In the current debate over whether Arizona should expand Medicaid services pursuant to the federal Affordable Care Act, questions have arisen regarding the funding of abortion providers. To clarify the misinformation surrounding this issue, Center for Arizona Policy (CAP) has provided the following analysis of the concerns raised along with our recommendation on how the Legislature might address the issue.
Medicaid Expansion Pro-Life Issues Q & A
Question: Will Medicaid expansion result in additional money and benefits for abortion providers in Arizona?
Answer: YES. There is no law currently in force to prevent abortion providers from receiving payment from AHCCCS for providing family planning or medical services other than abortion. These taxpayer dollars subsidize the abortion business by freeing up additional money to be spent on abortion services.
Additionally, an AHCCCS patient who receives family planning services from an abortion provider might not otherwise have had a relationship with an abortion provider. Once that relationship is established, the patient will be more likely to return to that abortion provider if that patient has an unexpected pregnancy.
Thus, abortion providers’ participation in Medicaid necessarily benefits them both financially and through creating a stream of patients for the abortion side of the business.
With the proposed expansion of Medicaid to cover additional childless adults, the likelihood of this “patient stream” benefit is magnified because the population being covered is the prime target of the abortion industry.
Question: But doesn’t federal law already prohibit using Medicaid to pay for abortions?
Answer: YES, but the prohibition only applies to direct funding for abortion.
Currently, because of state law and the federal Hyde amendment, Medicaid dollars cannot be used to pay directly for abortions, except under the following circumstances:
- Federal law requires AHCCCS to pay for abortions resulting from rape and incest.
- State law requires AHCCCS to pay for abortions to save the life of the mother.
- The Arizona Supreme Court decision in SIMAT requires the state to pay for “medically necessary” abortions for indigent women.
There is no evidence to date that these categories are currently being abused, but an unscrupulous abortion provider could be found stretching the definitions in an effort to receive government funding for abortions.
However, the concern is not generally these limited categories. As explained above, the concern is primarily that taxpayer dollars funding Medicaid subsidize the abortion business and provide new patients to abortion providers who participate in AHCCCS.
Question: Didn’t the Legislature address this last year through HB 2800?
Answer: YES, but that law is not currently in force.
Federal district court Judge Neil Wake issued a permanent injunction preventing the State from enforcing HB 2800 to exclude abortion providers from AHCCCS. His ruling is based on federal Medicaid statutes and rules, and the decision is currently being appealed to the U.S. Court of Appeals for the Ninth Circuit. The U.S. Supreme Court will soon decide whether to take a similar case out of Indiana.
Question: Can the Legislature do anything to address the issue?
Answer: YES, but until we receive a favorable court ruling or see Congressional action, there are only limited steps the State may take to partially restrict the benefits of Medicaid to abortion providers.
Some potential incremental options for amending Medicaid expansion include:
- Clarifying that Medicaid dollars cannot be used either directly or indirectly for performing, assisting, or encouraging abortions and requiring AHCCCS to conduct audits to ensure compliance.
- Prohibiting abortion providers from performing abortions on AHCCCS members who have come to them previously for family planning services.
- Enhancing abortion reporting requirements to include information about which abortion providers are receiving AHCCCS money.
Recommendation: Center for Arizona Policy requests that the incremental steps listed above be included in the final adoption of any Medicaid expansion measure.
It should be clear that these steps will not completely prohibit new taxpayer funds from going to abortion providers under Medicaid expansion.