Not long after a federal district court judge in Indiana temporarily enjoined a law excluding Planned Parenthood from participation in a federally funded program, a federal court in Kansas did the same. In both instances, the state law effectively singled out Planned Parenthood for exclusion because of its association with abortion. And in both cases, the court issued a preliminary injunction and held that the law would likely be found unconstitutional because it imposed additional eligibility criteria that were inconsistent with the federal law.

The Kansas case is significant because it went even further. It held that by targeting Planned Parenthood for exclusion because of its association with abortion, the state law created an "unconstitutional condition" on public funding that violated the First and Fourteenth Amendments. In this way, the court highlighted the real problem with state defunding attempts: it isn't simply about states getting carried away legislatively in ways the conflict with federal law; rather it is about states deliberately using their administrative power to punish not only providers that perform abortions, but those who actively seek to promote women's access to this kind of health care.

Continue reading "Another Court Prevents State Attempt to Defund Planned Parenthood" »

In the last few years, a renewed wave of attacks on abortion rights has captured media attention. One form of attack has been to target public funding for Planned Parenthood -- a provider of a wide range of women's reproductive and other preventive health services that some associate with abortion, despite the fact that abortion only makes up a very small percentage of the services it offers, and that some Planned Parenthood facilities do not offer abortion at all. At the national level, Republicans in the U.S. House of Representatives led an unsuccessful attempt to defund Planned Parenthood, but now states have taken up the fight. Indiana was the first to enact a law prohibiting Planned Parenthood from receiving Medicaid payments or federal funding for disease intervention services, and other states are trying to follow Indiana's lead. A successful challenge to Indiana's law in federal court, however, shows that these defunding attempts likely violate federal law.

In May of this year, Indiana enacted a law prohibiting the state from contracting with entities that perform abortions, but it exempted hospitals and ambulatory surgical centers. Effectively, this meant that the state could exclude Planned Parenthood of Indiana (PPIN) from participating in its Medicaid program, as well as prevent it from receiving other grants administered through the state, such as the Disease Intervention Services grant funded entirely by federal money. A number of plaintiffs, including PPIN, Medicaid beneficiaries, and individual health care providers, challenged the law in Planned Parenthood of Indiana (PPIN) v. Commissioner of Indiana State Department of Health. In June, a federal district court judge enjoined the state from implementing the law, holding that the exclusion from both programs violated federal law. A full hearing on the merits has not occured yet, but the plaintiffs won the preliminary injunction because they were able to prove a likelihood of winning on the merits, a lack of adequate remedy at law, and future irreparable harm if the injunction were not granted. The plaintiffs challenged the exclusions on several grounds, but the court's decision turned on plaintiffs' claim that the Indiana law conflicted with express federal spending conditions that regulated each program, and thus was preempted under the Supremacy Clause of the U.S. Constitution.

Continue reading "Federal Court Halts Indiana's Defunding of Planned Parenthood" »

Today, July 21st, the National Women's Law Center is hosting the "Birth Control: We've Got You Covered" Blog Carnival to discuss the Institute of Medicine (IOM)'s recent recommendations on women's preventive health services. Click here to join the Blog Carnival.

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Health and women's advocates are praising the Institute of Medicine (IOM)'s recent recommendations to include prescription birth control among the preventive health services that insurance companies must cover without a co-pay under the Affordable Care Act. This is important because cost can be a significant barrier to the consistent, effective use of birth control. For decades, birth control has been excluded from many health plans, but even when it is covered, cost-sharing keeps some women from getting it or using it consistently. A 2010 survey reveals that more than a third of women voters struggle with the cost of birth control, and the IOM report notes that women are consistently more likely than men to delay or forego health care because of cost.

The consequences of cost-related barriers to birth control are signficant: According to the Guttmacher Institute, women who do not use contraceptives or use them inconsistently account for 95% of the three million unintended pregnancies that occur every year. Unintended pregnancies can have harmful physical and emotional health effects for women, especially those who sufffer from chronic medical conditions or are at risk for health complications resulting from pregnancy. The IOM's recommendation to provide birth control as part of preventive health services is an important step toward improving the health and well-being for insured women.

As we celebrate this achievement, however, we must remember that for many women the fight for reproductive and sexual health care continues. Even with private insurance expansion under the Affordable Care Act, many women will be uninsured or covered by Medicaid. Currently, the uninsured and many Medicaid beneficiaries rely on clinics that provide free or low-cost reproductive health care, including birth control, and these clinics depend heavily on federal and state funding. Cuts in funding for family planning services, and the more radical defunding attacks that target providers of free and low-cost birth control are threatening reproductive health access and the well-being of our most vulnerable women.

Continue reading "Birth Control Coverage is a Critical Win for Women's Health, but the Fight Continues for Medicaid Beneficiaries & the Uninsured" »

The first part of 2010 has brought a flurry activity on the abortion front. Anti-abortion activists are fighting hard to get laws passed that are designed to discourage abortion by creating additional obstacles for the women seeking abortion and new liability for the physicians performing abortions. This fight is being played out in federal courts -- patients' advocates and providers are immediately challenging these laws as unconsitutional. Last week, two federal district courts granted temporary injunctions blocking abortion laws in Nebraska and Oklahoma, respectively. This is a promising sign for patients and providers because in order to get the injunction they had to convince the court that they would likely be succesful on the merits of their claim and that the law presented an imminent threat of irreparable harm by jeopardizing women's access to important reproductive health services. Full hearings will probably occur early next year.

Continue reading "Reproductive Health Update: Courts Temporarily Enjoin Abortion Laws" »

A recent New York Times article describes a growing trend among states to restrict access to abortion. These restrictions are coming in various forms: some are outright bans on abortion after a certain time, some ban insurance coverage for abortions in the new health insurance exchanges, and some try to discourage abortion through the use of ultrasound and the interrogation of women about their reasons for seeking an abortion. In an earlier posting, I have explained why mandatory ultrasound laws are unconstitutional and unethical, and I will continue to look at other laws to examine their legality and impact on health care for women. For a comprehensive overview on state laws regulating abortion, you can visit the Guttmacher Institute website at http://www.guttmacher.org/sections/abortion.php. The Guttmacher Institute is an organization dedicated to advancing sexual and reproductive health through research, policy analysis, and public education. It monitors these state developments and provides regular updates.

There is a growing trend among states to try to make abortions more difficult to access, and a law passed in Oklahoma provides the latest example of this trend. In April, Oklahoma passed a law that requires women seeking an abortion to undergo an ultrasound, and during the ultrasound, the woman must be shown a fetal image and hear a verbal description of fetal characteristics, such as heartbeat and size. The hope is that if women view a sonogram and hear details about the embryo or fetus they will change their minds and decide to preserve the pregnancy.

Supporters of these "mandatory ultrasound" laws try to justify them on "informed consent" grounds - they claim that this is necessary to ensure that women have all the information they need to make an informed choice about abortion. However, a closer look at the Oklahoma law reveals a much more insidious purpose and strategy to undermine informed consent and interfere with women's reproductive choice. The law is an unethical invasion into the physician-patient relationship and an unconstitutional burden on a woman's reproductive rights.

Continue reading "Oklahoma Imposes Unethical and Unconstitutional Barriers for Women Seeking Abortion" »