Amid furor over abortion, revised restrictions are expected to cut down on travel

JUNEAU — The Alaska State Medical Board has approved rewritten regulations that will likely cause a sharp decrease in the number of women traveling Outside for abortions.

The board voted earlier this month to loosen the regulations, which are nearly a half-century old and require blood and an operating room equipped for major surgery to be "immediately available" when second-trimester abortions are performed.

The changes come after Planned Parenthood sued the state in November, saying the regulations made it impossible for the organization to do second-trimester abortions in its Alaska clinics. But Planned Parenthood agreed to put the lawsuit on hold while the medical board drafted new regulations.

[Planned Parenthood says restrictions on second-trimester abortions are unconstitutional]

Women's reasons for leaving Alaska for abortions emerged as a political issue this month after a Wasilla legislator, Republican David Eastman, asserted that poor women deliberately prolong their pregnancies to force Alaska Medicaid to pay for trips to Seattle. Under the new regulations, those abortions could likely be performed in Alaska.

Planned Parenthood wouldn't say if it would drop its case when the revised regulations take effect after a review by state attorneys, and the organization wouldn't make anyone available for an interview.

But a Planned Parenthood spokeswoman, Katie Rogers, wrote in an email that it appears the board "has taken steps in the right direction to remove unnecessary barriers that force women to leave the state to get care."

Planned Parenthood has said that about 100 women leave Alaska for abortions each year, and Rogers said that number is expected to drop "dramatically" if the state eliminates its current restrictions.

The changes, approved at a May 5 meeting in Anchorage, come amid a furor in Juneau that erupted after Eastman's unsubstantiated claims about abortion-related travel.

"We have folks who try to get pregnant in this state so that they can get a free trip to the city," he told the Associated Press in an interview. "And we have folks who want to carry their baby past the point of being able to have an abortion in this state so that they can have a free trip to Seattle."

The House voted Wednesday to formally reprimand Eastman for his statements.

[Alaska House votes for public reprimand of Wasilla representative after abortion comments]

Alaska women do travel to a Seattle Planned Parenthood clinic for second-trimester abortions. And the state does sometimes pay for out-of-state medical services and travel connected to abortions for poor women eligible for Medicaid, the state-federal health care program.

Medicaid and private insurance also pay for travel Outside for other medical conditions that require complex services not available in Anchorage.

Eastman, a social conservative, has focused on abortions and has called for an audit into state spending on that particular procedure and to travel connected to it.

But it appears unlikely such an audit could yield much in savings. The state spent $53,400 on out-of-state medical services and travel connected to abortions for Medicaid-eligible women in the last fiscal year, according to figures released this week by the state health department.

In-state spending on abortion-related services was higher, at $440,000. But it was still less than 1 percent of the $80 million in state spending on all pregnancy-related care during the same time period, according to the health department.

Alaska women travel out of state for second-trimester abortions because of the medical board regulations — not because they want to, said Tara Rich, legal and policy director for the American Civil Liberties Union of Alaska, which is assisting Planned Parenthood with its lawsuit.

"They really have no choice," Rich said. "These women are forced to travel thousands of miles away from their families, away from the people who know and love them to a strange place."

But even as GOP lawmakers have questioned travel paid by Medicaid, they've also opposed the revisions to the medical board regulations that could allow women to get second-trimester abortions inside Alaska, instead of Outside.

"Please retain regulations as they currently appear, and leave the political questions to those of us who were elected to address such questions in the proper time and place spelled out in our state law and Constitution," Eastman wrote in public comments to the board.

Asked to explain his opposition to the changes, Eastman wrote in an email: "I do not support allowing women to get second-trimester abortions."

Several lawmakers and aides submitted comments to the medical board, which received 467 pages of testimony.

Senate President Pete Kelly, R-Fairbanks, wrote that "making changes to regulations under the threat of a lawsuit is not sound public policy." Anchorage Democratic Sen. Berta Gardner, the minority leader, offered her "utmost support" for the proposed changes, saying they would remove an undue burden from Alaska women and produce "a higher quality of health care."

The medical board approved the revisions that were circulated for public comment with two minor changes — tweaking a reference to guidelines for doctors, and preserving a requirement that doctors evaluate a woman's "physical and emotional" health before performing abortions. The phrase "physical and emotional" was initially proposed to be deleted.

The revisions will repeal a requirement that doctors get a second opinion before an abortion after the 12th week of pregnancy.

They also would eliminate the requirement for an operating room and blood to be immediately available for second-trimester abortions. It's replaced with a new regulation that says abortions after a fetus has become viable can only be done at a hospital with a neonatal intensive care unit.

The "age of viability" — about 24 weeks, according to most medical experts — overlaps with the end of the second trimester of pregnancy by about a month, meaning that the new regulation could force some second-trimester abortions to be performed in hospitals.

Planned Parenthood said in its legal complaint that if it were to perform second-trimester abortions in Alaska, it would use clinics outside of hospitals. It argued that comparable and even more risky procedures, like colonoscopies and vasectomies, are already legally done outside hospitals in Alaska.

The medical board, at its meeting, considered adding a clause to allow abortions after the age of viability to be done at a "facility with the ability to immediately transport" a patient to a hospital with a neonatal intensive care unit — rather than at such a hospital. But that change was "not widely supported by board members," according to draft minutes of the meeting.

The revision was ultimately approved in a 5-3 vote.