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State proposing strict new definition of 'medically necessary' abortion

  • Author: Lisa Demer
  • Updated: September 28, 2016
  • Published August 16, 2013

In the latest effort at restricting abortions in Alaska, state health officials are proposing to ask doctors for detailed information to justify that an abortion is medically necessary, defining what's allowed almost as narrowly as a stalled and bitterly opposed Senate bill did earlier this year.

The proposed new rule, published Friday, relates only to abortions provided to low-income women and paid for by the state through Medicaid, said Bill Streur, health and social services commissioner. He said he is pushing the change, not Gov. Sean Parnell, an abortion opponent. He said he hadn't discussed it with the governor but did alert a Parnell aide, Mike Lesmann, of what was likely to be a controversial rule.

The department is aiming to refine a requirement that took effect Jan. 16. Under that new standard, Alaska doctors seeking Medicaid reimbursement must certify that an abortion "was medically necessary," if it didn't meet criteria for federal funding. Under the federal Hyde Amendment, which has appeared in federal budgets in one way or another since 1976, federal dollars can only pay for abortion in cases of rape or incest or when the mother's life is in danger.

The current form is simple, with two boxes for doctors seeking Medicaid payment to pick from. Doctors can check a box that says the pregnancy was the result or rape or incest, or that continuing it "would place the woman in danger of death." The federal government pays for a portion of those abortions.

If that's not the case, doctors can pick the second box. On the current form it says "I certify based upon all of the information available to me that the above does not apply, but the abortion procedure was medically necessary." State general funds pay for those, for low-income women.

The proposed new form echoes the language of a bill pushed by Sen. John Coghill, R-Fairbanks, by defining medical necessity as specific, serious conditions including diabetes with severe organ damage, kidney disease that requires dialysis, heart failure, convulsions or a coma.

The health department measure differs from Coghill's Senate Bill 49 in one key respect: It includes psychiatric disorder as a reason for an abortion, though that too appears to be linked to "medical impairment."

If they claim medical necessity, doctors will be asked first to certify that the abortion was necessary "to avoid a threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function."

They then must check one of 21 conditions or an "other" category that gives the reason as "another physical disorder, physical injury, physical illness, including a physical condition arising from the pregnancy, or a psychiatric disorder that places the woman in imminent danger of medical impairment of a major bodily function if an abortion is not performed."

As of the end of May, the state had received about 260 certificates requesting state funds, and not a single doctor checked the first box indicating rape, incest or a risk of death, Streur said.

The new effort is "an attempt to identify what kinds of medical conditions we are dealing with," he said.

Some abortions surely are due to rape, incest, or a risk of death, he said. "But they are getting reported under other issues and we are paying them with our general funds. We could recover between 50 and 65 percent of the costs of those abortions from the federal government."

The proposed new certificate will require doctors to make a conscious choice, he said.

"Does it fit the letter of the law, or is it a catchall to get paid for it?" Streur said.

Health officials had hoped the certification requirement would result in fewer state-paid abortions. When that didn't happen, Streur said, the department took a second look.

"I think it will make them think about it more before signing the box and rendering the abortion and billing us for it," the commissioner said. "I'm not saying it will reduce the number of abortions. I'm hoping it will reduce the number of state-paid abortions."

According to the state's 2012 report documenting abortion numbers, Medicaid paid for at least 581 abortions in Alaska last year and the numbers so far this year are on pace to top that, he said. There were a total of 1,629 abortions in Alaska last year, the report said.

Coghill, one of the Legislature's leading social conservatives, has said the state is paying for too many elective abortions. He pushed for a strict definition of medical necessity that didn't allow for mental health issues.

Planned Parenthood of the Great Northwest, the main abortion provider in Alaska, and a number of individuals testified against his bill, saying a doctor should be trusted to decide what's medically necessary.

Planned Parenthood didn't have an immediate assessment of the proposed new rule.

When it came to Coghill's proposal, some said poor women with little recourse might resort to dangerous back-room abortions. Planned Parenthood's lawyer, Laura Einstein, told Coghill's Judiciary Committee that his proposal was so restrictive that it would violate a state Supreme Court ruling requiring the state to cover abortions if it covered pregnancy care.

The Senate passed the measure with an amendment to boost funding for family planning and health services for low-income women. It was stuck in the House Finance Committee when the Legislature adjourned.

Streur said he's within bounds to make the change through regulation. The bill remains alive in the Legislature, he noted.

He wouldn't say where he stood on abortion, but said that's beside the point.

"I have to ensure that health care is available to those who are eligible," Streur said. "If I don't believe in sterilizations, if I don't believe in abortions, if I don't believe in lobotomies, that doesn't really matter. If they are allowed under the law, that's what I am going to follow."

The proposal is open for public comment through Sept. 27.

Reach Lisa Demer at or 257-4390.