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Abortion Access and Pending Pennsylvania Legislation

Sara Jacobson, Esq. on 06/10/2011

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abortion article image Politicians often say that abortion should be, “safe, legal, and rare.” This week Pennsylvania’s General Assembly passed bills in reaction to the abuses in the Gosnell clinic, seeking to prevent such harm in the future and to protect women’s health. Recently passed and pending legislation increases the regulation of abortion providers while restricting resources available to pay for the procedure. The new laws burden access to abortion, and may ultimately make women less safe.

On June 7th the Pennsylvania State Senate passed legislation that will make abortion harder to pay for. SB 3, passed by a vote of 37 to 12, prohibits private insurance plans qualified in the forthcoming health insurance exchanges from providing coverage for abortion. There are exceptions to the prohibition for rape and incest, but to qualify for them a woman must contact police and name her assailant. The bill permits, “optional supplemental abortion coverage provided the individual pays a separate premium for the coverage,” which means that if someone has the forethought and the means, she can purchase additional coverage for abortion services. Although the contours of the federal health care overhaul are still being determined while courts consider its constitutionality, enacting SB 3 will make it harder to pay for abortion in Pennsylvania once the health care exchanges come into effect. Pennsylvania has long banned Medicaid funding for abortion services, and federal funds cannot be used to pay for abortions except in specific circumstances. While abortion will become harder to pay for, other new legislation will also make it more difficult to obtain.

A second abortion bill under consideration in the state senate this week, SB 732, adds new regulation of abortion providers that operate independently from hospitals. The Mensch amendment to SB 732 passed by a vote of 31-19 on June 8th mandates the expansion of procedure rooms. Among other things, it also requires freestanding clinics to have an RN on duty at all times, even when abortions are not being performed. These new regulations will necessitate remodeling and will increase staffing costs. Increased abortion costs will either be passed on to patients or, alternatively, could cause clinics to close. When similar ambulatory surgical facility regulations passed in Texas, the number of providers dropped from 20 in 2004 to two in 2005. Bonnie Scott Jones, JD, and Tracy A. Weitz, Legal Barriers to Second-Trimester Abortion Provision and Public Health Consequences, Vol 99, American Journal of Public Health, No. 4 (April 2009). By 2007 only 2 additional clinics made the compliance renovations, at an estimated cost of $750,000 to one clinic. Id.

There are currently about 20 freestanding abortion clinics in Pennsylvania, none of which are believed to be in compliance with the proposed requirements of the Mensch amendment for larger patient rooms and hallways. Cost for abortion services are expected to triple at any freestanding clinics that are able to comply with the legislation instead of shutting their doors. 88% of counties in Pennsylvania do not currently have an abortion provider, and there are no freestanding abortion clinics north of Lehigh County.

SB 3 and SB 732 as amended will make it harder to legally obtain and pay for abortion, particularly for women who cannot afford the rising costs. The new laws, however, will not reduce demand for abortion because they cannot stop unwanted pregnancies. Estimates say that at current rates, one woman out of every three will have an abortion by the time she is 45. Guttmacher Institute. State Facts About Abortion. 2011. http://www.guttmacher.org/pubs/fb_induced_abortion.html#5 And See. Jones RK and Kavanaugh ML, Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion, Obstetrics&Gynecology, 2011. When federal funding, state funding, and private insurance coverage will not pay for abortion, access to safe, legal abortion becomes determined by wealth, and “rare” becomes the equivalent of poor. If poor women cannot access abortion without financial struggle, some abortions will be delayed until sufficient funds can be raised, increasing demand for clinics that operate outside of existing regulations and provide late term services. When asked at a recent Senate Public Health and Welfare committee hearing why she went to Gosnell for an abortion, Tyihisha Hudson, explained she went there because he had a reputation for providing the cheapest services.

In Planned Parenthood of Southeastern Pennsylvania v. Casey, 112 s. Ct. 2791 (1992), the Supreme Court held that although states may regulate abortion, regulations that unduly burden access to it, violate constitutional due process. It may ultimately be up to the courts to determine whether legislation that makes abortion functionally unavailable to poor women qualifies as an undue burden to the right to access. Any such challenge would take years, and ultimately this new legislation may prove to not be legal. In the interim, it will make obtaining abortion costly and therefore difficult, but not necessarily any more rare. If existing facilities close, leaving low income women without legal, regulated options, it will not make anyone safer.

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