Prevent Political Interference from Delaying Abortion Act

Summary: The Prevent Political Interference from Delaying Abortion Act would remove restrictions that delay access to early abortion care, such as waiting periods and TRAP laws, and it would expand access to abortion providers as well as guarantee public and private insurance coverage for abortion.

Background Summary

Abortion is one of the safest and most common medical procedures in the United States. The Centers for Disease Control found that legal abortion is significantly safer than childbirth, and a study in the American Journal of Public Health reported that first-trimester abortion is one of the safest medical procedures in America. Approximately three in ten women will have an abortion in their lifetimes and will need access to safe, legal facilities to obtain abortion care.

Mandatory waiting periods delay abortions. Twenty-seven states have mandatory waiting periods requiring women to wait from 24 to 72 hours before obtaining an abortion. Thirteen states require in-person anti-abortion “counseling” before the waiting period begins, thereby requiring two trips to the clinic. Yet, there are no waiting periods or “counseling” when people receive far more serious medical procedures.

Lack of insurance coverage delays abortions. Thirty-three states and the District of Columbia prohibit the use of state Medicaid funds for abortion, except in limited cases. Twenty-five states restrict abortion coverage in their insurance exchanges. Twenty-one states restrict abortion coverage for state employee health plans. Ten states restrict abortion coverage in standard private insurance plans. And eighteen states have more than one of the above restrictions.

A lack of qualified abortion providers delays abortions. Because of restrictive laws and physical threats, the number of abortion providers has declined over the years. The American College of Obstetricians and Gynecologists (ACOG) recommends allowing trained advanced practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to perform aspiration and medication abortions, yet only a few states allow it.

TRAP laws which cause high-quality health clinics to close, delay abortions. Currently, 24 states have Targeted Regulation of Abortion Providers or “TRAP laws” that are intended to close abortion clinics. Most often, the restrictions dictate that abortions be performed at sites that are the functional equivalent of ambulatory surgical centers, or even hospitals, which makes the delivery of health care services prohibitively expensive. Other TRAP laws require clinicians at abortion facilities to have admitting privileges at a local hospital or mandate transfer agreements with hospitals, effectively giving hospitals veto power over whether an abortion clinic can exist.

Delays serve no positive medical purpose and, in fact, often make a woman’s health care harder to access and more expensive. Laws that delay abortion are not intended to protect a woman’s safety; they are designed to coerce women to give birth to unwanted children.

The practice of abortion care, like all medical care, should be driven by evidence-based standards. Like other areas of medicine, standards should be developed and supported by medical professionals, not by ideologues.


Model Legislation

SECTION 1. SHORT TITLE

This Act shall be called the “Prevent Political Interference from Delaying Abortion Act.”

SECTION 2. FINDINGS AND PURPOSE

(A) FINDINGS—The legislature finds that:

1)      Abortion care is one of the safest medical procedures in the United States.

2)      Approximately three in ten women will have an abortion in their lifetimes, and will need access to safe, legal facilities to obtain abortion care.

3)      If a woman seeks an abortion and her access is delayed, it may increase the risk of adverse health outcomes as well as the cost.

4)      If a woman seeks an abortion and her access is delayed, it frustrates a woman’s constitutionally protected capacity to make her own personal medical decisions.

5)      Abortion care may be delayed by lack of insurance coverage.

6)      Abortion care may be delayed by an insufficient number of health care professionals who perform abortions.

7)      Abortion care may be delayed by arbitrary waiting periods.

8)      Abortion care may be delayed by lack of nearby clinics because of closures caused by arbitrary regulation of healthcare facilities that handle abortion.

9)      The practice of abortion care, like all medical care, should be driven by evidence-based standards developed and supported by medical professionals, not by arbitrary requirements that delay medical care.

(B) PURPOSE—This law is enacted to ensure that women, regardless of their economic status, are able to obtain access to abortion care without medically unnecessary delay.

SECTION 3. ABORTION COVERAGE EQUITY

After section XXX, the following new section XXX shall be inserted:

(A) DEFINITIONS—In this section:

1)      “Abortion” means any medical treatment intended to induce the termination of a pregnancy except for the purpose of producing a live birth.

2)      “State” means the state and every county, city, town, municipal corporation, quasi-municipal corporation, and public institution of higher education in the state.

(B) POLICY TO COVER ABORTION

Abortion shall be covered in all types of health insurance offered, sold, or purchased in this State, including all private plans, all state-funded plans, and all state-provided benefits.

(C) RESTRICTIONS REPEALED

1)      Section XXX [any provision of law that prohibits abortion care in private health insurance plans] is hereby repealed.

2)      Section XXX [any provision of law that prohibits abortion care in state employee insurance plans] is hereby repealed.

3)      Section XXX [any provision of law that prohibits abortion care in the state insurance exchange] is hereby repealed.

4)      Section XXX [any provision of law that prohibits abortion care in Medicaid coverage] is hereby repealed.

5)      Section XXX [any provision of law that prohibits abortion care in any other state-funded insurance program] is hereby repealed.

(D) SEVERABILITY

The provisions of this Section shall be severable, and if any phrase, clause, sentence or provision is declared to be invalid, is preempted by federal law or regulation, or results in noncompliance with federal requirements that are a condition to the allocation of federal funds to the state, those words are inapplicable and the validity of the remainder of this Act shall not be affected.

SECTION 4. QUALIFIED PROVIDERS OF ABORTION

(A) DEFINITIONS—In this section:

1)      “Aspiration abortion” means medical treatment intended to induce the termination of a pregnancy by dilating the cervix and using suction to remove the fetus and related pregnancy material from the uterus.

2)      “Certified nurse-midwife” means a person licensed under [insert relevant provision].

3)      “Medication abortion” means the use of medication intended to terminate a pregnancy so that it does not result in a live birth.

4)      “Nurse practitioner” means a person licensed under [insert relevant provision].

5)      “Physician assistant” means a person licensed under [insert relevant provision].

(B) QUALIFIED PROVIDERS TO INCLUDE NURSE PRACTITIONERS AND NURSE-MIDWIVES

1)      A nurse practitioner or a certified nurse-midwife is authorized to prescribe and supervise medication abortions and to perform an aspiration abortion if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing nurse practitioners and certified nurse-midwives].

2)      It is unprofessional conduct for any nurse practitioner or certified nurse-midwife to prescribe or supervise an aspiration or medication abortion without prior successful completion of training and validation of clinical competency.

3)      The [insert relevant board governing nurse practitioners and certified nurse-midwives] shall issue rules for training, clinical competency, and standardized procedures for medication abortion and aspiration abortion.

(C) QUALIFIED PROVIDERS INCLUDE PHYSICIAN ASSISTANTS

1)      A physician assistant is authorized to prescribe and supervise medication abortions and to perform an aspiration abortion if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing physician assistants].

2)      It is unprofessional conduct for any physician assistant to prescribe or supervise an aspiration or medication abortion without prior successful completion of training and validation of clinical competency.

3)      The [insert relevant board governing physician assistants] shall issue rules for training, clinical competency, and standardized procedures for medication abortion and aspiration abortion.

[Bill drafting note: You will have to consult with local advocates and the effected healthcare professional associations before writing this bill. Healthcare regulatory schemes often differ from state to state. In addition, there are various ways to achieve the same goal, depending on the wording of your state’s “physician-only” provision (that is, existing statutory language that an abortion can be performed only by a physician):

a)      A few states have used regulatory processes and a few have used Attorney General opinions to allow APCs to practice despite so-called “physician-only” laws. These non-legislative avenues might be possible in your state.

b)      Depending on the state, you might simply repeal the “physician-only” provision; the underlying statutory and regulatory scheme might be sufficient to allow APCs to handle both aspiration and medication abortions.

c)      Alternatively, by inserting definitions of APCs or by using current definitions in state law, you might amend the existing “physician-only” provision to add APCs, making it a physician and APCs only law. Unless you add additional restrictions, this approach would cover both aspiration and medication abortions.]

SECTION 5. REPEAL OF TARGETED REGULATION OF ABORTION PROVIDERS

1)      Section XXX [any provision of law that singles out abortion facilities or personnel for requirements that are more burdensome than those imposed on facilities that provide medically comparable procedures] is hereby repealed.

2)      Section XXX [any provision of law that is the proximate cause of the closure of an abortion facility or facilities and which has not been proven by clear and convincing evidence necessary to prevent a bona fide threat to patient safety] is hereby repealed.

3)      Section XXX [any provision that includes onerous licensing standards comparable or equivalent to the standards of ambulatory surgical centers e.g. procedure room size, corridor width, required minimum distance from hospital, transfer agreement with hospitals] is hereby repealed.

4)      Section XXX [any provision that includes onerous requirements on clinicians that perform abortions e.g. admitting privileges] is hereby repealed.

SECTION 6. REPEAL WAITING PERIODS AND MANDATORY BIASED COUNSELING

1)      Section XXX [any provision of law that requires a waiting period before an abortion is performed] is hereby repealed.

2)      Section XXX [any provision of law that necessitates multiple trips to a clinic for reasons other than medical necessity] is hereby repealed.

3)      Section XXX [any provision of law that necessitates an ultrasound or sonogram for reasons other than medical necessity] is hereby repealed.

SECTION 7. REPEAL

The following are repealed: [If there are provisions in existing law that are inconsistent with this Act, and have not been directly addressed in sections above, this section should repeal them.]

SECTION 8. SEVERABILITY

The provisions of this Act shall be severable, and if any phrase, clause, sentence or provision is declared to be invalid or is preempted by federal law or regulation, the validity of the remainder of this Act shall not be affected.

SECTION 9. EFFECTIVE DATE

This Act shall take effect on XXXX 1, 2016

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