This spring, state legislators considered a controversial bill that would define what counts as a “medically necessary” abortion for the purpose of Medicaid reimbursement. Now, the Alaska Department of Health and Social Services is considering regulations tackling the same issue. That proposed rule would require doctors to get specific on why they think the state state should cover the procedure.
Abortion policy in Alaska is a war of inches. Because of a privacy clause in the state constitution, most of the fights don’t involve prohibitions of the procedure. They play out at the margins. And the question of whether the state should cover abortions for low-income women for medical reasons is one of the most contentious fights.
The latest battle comes in the form of physician paperwork. The Department of Health and Social Services wants doctors to fill out a sheet checking off why an abortion should be reimbursed. Commissioner Bill Streur says the point is to make doctors reflect on whether an abortion is medically necessary or elective. He wants the state reduce the number of payments for abortions he thinks are in the second category.
“We hope so. We don’t know, because I thought the last one would have helped, but it didn’t help. In fact, our numbers seem to be up this year from previous years.”
When Streur says the “last one,” he’s referring to a form that doctors have been filling out for a year now. That form puts abortions in two categories: ones the federal government pays for because the pregnancy could kill the woman or because it’s the result of rape or incest, and ones that the state pays for because they could have a dangerous effect on a woman’s physical or mental health.
The new form gets even more detailed. It would make doctors check off a specific medical condition — like epilepsy or heart disease — as a reason for getting a reimbursement. While opponents of the new regulations have privacy concerns, Streur says he doesn’t see an issue with patient confidentiality.
“For instance, if a recipient has diabetes or if a recipient has a heart condition, if they have other issues — a cancer– if they’re on special medications that preclude or make it dangerous to continue with a pregnancy, we already have that information because we’ve been paying for their care.”
Planned Parenthood has already come out against the regulations, saying that if the goal is to limit state payment for abortion the Department is putting a de facto restriction on access for low income women. They also say the proposed rule could violate the equal protection clause by placing different requirements on women who get abortions instead of taking their pregnancies to term.
Other providers describe the regulations as a form of bullying, meant to discourage doctors from getting Medicaid reimbursement by making them feel like the state is scrutinizing them more intently. One physician, who didn’t want his name used, says he personally thinks the regulations are intimidating:
“This actually happened to me about 15 years ago. But if someone from the enforcement branch basically said, ‘I don’t think you’re exercising due clinical oversight, and you’re essentially billing the state for things they shouldn’t be paying for, and you’re breaking the law.’ So from that practical point, that’s chilling to me.”
This provider added that he sees the regulations as intruding on the doctor-patient relationship.
For his part, Commissioner Streur says he doesn’t think the new form would be much more burdensome than the previous one, and that it would give the state a better data set to work with when trying to curb the number of abortion payments.
But Streur says the proposed regulations have stirred up some controversy. Since the rules were first introduced on Friday, he’s gotten a mixed response. The e-mails have broken down along political lines, with opponents of abortion being especially supportive:
“[They’ve been] very nice, very complimentary because of the direction that we’re going in terms of right to life … and not very nice from those I’m denying care,” says Streur. “I’m not denying care. I’m denying reimbursement for the services performed that are not medically necessary. That’s the only thing we’re doing. We are not denying care. We can’t deny care.”
The Department is taking public comment on the proposed regulations until September 27.