A public hearing on a proposed ban of most Medicaid-funded abortions will be held Monday morning.
In 2017, a single woman making up to about $17,000 a year — 150 percent of the federal poverty level — in West Virginia was eligible for a Medicaid-funded abortion based on medical necessity. House Bill 4012 aims to prevent Medicaid dollars from being spent on any abortions in West Virginia, except to save the life of the mother.
Only South Dakota has similar legislation, which is stricter than the federal Hyde Amendment.
The Hyde Amendment prevents federal dollars from being spent on abortions, except to save the life of the mother or in cases of rape or incest. During discussion of the bill during a House of Delegates health committee meeting last month, committee members denied a motion by Delegate Mike Pushkin, D-Kanawha, to add exceptions for rape and incest.
Delegate Barbara Fleischauer, D-Monongalia, also asked a series of questions, to which an attorney for the committee responded that women who are suicidal, women whose doctors say they are psychologically or emotionally unready for a child and women who are addicted to drugs would also not be eligible.
“While this bill would not prohibit a woman from obtaining an abortion, it will limit the amount of tax dollars that fund a procedure many West Virginians have a moral and conscientious objection to,” Delegate Kayla Kessinger, the bill’s lead sponsor, said in an email. “Women in West Virginia, regardless of their socio-economic background, deserve better than abortion, and have many choices when it comes to pregnancy, including adoption, if they feel as though they are not prepared to be mothers.”
Kessinger, R-Fayette, also said, “If women choose that motherhood is best for them and their child, the state and nonprofit organizations provide healthcare and benefits to women and their families.”
In 1993, the state Supreme Court overturned a state law banning Medicaid funding of abortion, ruling that Medicaid exclusions of abortion are unconstitutional. Then-Chief Justice Margaret Workman wrote in the opinion that the law “constitutes a discriminatory funding scheme which violates an indigent woman’s constitutional rights.” The West Virginia Department of Health and Human Resources has not taken a side in the current debate, but sided with advocates for abortion rights at the time.
The bill would ban Medicaid funding of abortion by amending the definition of “medical services” in state law to exclude abortion. Bob Bastress, a constitutional law professor at West Virginia University who is married to Fleischauer, said the bill would still be unconstitutional, because it “violates the principles set forth in the WV Supreme Court’s decision.”
Sharon Lewis, director of the Women’s Health Center in Charleston, remembers before the state Supreme Court decision, although she wasn’t working in administration at the time. Lewis has worked at the clinic, the sole provider of abortions in West Virginia, for 29 years.
She recalled poor women using rent, utility and grocery money to pay for abortions. Some even drank motor oil to try to terminate pregnancies, she said. She remembers wards at hospitals devoted to botched abortions.
“Desperate women died,” Lewis said. “They did what they had to do and this, as it is written, is a blatant effort to eliminate access to safe abortion care for poor women, and it’s outrageous.
“Women should have the ability to control their bodies without government interference, and poor women are as entitled to that as rich women.”
The West Virginia section of the American College of Obstetricians and Gynecologists opposes the bill.
“Funding restrictions and restrictions that unduly single out abortion from other medical procedures have no basis in evidence,” the section wrote in a letter to health committee members. “They only serve to impede access to safe abortion care and, in some cases, function as a de facto abortion ban.”
It’s unclear what percent of abortions in the state are paid for by Medicaid. The Kaiser Family Foundation reports that in 2013, there were about 1,800 abortions in the state. DHHR officials did not respond to several requests for a more recent total.
DHHR said that Medicaid paid for about 1,500 abortions last year, at a cost of $326,000. That’s up from 657 abortions in 2008, at a cost of $222,000. West Virginia expanded its Medicaid program to cover more people, a result of the Affordable Care Act, in 2014.
“This bill will impose profound hardships for some of the most vulnerable West Virginia women, who already face significant barriers to accessing health care,” ACOG wrote.
Christina Mullins, director of the Office of Maternal, Child and Family Health at DHHR, spoke to the economic effects of unintended pregnancies. Nearly half of pregnancies in West Virginia are unintended, according to Mullins.
Women who become mothers as a result of unintended pregnancies are less likely to finish high school or college, more likely to be single mothers, and have more trouble paying for childcare and the expenses of pregnancy, according to Mullins. She said DHHR’s programs, such as the Adolescent Pregnancy Prevention program and its family planning programs at health departments and community health centers, stress the importance of being ready for pregnancy.
“It’s something we talk about every day,” she said. “The economics of an unintended pregnancy can be devastating.”
West Virginia had the second highest rate of nonelderly women in poverty in the country in 2016, next to Mississippi, according to the Kaiser Family Foundation.
Mullins, addressing whether she’s seen any other states see success addressing the issue in a bipartisan manner, pointed to Colorado. The Denver Post reported in November that the teen birth rate fell 54 percent and the teen abortion rate fell 64 percent in eight years, after spending $28 million to distribute IUDs for low-income women to health clinics and school-based health centers at high schools.
Researchers at the University of Colorado found the drop in pregnancies saved almost $70 million in costs on state and federal assistance and health care programs for low-income mothers, according to the report.
Delegate Amy Summers, R-Taylor, had said during the health committee meeting that women seeking abortions could get funding from nonprofits. She confirmed later that she made the statement but did not answer a request for an example of such a nonprofit.
Kessinger, the sponsor, and Fleischauer said they knew of no organizations that assisted with this; Lewis said she knew of no substantial resources. Margaret Chapman Pomponio, of the women’s health and abortion rights advocacy organization West Virginia Free, said the organization has about $15,000 for that purpose.
The bill was sent from the House health committee to House judiciary. Supporters and opponents of the bill may speak at the public hearing in the House of Delegates chamber at 8:30 am on Monday.