February 20, 2014 — An Iowa law requiring Gov. Terry Branstad (R) to approve Medicaid reimbursements for abortions has unexpectedly gone untested because a state hospital refuses to submit the claims, the AP/Omaha World-Herald reports (AP/Omaha World-Herald, 2/18).
Iowa's Medicaid program covers abortions in instances of rape, incest and fetal anomalies, as well as to protect a woman's life. The new law requires the governor to sign off on all reimbursement requests for Medicaid-funded abortions.
The change was 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 hoped would reduce public funding for abortion (Women's Health Policy Report, 9/12/13).
However, the University of Iowa Hospitals and Clinics, where most Medicaid-eligible abortions are performed in the state, has declined to submit any Medicaid reimbursement claims since the law's enactment. As of mid-February, the hospital had provided 15 abortions for Medicaid beneficiaries who would have qualified for the coverage.
As a result, Branstad has never had to decide whether to approve any abortion payments. In the meantime, the hospital is absorbing the cost of the procedures, totaling $27,500 to date.
According to the AP/World Herald, the situation has kept Branstad, who is facing re-election this year, from having to decide between approving a reimbursement request for an abortion and potentially violating federal law by declining the coverage.
Republicans said the law is working. State Rep. Matt Windschitl (R) said, "The ultimate goal is to make sure taxpayer dollars are not being used for a purpose that people find morally unconscionable."
Abortion-rights advocates said the situation is still problematic, even if patients are still able to access abortions. Planned Parenthood of the Heartland President Jill June said, "At its heart [the outcome] is very deceitful. The governor gets to say he never approved any Medicaid payments because no one ever asked him to."
Elizabeth Nash, state issues manager at the Guttmacher Institute, said, "Certainly this idea that a provider doesn't seek out a reimbursement is troubling ... because this is a medical procedure that is legal and covered under some very limited circumstances but still is covered and should be treated as any other medical service" (AP/Omaha World-Herald, 2/18).