By Tessa Weinberg
More than half a dozen bills have been filed so far that aim to strip abortion providers or their affiliates of participation in the state’s Medicaid program or from receiving public benefits more broadly.
In Missouri, there is only one facility currently remaining where abortions are performed — Reproductive Health Services, affiliated with Planned Parenthood in St. Louis.
Since the mid-90s, lawmakers have attempted to restrict public funds from going to Planned Parenthood, but legislative efforts last year gained new ground when an essential tax on hospitals, nursing homes and pharmacies, known as the federal reimbursement allowance (FRA), was used as leverage.
That effort fizzled during a special session over the summer. But heading into the 2022 legislative session, lawmakers and anti-abortion advocates say it is time for action.
“When Republicans took over supermajorities in the early 2000s, that was a big promise that was made to the voters that we would stop taxpayers’ dollars from funding abortions,” said state Rep. Mary Elizabeth Coleman, R-Arnold, later adding: “Our inability to get that done with the FRA is very frustrating to me.”
Abortion-rights advocates are gearing up for a fight, arguing that the legislative attempts are aimed at more than just limiting access to abortion, but targeting access to reproductive health as a whole.
“The irony of targeting Planned Parenthood and more broad reproductive health services is that if you’re really truly trying to reduce and eliminate abortion, attacking access to birth control and more comprehensive sexual and reproductive health is not the way to do that,” said Colleen McNicholas, the chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri.
With an election on the horizon and a bevy of must-pass priorities, like redistricting and distributing federal funds that will soon expire, it remains to be seen whether a vehicle similar to the FRA tax will arise for lawmakers to ensure the issue is acted on.
“Time will tell,” said Rep. Adam Schnelting, R-St. Charles, who filed legislation on the issue.
Legislative attempts
In 2020, the Missouri Supreme Court struck down language in a 2018 budget bill that excluded abortion providers or their affiliates from receiving Medicaid reimbursements.
In response, a slew of bills have already been filed for the upcoming legislative session once again targeting the Medicaid reimbursement issue.
Sen. Bob Onder, a Lake St. Louis Republican who led the charge to add language to the FRA, once again filed a bill to ban abortion providers or their affiliates from MO HealthNet, Missouri’s Medicaid program.
A handful of other bills would do the same, and also bar public funds more broadly from going to Planned Parenthood. A bill filed by Sen. Bill Eigel, R-Weldon Spring, would put the issue before voters, asking them to amend the state constitution.
“It’s one of the biggest issues out there,” Sam Lee of Campaign Life for Missouri said of restricting public funds to abortion providers. “But all of these bills are potentially in play.”
The state’s Medicaid program is already prohibited from paying for abortions, except in the instances of rape, incest or to save the mother’s life.
Planned Parenthood affiliates in Missouri provide reproductive health services like STI screenings or contraceptives, and serve patients on Medicaid.
Recently, Missouri Planned Parenthood affiliates also re-entered Title X, a national grant program that covers family planning services for low-income individuals, after President Joe Biden’s administration revoked a rule enacted under former President Donald Trump that prohibited providers from referring patients for abortion.
A bill filed by Schnetling would set up a hierarchy of providers that family planning funds allocated to the state health department would be distributed to. While Title X funds are listed under the definition of public funds in the bill, currently state lawmakers do not have oversight of the federal funds, as they are administered by the Missouri Family Health Council.
Missouri’s Department of Health and Senior Services previously applied in 2018 for Title X funds — the first time the department had done so — but was denied, and applied again in 2019 Politico previously reported. A DHSS spokeswoman did not immediately respond to a request for comment if the department is applying again for the funds.
Susan Klein, the executive director of Missouri Right to Life, argued that with Planned Parenthood receiving public funds, like reimbursements through the state’s Medicaid program, tax dollars are indirectly subsidizing the abortion industry.
“I think people in Missouri should have a say so in what happens with their tax dollars,” Klein said.
Opponents have long-warned that if abortion providers and their affiliates are singled out, Missouri’s entire Medicaid program may be put in jeopardy.
“This tactic to limit providers is in violation of Medicaid to begin with,” said Michelle Trupiano, the executive director of Missouri Family Health Council Inc., which administers federal funds for family planning services.
But Klein noted that hasn’t happened yet, even when Missouri lawmakers restricted Medicaid payments to Planned Parenthood affiliates previously.
“I just don’t think that (Biden) cares so much about celebrating abortion that he would put at risk the care for marginalized groups in our state,” Coleman said.
Lee noted there’s precedent of Planned Parenthood being removed from other states, and courts upholding it.
Planned Parenthood is blocked from Arkansas’ Medicaid program, and last year a U.S. Circuit Court of Appeals ruled that Planned Parenthood could be kicked off of Texas’ Medicaid program. Democratic lawmakers in Texas have asked the federal government to intervene.
McNicholas and Trupiano also hope the federal government will weigh in on the issue.
“Medicaid recipients across the country must have access to the provider of their choice. That has been clear and consistent,” McNicholas said. “And so I agree that the ball is now in the court of the administration to enforce that any willing provider regulation.”
It’s a call Planned Parenthood and U.S. Rep. Cori Bush made last year when the state health department implemented a new emergency regulation allowing various inspection violations of abortion providers to be referred to the Medicaid Audit and Compliance Unit within the state social services department.
The Centers for Medicare and Medicaid previously said it’s evaluating the regulation. A CMS spokesperson said the agency is still reviewing the policy.
Political will
Attempts last year to bar abortion providers from Medicaid derailed the final day of the 2021 legislative session, resulting in a day-long filibuster and the Senate adjourning four-hours early — killing a slew of bills along with it.
Tensions continued throughout a subsequent special session, in which the FRA tax was ultimately renewed for three years and without the language barring Planned Parenthood providers from Medicaid.
Disagreement within the Republican Caucus even resulted in Sen. Paul Wieland, an Imperial Republican who attempted to ban taxpayer funds from going toward certain contraceptives, calling for a change in Senate leadership.
Following the FRA’s renewal, Missouri Right to Life publicly praised lawmakers who opposed renewal.
“I think if you ask any Republican to show you the lit pieces that they put on mail, pro life is the very first thing that’s listed,” said Coleman, who voted against FRA renewal and is running for state senate in 2022. “And so I think that there’s an expectation that people are going to show up and do the work that they promised people that they will do.”
They want to shut things down like Todd Akin's last campaign!
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