Abortion in an Election Year: Constitutionality Central to the Debate Over Taxpayer-Funded Services

A bill that would remove Medicaid funding for medically necessary abortions has been drawing a lot of attention in the House since passing through that chamber’s Health Committee last week. While the issue is inherently divisive, many questions about House Bill 4012’s constitutionality have been raised — further drawing attention to the matter.

According to a recent Hart Research poll, nearly two-thirds of West Virginia voters support the state’s Medicaid program covering a range of reproductive health care services, including annual check-ups, prenatal and maternity care, birth control and abortion. House Bill 4012 would remove medically necessary abortions from a list of those services that Medicaid provides.

In 1993, the West Virginia Supreme Court of Appeals overturned a law signed by then-Governor Gaston Caperton that included a provision banning abortions for low-income women when medically necessary. The court determined that it was discriminatory to not provide such services to low-income women.

 

Republican Del. Kayla Kessinger is the lead sponsor of House Bill 4012. She said the bill takes a different approach to the one that was struck down in 1993.

 

“The way that we are going about this bill is to redefine the medical procedure and we are well within our rights as the Legislature to define and redefine words. We do it almost every day in the Legislative and the legislative process,” Kessinger said.

 

“So, I believe that this bill is constitutional. But as with every piece of legislation we pass the Supreme Court can and may have a final decision.”

 

Kessinger also argues that some taxpayers object to paying for abortions and that the number and cost of them has increased in recent years.

 

According to data from the West Virginia Department of Health & Human Resources’ Bureau for Medical Services, 1,506 abortions were provided by Medicaid in State Fiscal Year 2017 — coming in at a cost of more than $326,000. While the number of Medicaid funded abortion has more than doubled since 2008, the cost to the state has increased by about a third — an increase of just over $100,000.

 

The American College of Obstetricians and Gynecologists opposes House Bill 4012. As an OB-GYN, House Health Chairman Joe Ellington is a member of that organization. His committee advanced the bill last week, sending it on to its second reference in the House Judiciary Committee. An amendment to House Bill 4012 was shot down in the House Health Committee that would have kept Medicaid funding in place for abortions if the pregnancy occurred as a result of rape or incest.

 

Chairman Ellington acknowledged the controversial nature of the bill, but said he could not speak to any issues of constitutionality.

 

“One concern is that having taxpayer money that goes toward performing an abortion but on the other side in the position the West Virginia colleague has is that you want to make sure that our citizens can obtain safe and legal abortions if they so desire,” Ellington said.

 

“Paying for that is how you would go about that, though. So, whether taxpayer funds go to it — or contributions — from private organizations or nonprofit organization that may supplement the costs for individuals that are seeking abortions. So, as long as they do it under the code of West Virginia, it should still be legal,” he said.

 

Top House Democrats, though, argue that the bill should not be a priority for the Legislature. Minority Leader Tim Miley also said the legislation addresses an issue that doesn’t need attention and, furthermore, gets in the way of decision made between a woman and her doctor.  

 

“This is par for the course for this leadership team of raising issues that try to divide people instead of bringing people together. But, in this case, I understand the bill is to address pregnancy terminations that are paid for by Medicaid,” said, Miley, noting that the the only pregnancies that are terminated by using Medicaid are those that are medically necessary and certified by a doctor.

 

“I’m not really sure what the issue is and why they’re trying to make it an issue other than having government inject itself into the lives of a woman and the advice she’s getting from her doctor,” he added.

 

House Minority Whip Mike Caputo echoed Miley’s concerns as far as legislative priorities. And with House Bill 4012’s constitutionality in question, Caputo says the Republican majority may be using the measure as a barometer for support for a joint resolution that could find its way onto a ballot as a constitutional amendment. But, if it comes to that, Caputo said the issue should stand on its own and away from election of state officials.

 

“If this Republican leadership team really believes that’s an issue that should be on the ballot — and if it’s about policy — then let’s have a special election and let’s do it prior to the general election,” Caputo said.

 

Caputo and other Democrats believe that putting a constitutional amendment on the ballot could be a way for Republicans to try to retain the majority in the Legislature.

 

“The only point I want to make is, if this is really about policy —  if this is something they think is good for West Virginia — then we should have it on a special election with no other candidates on there and just these issues. And let’s find out what people really want,” Caputo said.

 

While not yet on the agenda, the House Judiciary Committee is expected to take up House Bill 4012. As for the larger issue of abortion, lawmakers from either chamber have yet to introduce a joint resolution that would address the matter.  

House Passes Raw Milk Bill, Goes to the Governor

After a veto from Governor Tomblin last year, members of the Senate and the House have both taken up a bill that would allow West Virginians to consume raw milk. Members of the Senate passed the bill earlier this month on a vote of 22 to 12, and yesterday, Delegates cast their final votes.

Senate Bill 387 would allow West Virginians to enter herd-sharing agreements, or shared ownership of milk producing animals. After filing the agreements with the state Department of Agriculture, it would then be legal for all of the owners to drink the raw milk produced by the animal. The herd-sharers would also be required to meet state and federal standards set by the state veterinarian and report any instances of illnesses.

The bill would not allow the owners to sell or distribute the raw milk to anyone else.

Delegate Kelli Sobonya, a Republican from Cabell County stood in favor of the bill.

“There’s many products that remain legal in West Virginia that have presented true dangers,” Sobonya noted, “Tobacco’s still legal, yet we keep talking about how dangerous it is; artificial sweeteners, certain legal drugs are dangerous. Ladies and gentlemen, this bill has been discussed for several years. Let’s get this out of the House, back to the Senate for a House message, let it go to the governor. If you’re against it, vote against it, but if you’re for liberty and food freedom, vote for it.”

Delegate Don Perdue is a Democrat from Wayne County and the former chair of the House Health Committee. He stood against the bill.

“We bring this down to suggest it’s an issue of freedom. It’s freedom we’re talking about here; freedom to do whatever you want. Well folks, that means we need to get rid of all the public health laws; smoking in buildings, we need to get rid of all of those; that’s what’s being said. And the troubling thing about that is; your right to be sick ends where my right to be healthy begins,” Perdue said.

House Health Committee Chair Joe Ellington spoke in support of the bill, citing other foods like raw meats, certain vegetables, and even water that could contain harmful bacteria.

“So you have to put in perspective as far as numbers. Yes there are potential serious infections, yes people can potentially die, but as I mentioned last year, most of the things we’re exposed to everyday can do the same thing,” Ellington explained.

Senate Bill 387 passed 88 to 11 and now goes to the governor for consideration.

In the governor’s veto message last year, Tomblin said the bill could pose serious risk to public health particularly in children, pregnant women, and people with compromised immune systems.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

House Begins Discussion Over Abortion Bill

The House of Delegates is just beginning its work on a bill that would ban one of the nation’s most commonly used second-trimester abortion methods.

As approved in the Senate, Senate Bill 10 would ban what are commonly referred to as dismemberment abortions. That ban is only when the abortion is elective, not in cases of medical emergencies. Discussion over the bill began with a public hearing Monday morning.

Senate Bill 10 would ban what are medically known as dilation and evacuation abortions in West Virginia. While physicians say D&E abortions are common across the country, testimony given before the state Senate said those abortions is actually rare in West Virginia. Physicians also testified it is one of the safest abortion options.

But during a public hearing on the bill Monday morning, 5 people spoke in favor of banning the practice, calling the technique gruesome. 

Senate Bill 10 requires doctors performing these types of abortions euthanize the fetus before dismemberment. Delegate Joe Ellington is the House’s Health Committee Chair, and he’s also a practicing OBGYN.

“There’s pros and cons to both sides of it,” Ellington said, “One part is terminating a fetus that’s alive before it is extracted by the procedure that the sponsors are trying to eliminate. It does affect the standard of care that’s currently in place with the medical profession. From an obstetrician’s standpoint, I’m going to have to balance that with what the proponents are willing to try to do.”

Members of the House Health Committee could take up Senate Bill 10 as soon as Tuesday.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

Could Drug Testing Save W.Va. Dollars?

The debate over drug testing public assistance recipients was revisited in an interim session Monday. One of the issues on the table is how to make a pilot program work without costing the state additional dollars that are hard to come by.

The Legislative Oversight Commission on Health and Human Resources Accountability met at the Capitol Monday to continue their discussion on a possible pilot program that would drug test public assistance recipients.

“A lot of people are interested in us having the testing program as one tool to decrease drug abuse in the state,” said Delegate Joe Ellington, a Republican from Mercer County and the chairman of the committee, “I, as a practicing obstetrician, see a lot of babies being born to drugs.”

Ellington says this is where many substance abuse problems start. The babies are born addicted to drugs and could either develop behavioral issues, or become more prone to addictive behaviors in the future.

“The current structure we have to help prevention and training and teaching and rehabilitation does not seem to be solving the problem. We’re not opposed to any of those parts. We want to try to enhance those efforts to decrease drug use, but we’re looking at other ways of identifying who is using drugs, so we can get them into programs.”

At the forefront of the discussion Monday were two bills introduced during the 2015 legislative session.

Senate Bill 348 would’ve created a pilot program for drug screening of cash assistance recipients. House Bill 2021 would’ve implemented drug testing for recipients of federal-state and other state assistance dollars.

While both bills had minor differences, what they did have in common was a requirement to drug test based on reasonable suspicion.

At the end of the 2015 session however, both bills were left on the table.

Now lawmakers are reconsidering the issue for the 2016 session.

The committee posed a few questions to the Department of Health and Human Resources and the Bureau for Public Health. They discussed the anticipated cost of target type enforcements on specific populations, the impact on pregnant women who abuse illicit drugs, and what happens to someone after they’ve tested positive for an illegal substance.

Lawmakers were trying to get a sense of how to potentially re-draft legislation that died last year.

But the question still stands – is drug screening of people in state assistance programs constitutional? And would it actually save the state money by implementing these kinds of tests?

Delegate Ellington thinks there’s a good chance.

“Data I received from DHHR previously, a couple years ago, said the average cost for detox was $230,000 a kid,” he said, “That’s a lot of money that could go back to our schools, to teacher pay, to education, to other services, to rehab, and then you look at the lost productivity and the livelihood of those kids and the future to grow up into, and that’s what we’re looking at – the future of our kids in West Virginia altogether.”

However, Sean O’Leary, a policy analyst at the West Virginia Center on Budget and Policy, says the facts show otherwise – many states that have implemented screening programs in the hopes of saving money, haven’t seen the results.

“Policies like this has really two goals, one to curb substance abuse and two to save state money by not paying people who are using drugs, but when you look at what other states have gone through it’s failed to achieve either one of those goals,” O’Leary said.

Thirteen states have passed legislation to drug test or screen public assistance applicants or recipients, and as of July 2015, at least 18 states have proposed legislation requiring some form of drug testing or screening.

West Virginia is one of those eighteen states.

“Under 1 percent of applicants are testing positive when they do, do these tests, so they’re not saving significant amounts of money,” O’Leary explained, “In some cases, they’re actually spending more money administering and collecting these results or these tests, then they are actually saving money from stopping people from using drugs and collecting assistance.”

O’Leary says there’s a misconception that drug abuse is more prevalent among low income people, when actually substance abuse can affect all walks of life.

Delegate Ellington says he knows finding the right legislation won’t be easy.

“The Senate one was looking at three counties as a smaller group to cut down the expense. The other, the House bill, looks at people that have a higher suspicion of drug use, whether they’ve had a previous conviction, or the children were born addicted to drugs, we know that those are positives, so that’s where the higher suspicion is. We want to just target that part. Will you miss some others, yes, but we’re looking at the numbers, we’re trying to decrease the number of testing that has to be done, and look at the number of individuals we can get back off. So there’s no great way to do it, but we’re trying to make an effort to.”

Next month, the committee on Health and Human Resources Accountability will likely begin to draft legislation that could become the new drug testing bill of 2016.

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