Buried in Iowa’s Medicaid expansion legislation is an amendment that empowers Governor Branstad – who is not an MD – to determine if an abortion procedure was “medically necessary” for purposes of Medicaid reimbursements to abortion providers.
U.S. law permits payment for abortions for rape, incest, and if the pregnancy threatens a woman’s life. Iowa law expands that to include terminations of pregnancies if the fetus is severely deformed and unviable.
Historically, the Department of Human Services had been the agency that governed this determination, but in the final negotiations between House Republicans and Senate Democrats, this incredible power over women’s lives was assigned to Governor Branstad.
Did I already mention that he is not a doctor?
Extremist Republicans in the Iowa House initially wanted the Governor to use his non-expertise to block abortions for poor women enrolled in the Medicaid program, but the half-spined Democrats desperate to expand Medicaid to cover the uninsured working poor settled on the reimbursement-after-the-fact compromise.
Which actually makes for an interesting scenario.
If the Governor, who didn’t even enroll and drop out of Medical School, decides that a fetus is not sufficiently deformed, and thinks perhaps it should suffer three, four days outside the womb before succumbing, the state won’t reimburse the abortion provider (Medical Doctors) who thought otherwise.
If the Governor uses his wisdom – I don’t have access to his college transcripts, but I seriously doubt he even took a pre-med biology course – to validate that an abortion for an ectopic pregnancy was “medically necessary,” this puts him at odds against the Vander Plaats extreme right-wing of his party who oppose all abortions, even to save a mother’s life.
If Governor Branstad (ok, he does have an honorary doctorate from Buena Vista University) gives in to his party’s extremists and decides to not reimburse providers because it wasn’t a “legitimate” enough rape, or perhaps it was one of those God-intended pregnancies, he risks losing the centrists he needs to be re-elected in 2014.
As leader of his party, having decision-making authority over abortion reimbursements places him in case-by-case tight spots that could also jeopardize Republican chances in winning the 2014 races for Senate and the First Congressional District.
Fortunately, the Governor has the option of line-item vetoing this amendment, but risks angering the House GOP members who have pushed for it. It’s my understanding that if he does veto it, the determination will return back to the Department of Human Services where it has historically been conducted. It should be noted that Medicaid covered abortions are rare, in fact only 22 abortions were reimbursed last year at a cost of less than $20,000. But this is the politically charged petri dish called Iowa. And it is the nearly longest-serving executive in the country, Branstad.
Nothing is predictable. Stay tuned.