September 12, 2013 — University of Iowa hospitals have essentially circumvented a law requiring Gov. Terry Branstad (R) to approve Medicaid claims for abortions by declining to bill the insurance program for the procedures, the Des Moines Register reports (Leys, Des Moines Register, 9/11).
Iowa's Medicaid program covers abortions in instances of rape, incest and fetal anomalies, as well as to protect a woman's life. The recently passed law requires Branstad to sign off on all reimbursement requests for Medicaid-funded abortions.
The changes were billed as a compromise in a larger health care bill that includes a Democratic proposal to expand the state's Medicaid program and a Republican proposal to give Branstad authority over Medicaid abortion coverage decisions, which conservatives hope will reduce public funding for abortion (Women's Health Policy Report, 8/6).
Only 22 abortion procedures were submitted for Medicaid reimbursement in the most recent year for which data are available, and nearly all of them occurred at University of Iowa hospitals, according to the Register.
State officials in April said that Medicaid had paid for seven abortions -- all related to fetal anomalies -- at that point in the fiscal year (Des Moines Register, 9/11). The new law took effect on July 1, and a Branstad spokesperson said in August that no claims had been submitted since then (Women's Health Policy Report, 8/6).
University of Iowa Vice President of Medical Affairs Jean Robillard on Wednesday said that since the law took effect, the hospital has provided two abortions involving fetal anomalies that could have qualified for Medicaid reimbursement but were not billed to the program. He did not indicate if the university's hospitals would rule out seeking Medicaid funds for abortions in cases of rape or incest or when a woman's life is endangered, which may be paid for with federal dollars.
Robillard said that billing issues would not affect patient treatment.
No Reason Given for Policy Change
When asked whether the decision to not submit the claims was related to the new law, Robillard said he did not "want to get involved with the politics" of the situation. However, he noted that federal dollars are not available for abortions in cases of fetal anomalies.
The Guttmacher Institute's Elizabeth Nash noted that the university's decision cannot be attributed to changes in the federal policy, which has been the same for decades. She explained that Iowa is among several states that use their own money to pay for abortions in cases of fetal anomalies, although it is the only one that requires the governor's approval for individual cases.
Planned Parenthood of the Heartland President Jill June in a statement said the university's decision highlights the law's shortcomings, adding that the university's "reluctance to submit legitimate claims underscores the fact that this is bad public policy; it discriminates against women and the physicians who provide the health care they need."
Branstad spokesperson Tim Albrecht did not comment on the governor's thoughts on the university's decision. "Medicaid providers have a great amount of discretion in the claims they submit to the state for reimbursement," Albrecht said.
State Sen. Joe Bolkcom (D) said that he is "proud" the university is "stepping up to help these women" but added that he would prefer the hospitals submit the claims.
State Rep. Matt Windschitl (R) -- a supporter of the law -- said he also backs the university's decision because it is a "step forward for the pro-life community." However, Windschitl acknowledged that the state could still be considered to be involved in financing the procedures because the university is a public institution (Des Moines Register, 9/11).