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Any Iowa hospital or clinic looking for Medicaid cost for offering an abortion would want approval from the state’s most distinguished abortion opponent: Gov. Kim Reynolds.

Nobody bothers to strive.

Iowa’s Medicaid rules embody an uncommon coverage requiring signoff from the governor’s workplace earlier than the general public medical health insurance program might pay for any abortion companies, even when they meet the state’s strict standards.

Reynolds is a Republican and a vehement foe of abortion. In additional than six years as governor, she has by no means been requested to approve a Medicaid cost for an abortion, mentioned her spokesperson, Kollin Crompton.

The novel coverage, instituted a decade in the past by legislators, leaves suppliers who carry out abortions with a selection: Swallow the process’s prices, or threat a showdown with the governor.

The state’s Medicaid program spends roughly $8 billion a yr to cowl about 800,000 Iowans with low incomes or disabilities. It permits cost for abortions if a being pregnant endangers a lady’s life, is the results of rape or incest, or includes a fetal deformity. The Iowa Division of Well being and Human Providers posts a type for abortion suppliers to fill out for Medicaid compensation, however this system hasn’t paid for any abortions in a number of years, spokesperson Alex Carfrae mentioned.

The federal authorities, which funds greater than half of Medicaid prices, helps pay for abortions solely in circumstances of rape or incest or when a being pregnant endangers a lady’s life. Nevertheless it requires state Medicaid applications to cowl such circumstances.

Most state Medicaid applications pay for no less than just a few abortions, in accordance with a 2019 report from the federal Authorities Accountability Workplace. The report discovered that in fiscal years 2013 by way of 2017, solely Iowa, South Dakota, and Wyoming reported protecting no abortions assembly the federal standards.

Abortion stays authorized in the course of the first 20 weeks of being pregnant in Iowa, the place 4,062 abortions have been reported in 2022. Reynolds signed a invoice in July that might ban most abortions after six weeks, and she or he is combating in courtroom to implement the legislation. Nonetheless, the abortion ban would permit exceptions for circumstances of rape, incest, deadly fetal abnormalities, and medical emergencies.

Iowa’s Medicaid program paid for 22 abortions within the fiscal yr earlier than legislators handed the governor-oversight rule in 2013. Most have been carried out on the College of Iowa Hospitals and Clinics in Iowa Metropolis, a state-owned facility that handles lots of Iowa’s most intricate pregnancies. After the rule went into impact, hospital leaders determined to pay for such abortions out of the power’s revenues as an alternative of attempting to invoice Medicaid.

Jean Robillard, then a College of Iowa Hospitals vp, declined on the time to clarify how the state rule affected the choice to cease billing Medicaid for abortions. “I do not need to get entangled within the politics of this,” he advised the Des Moines Register.

College of Iowa Hospitals spokesperson Laura Shoemaker mentioned this fall that the hospital has not billed Medicaid for abortions in recent times. She declined additional remark.

UnityPoint Well being, a big nonprofit hospital system based mostly in West Des Moines, additionally often billed Iowa Medicaid for qualifying abortions earlier than the governor-approval rule went into impact. UnityPoint declined touch upon its present observe.

When the rule was carried out, it was known as distinctive by the Guttmacher Institute, a nationwide nonprofit that helps abortion rights. The group nonetheless lists Iowa as the one state requiring the governor’s permission for Medicaid funds for abortion. However a spokesperson mentioned the institute can not say for sure that no different state has carried out such a rule.

The coverage took impact whereas Reynolds’ predecessor, Republican Terry Branstad, was in workplace. Branstad additionally opposed abortion however urged the rule be rescinded. Reynolds’ spokesperson declined to say whether or not the present governor approves of the rule.

Maggie DeWitte, govt director of Pulse Life Advocates, an Iowa group opposing abortion, mentioned she favors the coverage as a option to restrict use of taxpayer {dollars} for the process.

“I do not suppose it is something the federal government must be paying for. It is the taking of an harmless life,” she mentioned. “We must always have as many stops alongside the best way as doable.”

Sally Frank, a legislation professor at Drake College in Des Moines who research ladies’s rights points, mentioned the rule seems meant to forestall requests for Medicaid cost. “It is type of set as much as fail,” she mentioned.

Frank, who helps abortion rights, mentioned a hospital or clinic would have robust authorized grounds to problem any denial by the governor of Medicaid cost for an abortion that met Iowa’s standards. She famous that states are required to cowl Medicaid companies spelled out below federal legislation. She added that if the governor blocked cost with out citing a sound cause, the supplier might argue in courtroom that they have been denied due course of. “It shouldn’t be as much as the governor’s discretion.”

However she wasn’t stunned to listen to no hospitals or clinics have challenged the coverage, given the state’s more and more conservative politics.

Kaiser Health NewsThis text was reprinted from, a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF – the impartial supply for well being coverage analysis, polling, and journalism.



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