PRCH Board Chair on Pitts Abortion Bill (H.R. 358)

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Testimony of Douglas Laube, MD, MEd Board Chair, Physicians for Reproductive Choice and Health Submitted to the House Energy and Commerce Committee Subcommittee on Health February 9, 2010
Physicians for Reproductive Choice and Health (PRCH) is a doctorled national advocacy organization. Since 1992, PRCH has used evidencebased medicine to promote sound reproductive health policies. PRCH’s network of physicians includes practitioners in obstetrics and gynecology, pediatricians, fertility doctors, family physicians, cardiologists, neurologists, radiologists, and others. We believe in reproductive choice for everyone. PRCH welcomes the opportunity to submit testimony on H.R. 358, misleadingly named the “Protect Life Act.” This harmful bill would deny insurance coverage for abortion to millions of American women. Moreover, this legislation has a broad refusal provision that would override current protections in federal law for patients in emergency situations. If H.R. 358 were enacted, hospitals could refuse to provide treatment, such as an emergency abortion, necessary to save a woman’s life. Every day my colleagues and I treat women who are able to use their insurance to obtain needed medical care. Sadly, we also see women struggling to make the best decision for themselves and their families without the financial resources to pay for an abortion. H.R. 358 would prevent insurance plans in the new health insurance exchanges from providing
abortion coverage except in very limited circumstances. But the impact would go beyond the health insurance exchanges. This policy would discourage insurance companies from providing any abortion coverage. Supporters of H.R. 358 argue that women could purchase a rider policy that would cover an abortion. As illustrated by the stories below, nobody plans to have an abortion, and the idea of a rider is entirely unworkable. If enacted, H.R. 358 would have a devastating impact on a woman’s ability to access safe and legal abortion care. In my practice in Wisconsin, I had a patient, Beth.* Beth was pregnant with her first child and looking forward to becoming a mother. Three months into her pregnancy, she developed dangerously high blood pressure. Without an abortion, she could have had a stroke or kidney damage. She made the very hard decision to end her pregnancy. Beth’s medical condition is just one of many that can complicate pregnancy. But H.R. 358 would leave women like Beth without insurance coverage for abortions necessary to protect their health. My colleague and fellow PRCH board member Dr. Nancy Stanwood from Rochester, New York, has seen the impact of policies such as this. She had a patient, Carol, who was excited to give birth to her first child. Her husband was a Marine, serving in Afghanistan. Their health insurance was provided through the military. Sadly, in Carol’s second trimester, she learned that her baby had anencephaly; it would be born without a brain. After much painful deliberation, she and her husband chose abortion. They were shocked to learn that their health insurance would not cover the abortion and would only cover situations where Carol’s life was in danger. Her husband was outraged, telling Dr. Stanwood, “I’m over there defending my country, and they won’t even take care of my family?” Under this bill, insurance coverage could be barred for heartbreaking situations like Carol’s.
*
All patient names have been changed to protect confidentiality.
Dr. Kristina Tocce in Denver treated a patient with a complicated pregnancy. An ultrasound showed that her patient Consuela’s fetus was not developing kidneys. Most infants with this problem do not live more than a few hours. Also, Consuela’s placenta was covering the opening to her cervix; this condition, if left untreated, can result in life-threatening bleeding during delivery and requires a cesarean section. Conseula and her husband decided to terminate the pregnancy, but her insurance was through Medicaid. Because Consuela’s medical condition did not yet endanger her life, she did not qualify for abortion coverage under Medicaid’s life exception. Out of pocket, her abortion would have cost more than $4,000, an impossible sum. Consuela continued to carry the pregnancy and suffered tremendous emotional turmoil. Six weeks later, her fetus died in utero. It is unfair to make women suffer when they do not have the financial resources to pay for health care they need. In Seattle, Dr. Deborah Oyer had a patient, Allison, a 34-year old mother of three with an unintended pregnancy. She was still deciding whether to continue her pregnancy when she discovered her youngest child had leukemia. She and her husband quickly realized that they could not have another child at that time. Allison needed to take leave from work and stay at the hospital with their daughter for the many treatments to come. Her husband needed to stay at home, two hours away from the hospital, to work and care for their two other children. Fortunately, Washington Medicaid covered her abortion. But Allison and her family would have faced great hardship if they had had to pay out of pocket. Access to affordable insurance that covers abortion is essential for women and their families. H.R. 358 also has a disturbing refusal clause that would allow individuals and entities to refuse to provide abortion care, potentially even in emergency situations. Dr. Sara Imershein in Washington, DC, cared for a pregnant mother of two, Brenda, who had vaginal bleeding and
bulging membranes—a sign in this case of an inevitable miscarriage. Brenda needed an abortion to stop the bleeding and avoid having a blood transfusion. The religious hospital where she was being treated opted to transfer Brenda across state lines to another facility, where she did need to have a blood transfusion. Treatment at the original facility would have been safer and less expensive. Such refusal to provide immediate medical care harms women. An individual right of refusal should never have the effect of limiting a patient’s access to care or putting her health at risk. But H.R. 358 goes even further, allowing corporations and entities such as hospitals to refuse lifesaving care by anyone for any reason. Dr. Paula Bednarek in Oregon recently cared for a woman named Ann with rheumatic heart disease. She had had surgery to replace two of her heart valves and to repair a third valve after heart failure during a previous pregnancy. Pregnant again, Ann was experiencing chest pain and carrying a baby with severe abnormalities. This pregnancy put her health, and likely her life, at significant risk due to her mechanical heart valves, weakened heart muscles, and anti-clotting medication. The stress on her heart would become more and more severe as the pregnancy moved farther along. Dr. Bednarek’s facility was able to help Ann, but under H.R. 358 a hospital could refuse to help a patient in need of a lifesaving abortion, whether or not she had insurance. PRCH’s medical director, Dr. Anne Davis, recently cared for Margaret, a woman with a much wanted pregnancy carrying twins. At 18 weeks, her water broke, five months prematurely. She had bleeding and an infection in her uterus. If untreated, serious infection, hemorrhage, and even shock would follow. There was no treatment that could save the twins, but it was an emergency situation for Margaret’s health. Dr. Davis provided an abortion. In an emergency, a woman has no idea if the nearest hospital or the hospital to which she is transported will refuse to treat her or has staff that will refuse to treat her. Her very life may
hang in the balance. This nonsensical policy could have the tragic effect of denying women lifesaving medical treatment. PRCH opposes refusal policies that ignore an individual’s need for health care and allow institutions to deny or delay care. For these real women and their families, abortion was a difficult decision made after consultation with their physicians and consideration of the medical issues involved. Abortion was a critical medical procedure that protected their physical health, the health and well-being of their families, and their lives. If H.R. 358 becomes law, real women like Beth, Allison, Brenda, Ann, and Margaret will suffer as a result. It is crucial to the lives and health of American women that this bill be defeated. On behalf of PRCH, I thank you for the opportunity to submit this testimony.