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By Rose Hoban
A four-line provision in the North Carolina Senate’s budget could make it more difficult for hospitals and other providers who receive state dollars to perform abortions in North Carolina.
In past years further restrictions on abortion have come in the form of high-profile bills making their way through raucous committee hearings. But this has been a quiet swipe at abortion services, a 65-word section tucked into the 360-plus page budget passed by the Senate on May 15 states that “no State funds shall be allocated to any provider that performs abortions.”
The language in Section 11F.4 resembles language placed by legislators in the final 2011 budget which prohibited North Carolina Medicaid or the health insurance plan for state employees from reimbursing for any abortion procedures.
A provision with similar language appeared again in the 2015 state budget. But that provision was more specific in its language, forbidding the state from entering into any contracts for providing teen pregnancy prevention training programs with any provider who did abortions. That effectively cut Planned Parenthood out of a contract to provide the training in Cumberland and New Hanover counties.
Sen. Ralph Hise (R-Spruce Pine), the chair of the Senate Health Care Committee and lead budget writer for the health and human services portion of the Senate budget, confirmed to North Carolina Health News that language in this year’s bill is “broader.”
“A provider… they would still be able to receive all of their payments from Medicaid, the State Health Plan for all the services,” Hise said. “It would prohibit the department from entering with them into contract for something else.”
Sarah Gillooly from the North Carolina chapter of the ACLU said she read the language as seeking to put hospitals in a bind.
“[This] seems to force physicians and facilities to either refuse to provide a common medical procedure or to give up important public health funding from DHHS,” wrote Sarah Gillooly from the North Carolina ACLU in an email to NC Health News.
Few, but complicated
Hise said he believed hospitals such as UNC Healthcare and East Carolina University do not perform abortions.
However, academic medical centers which train the next generation of obstetrician/ gynecologists often perform abortions, in particular, the later term cases that result from fetal abnormalities, congenital problems and genetic problems that start to become detectable in the second trimester of pregnancy, starting around 14 weeks.
In 2015, the last year data is available, there were 27,631 abortions performed in North Carolina according to the N.C. State Center for Health Statistics.
Kathleen Vessey-Jones from the Center said state law prevents her from saying how many procedures were done in each location, but she could say that in 2015, 1.2 percent, or about 330 abortions were performed in a hospitals. The rest were done in clinics.
The distribution of where abortions occur in the state show there are only 10 counties where abortions took place – Buncombe, Cumberland, Durham, Forsyth, Guilford, Mecklenburg, New Hanover, Onslow, Orange and Wake – all of which have medical centers and also have private clinic abortion providers. But it’s impossible to know which hospitals did the procedures, and how many.
So, there would be abortions performed within the walls of hospitals, and many of those same facilities receive state dollars to perform a variety of services. Those services range from the state’s Poison Control Center, housed at Carolinas Medical Center in Charlotte to the Telestroke Network at Wake Forest Baptist Health, to the Center for Telepsychiatry and e-Behavioral Health, which works with Vidant Hospital in Greenville.
And in academic medical centers, residents in OB/GYN training programs are being taught how to do the procedure. Since 1996, the American Council on Graduate Medical Education began requiring abortion training as part of accredited obstetrics–gynecology residency programs. Data from the Council indicate that there are OB/GYN training programs at eight academic medical centers and hospitals around the state.
How broad is broad?
“I agree that the language is broader. I don’t know if that means the actual restriction is broader,” wrote Jill Moore, who monitors public health law at the UNC Chapel Hill School of Government in an email.
“I don’t have a sense of what the practical effect of this provision would be, because I don’t know which state funds that are appropriated to DHHS are then passed along to hospitals or other abortion providers for some purpose other than reimbursement for services under the state health plan or Medicaid,” Moore wrote.
Gillooly said she felt the intent was “perfectly clear.”
“Legislators who oppose safe, legal abortion are attempting to disqualify physicians who provide abortion from other government funding,” Gillooly wrote.[sponsor]
She argued that the language could cause the state run afoul of U. S. Supreme Court rulings.
“Courts have been very clear that it is unconstitutional to disqualify organizations from government funding simply because they are providing patients with a health care service that is a constitutionally protected right,” she wrote. “The law may allow the government to say it will not directly fund that service, but it can’t tell a private entity what to do with its own money.”
When the House amended the budget bill, the Senate’s language was removed. In its place, House budget writers included a provision which appropriated $1.3 million to the Carolina Pregnancy Care Fellowship, a network of about 80 pregnancy care ministries. The money will go toward purchasing medical equipment for the centers, which are not clinics, but counseling centers which encourage women not to have abortions.
Now that a compromise budget is being hashed out behind closed doors, there’s no guarantee this language would be eliminated altogether.
Multiple health care lobbyists and advocates at the legislature privately expressed concern about the outcome of the provision in the budget negotiations. But when asked, none were willing to make a public statement, citing fear of reprisal from lawmakers.