Missouri lawmakers and advocates spent hours Thursday arguing over abortion and discussing the inner workings of women’s reproductive systems in a heated hearing that resembled a remedial sex education course.
A key Senate committee debated the merits of restricting Medicaid coverage of birth control and limiting payments to Planned Parenthood as part of a must-pass renewal of a hospital tax that generates $4 billion a year to fund Medicaid, which provides health coverage to low-income residents.
A group of conservative senators are demanding limits on birth control coverage and Planned Parenthood payments be included to win their support, though Medicaid is already prohibited from paying for abortions. The tax, called the Federal Reimbursement Allowance or FRA, expires Sept. 30. But Gov. Mike Parson plans to impose draconian spending cuts if an extension isn’t approved by July 1, when the new budget year begins.
The Appropriations Committee eventually advanced two bills during the second day of a special session called by Parson. One only renews the tax. Another renews the tax and includes language on contraception and Planned Parenthood that follows a compromise reached between some Republican senators and Parson.
A fiery debate on the Senate floor is expected Friday.
“Women in the state of Missouri want, need and deserve contraceptives,” said Sen. Jeanie Riddle, a Callaway County Republican. “And I really don’t want contraceptives to be part of this.”
The committee votes came after a hearing that pitted anti-abortion activists against women’s health providers and advocates for abortion rights. Senators interrogated both Missouri Right to Life and Planned Parenthood, which operates the only clinic that provides abortions in the state, in St. Louis.
Both groups struck a rare note of agreement in opposing the GOP compromise, but sharply split on the reasons. Right to Life said restrictions on Planned Parenthood don’t go far enough while Planned Parenthood voiced grave concerns about the fallout from the birth control coverage limits.
Senators also quizzed an OB-GYN on the mechanics of contraception and pregnancy.
“I have a feeling that a lot of us in the room and on this committee are probably a little embarrassed at our lack of knowledge on the female reproductive system,” said Sen. Greg Razer, a Kansas City Democrat opposed to the contraception proposals.
“So as the lone gay man in the room, I will just freely admit that … I am not familiar,” Razer said to laughter.
The Republican compromise would prohibit Medicaid from covering any “abortifacient drug or device,” which under the bill includes Plan B, Ella and IUDs “when used to induce an abortion.”
There’s also a catch-all provision that prohibits coverage of drugs or devices “intended to cause the destruction of an unborn child.” Missouri law defines an unborn child as beginning at conception, which is further defined in the law as when an egg is fertilized.
Mae Winchester, a Kansas City-based OB-GYN, told senators that contraception refers to any process that prevents the fertilization of an egg or the implantation of a fertilized egg in the uterus, which she said marks the start of pregnancy. Because Missouri defines an unborn child as beginning at fertilization, Democrats and women’s health advocates fear the state could wield the definition to prohibit coverage of anything that potentially stops a fertilized egg from implanting.
“Do you believe in birth control at all?” an exasperated Sen. Barbara Washington, a Kansas City Democrat, asked Samuel Lee, an anti-abortion lobbyist. Lee, a Catholic deacon, responded that he believes the teaching of the Church, which opposes artificial birth control.
Sen. Lauren Arthur, a Kansas City Democrat, asked Sen. Dan Hegeman, a Cosby Republican who chairs the Appropriations Committee, how an IUD causes an abortion. Hegeman replied that would be “more technical testimony.”
“I am largely unfamiliar with that device,” Hegeman said.
Arthur pressed Hegeman on whether thousands of Missouri women who use IUDs for contraception “are all having abortions?” Hegeman said he wouldn’t portray it that way.
“I mean, I think there was some concern about the use of it,” Hegeman said.
Michelle Trupiano, executive director of the Missouri Family Health Council, which supporters broader access to contraception, said that if Missouri passes the compromise and defines pregnancy as beginning at implantation, then the bill’s provisions probably won’t have an impact.
But if the state relies on other definitions, such as those advanced by abortion opponents, “then this would have a very severe impact and limits the ability of Medicaid patients to choose IUD and emergency contraception as a form of birth control.”
“So the question is: who’s definition are we going with — a medical community or personal beliefs? And who gets to decide that,” Trupiano said.
The arduous committee meeting set up a showdown debate Friday among Republican senators over the birth control provision and whether to tack on more aggressive restrictions on payments to Planned Parenthood.
When Parson set the scope of the special session, it included banning payments to Planned Parenthood under the Uninsured Women’s Health Program, which is administered by Missouri Medicaid but is paid for with state dollars.
Planned Parenthood disclosed it doesn’t receive reimbursements under the program. Conservative senators and anti-abortion activists then called the measure ineffective, painting it as symbolic.
“So that language at this time where it’s at doesn’t do any good as far as keeping our public tax dollars from going to fund abortion providers,” Susan Klein, director of Missouri Right to Life, said.
Instead, they want to ban Planned Parenthood from receiving reimbursements under Medicaid, a prospect that Democrats and even some Republicans fear could endanger federal funding of the program. They also note that many anti-abortion legislators have voted in the past to reauthorize the Medicaid tax without insisting on abortion-related language.
Klein and others say the ban on Medicaid payments is needed now because of the possibility that the federal prohibition on taxpayer funding for abortions could expire. President Joe Biden didn’t include the ban in his budget proposal, though Congress usually significantly alters presidential budgets.
They also point to a Missouri Supreme Court decision that limited the power of the General Assembly to block funding to Planned Parenthood through the state budget.
But many lawmakers, including some Republicans, worry about the potentially catastrophic consequences to medical providers if the FRA falls victim to a fight over abortion. Nikki Strong, director of the Missouri Health Care Association, repeated warnings on Thursday that nursing homes, which rely on Medicaid patients, could suffer devastating financial losses.
“Without the FRA, no question every Medicaid facility will be out of business,” Strong said.