Politicians and special interest groups aren’t telling the whole truth about the law’s impact on women’s health. With the help of an OB/GYN, we set the record straight.
People across the country are appalled by the new law passed by the Republican-led Michigan Legislature, based on a petition created by Right to Life of Michigan. The law prohibits all Michigan insurers from providing insurance coverage for elective abortions, unless women buy a separate policy. Healthcare providers who seek reimbursement for an elective abortion procedure are subject to a $10,000 fine per violation, with only a few poorly defined exceptions.
In response to the justified uproar over this new law, which Chris Savage wrote about here the day it was passed, Michigan House Republicans were quick to post a Q&A on their website entitled “Here’s the truth about the citizen-initiated elective abortion insurance law.”
The thing is, the Q&A doesn’t tell the whole truth. Not even close.
For starters, Michigan Republicans are trying to absolve themselves of responsibility for this new law, stating that “The Legislature didn’t draft the law, it was citizen-initiated.” But the Legislature did, in fact, have the option of choosing not to vote on the measure and bringing it to the ballot box statewide in November 2014. There’s a good chance the measure would have failed, based on a poll conducted on behalf of the ACLU of Michigan in which about 64 percent of likely Michigan voters opposed such legislation.
What’s most troubling, though, is the medical misinformation in the Q&A — and the vague language in the law itself, which puts both patients’ health and doctors at risk.
Here are the facts, provided not by a politician but by an OB/GYN: Matthew Allswede, M.D., a member of the Executive Board of the Michigan Section of the American Congress of Obstetricians and Gynecologists (ACOG), which opposes the law.
To fully understand the health implications of the law, it’s important to read the language that defines elective abortions and the narrow exceptions that would allow abortion or emergency contraception procedures to be used without penalty. You can read the full text of the law here, but this section is where the key health-related issues are:
Sec. 11. As used in this act:(a) “Elective abortion” means the intentional use of an instrument, drug, or other substance or device to terminate a woman’s pregnancy for a purpose other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a fetus that has died as a result of natural causes, accidental trauma, or a criminal assault on the pregnant woman. Elective abortion does not include any of the following:
(i) The use or prescription of a drug or device intended as a contraceptive.
(ii) The intentional use of an instrument, drug, or other substance or device by a physician to terminate a woman’s pregnancy if the woman’s physical condition, in the physician’s reasonable medical judgment, necessitates the termination of the woman’s pregnancy to avert her death.
(iii) Treatment upon a pregnant woman who is experiencing a miscarriage or has been diagnosed with an ectopic pregnancy.
Tough to make sense of? You bet. That’s undoubtedly the way the authors of the petition circulated by Right to Life of Michigan would have it. But Dr. Allswede puts the issues in real-world terms, in response to the claims in the House Republicans’ Q&A.
“The citizen-initiated law allows insurance payment for elective abortions only through optional coverage, often referred to as a ‘rider.'”
That’s from the Q&A. Dr. Allswede says the language in the law about what constitutes an “elective abortion” is the greatest concern to the Michigan Section of ACOG.
The exception uses the non-medical terminology of ‘miscarriage.’ Our group put a letter on each legislator’s desk on the day of the vote, explaining that miscarriage is not a medical term. We used the example of what’s known as ‘inevitable abortion’ — which means the fetus is not going to survive but has not yet passed. During that period, if the patient doesn’t have the rider they’d be subject to paying the entire bill for any services provided, or physicians would have to stand back and do nothing until the woman’s life was in danger. Cases like this often involve very costly hospital procedures that may involve blood transfusions. It’s the kind of thing you want to have insurance for.
An “inevitable abortion” is exactly the scenario that was faced by a woman turned away by a Catholic hospital while she was in the throes of a miscarriage, prompting the ACLU of Michigan to sue on her behalf. In cases like this, the pregnancy is doomed, and to let it continue until it spontaneously terminates increases the risk of infection, scarring in the uterus and fallopian tubes and an inability for the mother to conceive in the future, says Dr. Allswede.
“Health insurance companies are still required to cover the cost of an abortion if the physician determines the mother’s physical condition is dire enough to warrant the procedure.”
The House Republicans’ Q&A doesn’t tell the whole story. The language of the law states that a physician is allowed “to terminate a woman’s pregnancy if the woman’s physical condition, in the physician’s reasonable medical judgment, necessitates the termination of the woman’s pregnancy to avert her death.”
Dr. Allswede says the phrase “the physician’s reasonable medical judgment” is of great concern.
Reasonable to whom? Will legal challenges be brought forth to establish what’s “reasonable”? We’re concerned about anything that creates a legal quagmire for physicians to do what’s part of their normal job and responsibility.
As we know from the ACLU of Michigan’s lawsuit, doctors working in Catholic hospitals may not see an abortion-related service of any kind as “reasonable.” What’s more, the law’s wording is seen by some as an attempt to intimidate physicians so they won’t perform abortions for fear of being fined or sued. The law could penalize healthcare providers for doing what they believe is in the best interests of the patient. To complicate matters even more, it’s very unclear who gets to decide whether a physician is in compliance with the law, says Dr. Allswede.
There’s another concern, given that the law only allows an exception for a risk to the life of the mother.
What the language doesn’t take into account is a situation where complications, abnormal fetal development or other circumstances could pose a risk to a mother’s long-term health — even if it’s not life-threatening.
There are women whose underlying medical conditions — such as diabetes, lupus or high blood pressure — put them at risk of other complications including coronary artery disease, kidney disease and other organ-related issues. Those women may not want to accept the risk of a pregnancy for a baby that won’t survive, but this legislation prevents them from making that choice. So it’s not just death but disability, and the potential to take years off a mother’s life. But it’s much harder to justify an abortion in those cases under the law’s exceptions.
“Women who are sexually assaulted can receive treatment, such as the morning after pill or insertion of an IUD, to prevent an unwanted pregnancy with full coverage from their insurance company.”
The law is often referred to as “rape insurance,” because many opponents believe there are no exceptions in the case of rape (or incest). They’re right.
Nothing in the law itself clearly states what’s in the Q&A comment above. Because of the way the section defining “elective abortion” is written, the use of emergency contraception could be open to interpretation. According to Dr. Allswede, the language of the law is very “craftily worded.”
Contraception prevents conception from happening. Some emergency contraception prevents implantation, which some may consider an abortifacient [something that induces an abortion]. When inserted before intercourse, IUDs are contraception. But when inserted after intercourse, they work as an abortifacient. But no one really knows for sure because it’s very hard to do studies in that setting. So someone could assert that the use of this type of medication or device was an abortifacient.
Once again, vague legislative language leaves women and doctors unsure about what options are allowed under the law.
This law goes into effect on March 13, 2014. But even if that date comes and goes, the law may not be here to stay. Groups including the ACLU of Michigan, Planned Parenthood Advocates of Michigan and the Michigan National Organization for Women are at work on strategies to overturn the law.
We’ll provide updates on these actions as they develop. In the meantime, now you know the real truth about the threats this law poses to the health of Michigan women.
[CC image credit: Alex Proimos | Flickr]
