Medicaid payments to provide abortions at Iowa hospitals or clinics would require the approval of the state’s most prominent abortion opponent: Gov. Kim Reynolds.
No one bothers to try.
Iowa’s Medicaid regulations include an unusual policy requiring a signoff from the governor’s office before the public health insurance program pays for any abortion services, even if they meet the state’s strict criteria.
Reynolds is a Republican and staunch opponent of abortion. In more than six years as governor, he has not been asked to approve Medicaid payments for abortions, said his spokesman Colin Crompton.
The novel policy, introduced by lawmakers a decade ago, leaves providers who perform abortions with a choice: absorb the cost of the procedure or risk a showdown with the governor.
The state’s Medicaid program spends about $8 billion a year to cover about 800,000 Iowans with low incomes or disabilities. It allows payment for abortions if a pregnancy endangers a woman’s life, is the result of rape or molestation, or involves fetal malformation. The Iowa Department of Health and Human Services posts a form for abortion providers seeking Medicaid reimbursement, but the program hasn’t paid for any abortions in years, said spokesman Alex Carfrey.
The federal government, which finances more than half of Medicaid costs, helps pay for abortions only in cases of rape or abuse or when the pregnancy threatens a woman’s life. But state Medicaid programs are required to cover such cases.
Most state Medicaid programs pay for at least some abortions, according to a 2019 report by the federal Government Accountability Office. The report found that in fiscal years 2013 through 2017, only Iowa, South Dakota and Wyoming did not cover any abortions meeting federal criteria.
Abortions are legal in the first 20 weeks of pregnancy in Iowa, where 4,062 abortions were reported in 2022. Reynolds signed a bill in July that would ban most abortions after six weeks, and is fighting the law in court. However, the abortion ban would allow exceptions in cases of rape, torture, serious fetal abnormalities and medical emergencies.
Iowa’s Medicaid program paid for 22 abortions in the fiscal year before lawmakers passed the governor-oversight rule in 2013. Most were performed at the University of Iowa Hospitals and Clinics in Iowa City, a state-owned facility that handles many of Iowa’s most complicated pregnancies. . After the rule went into effect, hospital leaders decided to pay for such abortions out of facility revenue instead of trying to bill Medicaid.
Jeanne Robillard, then vice president of University of Iowa Hospitals, declined to explain how the state ruling influenced the decision to end Medicaid bills for abortions. “I don’t want to get involved in the politics of it,” he told the Des Moines Register.
University of Iowa Hospital spokeswoman Laura Shoemaker said this fall that the hospital has not billed Medicaid for abortions in recent years. He progressed further comments.
UnityPoint Health, a large nonprofit hospital system based in West Des Moines, occasionally billed Iowa Medicaid for eligible abortions before the governor-approved rule went into effect. UnityPoint declined to comment on its current practices.
When the rule was enacted, it was called unique by the Guttmacher Institute, a national nonprofit that supports abortion rights. The group still lists Iowa as the only state that requires the governor’s permission for Medicaid payments for abortions. But a spokeswoman said the institute could not say for sure that no other state had implemented such a rule.
The policy was in effect while Reynolds’ predecessor, Republican Terry Branstad, was in office. Branstad also opposed abortion but advocated repealing the rule. A spokesman for Reynolds declined to say whether the current governor approves the rule.
Maggie DeWitt, executive director of Pulse Life Advocates, an Iowa group that opposes abortion, said she favors the policy as a way to limit the use of taxpayer dollars for the procedure.
“I don’t think the government should be paying for this. It’s the taking of an innocent life,” he said. “We should have as many stops along the way as possible.”
Sally Frank, a law professor at Drake University in Des Moines who studies women’s rights issues, said the rule appears intended to curb Medicaid payment requests. “It’s kind of set up to fail,” he said.
Frank, who supports abortion rights, said a hospital or clinic would have strong legal grounds to challenge any denial by the governor to pay for Medicaid for an abortion that meets Iowa’s criteria. He noted that states are required to cover Medicaid services under federal law He added that if the governor blocked the payment without citing a valid reason, the payer could argue in court that they were denied due process. “It shouldn’t be up to the discretion of the governor.”
But he wasn’t surprised to hear that no hospital or clinic challenged the policy because of the state’s increasingly conservative politics.
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