria.
Proponents say the state should not pay for elective abortions and that Senate Bill 49 will ensure that is the case. The measure doesn't stop payments for abortions if the pregnancy was the result of rape or incest, or if the mother's life is in danger.
But opponents said the list of medical conditions was too restrictive and will limit choices for poor women.
Rep. Gabrielle LeDoux, R-Anchorage and sponsor of a House companion measure, told her colleagues Sunday evening that the proposal was simply to specify who pays for an abortion.
"This bill has nothing to do with restricting a women's right to an abortion," she said.
Responding to Democrats who noted that other medical procedures aren't singled out in state law for detailed descriptions of necessity, LeDoux said there isn't a problem with other health services being covered when they are unnecessary.
Rep. Geran Tarr, D-Anchorage, said an abortion is an intensely personal decision and that the bill will interfere with a woman's right to privacy.
The bill says an abortion is "medically necessary" if the pregnancy poses "serious risk to the life or physical health of a woman." Besides the risk of death, the measure says a serious risk would be a complication that could impair a major bodily function and lists 21 specific conditions and one blanket provision referring to other physical disorders or injuries.
The measure makes no explicit provision for covering abortions in cases of psychiatric illness or emotional crisis and some opponents said the absence of a mental health provision will be damaging to women and may not hold up in court.
Among the physical conditions that would qualify an abortion as eligible for state payment under the bill are a coma, epilepsy, seizures, heart failure and diabetes with severe organ damage. But others are less known, such as "amniotic fluid embolus" and "status epilepticus."
Rep. Lindsey Holmes, R-Anchorage, said she didn't hear any testimony about the how the list of conditions was created but wasn't familiar with all of the terms.
"I am kind of uncomfortable telling a doctor this is the exact right list," she said.
House Democrats last week tried to add a new Medicaid women's health program to the abortion bill to ensure low income women -- and men -- could get coverage for family planning and birth control.
Those backing that proposal had argued that it would reduce unintended pregnancies, abortions and even the number of babies born damaged from their mother's drinking.
"It is an anti-abortion bill that now serves to increase the number of abortions," state Rep. Les Gara, D-Anchorage, said Sunday.
Last year, the state Senate agreed to that provision but it was stripped out by the House Finance Committee and efforts to reinstate it on the House floor Thursday failed.
LeDoux argued then the state already pays for ample family planning services including at public clinics.
"Other than putting contraceptives in the drinking water, I mean we've done just about everything we can do as far as family planning services," LeDoux said during Thursday's debate.
Now the stripped-down abortion bill must return to the Senate.
Voting for the bill Sunday were these Republicans: LeDoux, Mia Costello, Mike Hawker, Craig Johnson, Bob Lynn, Charisse Millett and Lance Pruitt of Anchorage; Lora Reinbold and Dan Saddler of Eagle River; Bill Stoltze of Chugiak; Eric Feige of Chickaloon; Lynn Gattis and Wes Keller of Wasilla; Mark Neuman of Big Lake; Shelley Hughes of Palmer; Pete Higgins and Steve Thompson of Fairbanks; Doug Isaacson and Tammie Wilson of North Pole; Cathy Munoz of Juneau; House Speaker Mike Chenault of Nikiski; Kurt Olson of Soldotna; and Peggy Wilson of Wrangell.
Opposition came from both parties including Democrats Tarr, Gara, Harriet Drummond, Max Gruenberg, Andy Josephson and Chris Tuck of Anchorage; Scott Kawasaki and David Guttenberg of Fairbanks, Sam Kito of Juneau, and Jonathan Kreiss-Tomkins of Sitka. They were joined by Republicans Holmes; Alan Austerman of Kodiak; and Paul Seaton of Homer along with Bush Democrats who organize with the GOP-led majority: Neal Foster of Nome; Bryce Edgmon of Dillingham; Bob Herron of Bethel; and Ben Nageak of Barrow.
The Alaska Supreme Court ruled in 2001 that since Medicaid covers prenatal care, it also must pay for medically necessary abortions to avoid discriminating against women who chose different paths.
The Parnell administration last year approved regulations defining medical necessity for abortion with a list of conditions similar to those in the bill.
Planned Parenthood of the Great Northwest sued in January to have the new rules struck down as violations of constitutional rights, including the right to privacy. An Anchorage judge has put the rules on hold until a trial is held.
Democrats said Sunday that if the measure becomes law, it certainly will be challenged in court at a cost of hundreds of thousands of dollars to the state.
Last year, the Medicaid program paid for 547 of the 1,450 abortions performed in Alaska, according to state figures.
Reach Lisa Demer at firstname.lastname@example.org or 257-4390.
By LISA DEMER