Abortion bills heard, including to require prior authorization for Medicaid patients

By: - February 22, 2023 9:22 pm

Rep. Jane Gillette, R-Bozeman, speaks before the House Judiciary Committee on Wednesday, Feb. 22, 2023. (Photo by Nicole Girten/Daily Montanan)

Rep. Marilyn Marler, D-Missoula, said when she was walking in for a doctor’s appointment with her primary care physician at Blue Mountain Clinic in Missoula a few years ago, protesters got in her face, and she feared a physical altercation.

“They got very close to me and expressed their opinions about what they thought I was going to do,” she said.

Marler sponsored legislation, House Bill 570, that would establish a civil penalty for people who interfere with someone’s ability to access reproductive or endocrine (hormonal) healthcare. This bill was one of two the House Judiciary Committee considered on abortion during a marathon morning of hearings on Wednesday.

Rep. Lola Sheldon-Galloway, R-Great Falls, said she’s stood on sidewalks outside of clinics with signs, and things weren’t always rosy on her end either.

“I’ve had things thrown at me. I’ve been flipped off more than you can even imagine,” she said. “Why am I not protected in this?”

Marler responded that Sheldon-Galloway is already protected by the First Amendment and that this bill is not trying to prevent anybody from peacefully protesting outside of any facility.

Sheldon-Galloway said the definition for interfering was too broad and goes beyond physically impeding, but attempts to influence. She asked Marler if she made someone contemplate their actions, had she violated the bill?

Marler said the short answer was no, but that every case has lots of variables. She said she didn’t feel Sheldon-Galloway would make someone feel threatened.

Marler spoke to the history of violence against clinics that offer abortions and said the clinic her doctor practices out of was burned down by an arsonist in the 1990s.  She said that person went on to attack multiple clinics before being apprehended.

Slightly more proponents testified than opponents. Those in favor included Planned Parenthood and Blue Mountain Clinic, which provides abortion services in Missoula. Opponents included the Montana Family Foundation, which said this bill would conflict with Senate Bill 99, which bans gender-affirming care for minors in the state.

“This isn’t just an abortion bill, this bill would provide a civil cause of action if someone was interfering with gender transition procedures, maybe a parent of a minor suffering from gender dysphoria,” said Jeff Laszloffy with the foundation.

Shawn Reagor with the Montana Human Rights Network said there has been an increase in protests and violent attacks against clinics that offer gender-affirming care because people don’t understand what it is.

“Gender-affirming care is very safe. It is medically necessary. It is not happening without parental consent,” Reagor said.

The language for the bill was based on similar legislation out of the state of New York known as the “FIRE HATE Act.” Sen. Ryan Lynch, D-Butte, requested the bill.

“I’m not going to start naming them, but maybe there are some health care facilities that I don’t like. I have every right to go down there and hold the sign,” Marler said. “I do not have a right to go to those places and prevent people from getting the health care that they seek.”

Another bill on abortion heard Wednesday would require prior authorization for abortions covered by Medicaid.

The bill, requested and sponsored by Rep. Jane Gillette, R-Bozeman, would codify in statute a rule from DPHHS heard last month that seeks to require prior authorization for Medicaid abortions, as well as defining what is medically necessary and limiting who can perform abortions.

Montana is one of 16 states that offers Medicaid funds for abortions.

Medicaid covers abortions only under specific conditions where the life of the mother is endangered, the pregnancy is a result of rape or incest or the abortion is deemed medically necessary.

To be medically necessary, the bill says the patient would have to present:

  • a physical condition that would be significantly aggravated by the pregnancy; or
  • a severe mental illness or intellectual disability that would be significantly aggravated by the pregnancy.

There were no proponents for House Bill 544 and 10 opponents, including abortion providers and the American College of Obstetricians and Gynecologists, which represents the majority of OB/GYNs in the state

Opponents said the bill would impede access to abortion to an already vulnerable population and chips away at abortion rights in the state, protected under the state Supreme Court’s decision in Armstrong v. State.

Dr. Timothy Mitchell, an OB/GYN with a specialty in maternal fetal medicine, said Montana was 6th in pregnancy-related deaths in the U.S. and that number is seven times higher for Native women in the state.

“Delaying medically necessary abortions will only make this crisis worse,” he said. “The determination on whether a service is medically necessary is patient specific and should be made by a trained medical provider.”

Mitchell said it was unclear in the bill language if fetal anomalies would be covered, making it so patients would have to carry the pregnancy to term, risking complications for the patient.

“If passed, this bill will lead to litigation and will be enjoined, ultimately opening the state to even more financial liability, including the potential of paying attorneys fees,” said Robin Turner, with the ACLU of Montana.

Quinn Leighton, with Planned Parenthood, said abortions are time sensitive procedures, so adding prior authorization requirements would be harmful, especially as people sometimes have to take off work and travel hundreds of miles just to access a clinic.

Gillette said that prior authorization is commonplace for various procedures and cited at least one insurance company that required prior authorization for patients for medically necessary abortions.

Rep. Laurie Bishop, D-Livingston, though, questioned if these standards were consistent with requirements for other procedures.

“If somebody had an issue with their gallbladder and had to have it removed, would you be asking about their behavioral health issues?” Livingston said.

The committee did not immediately take action on either bill on Wednesday.

Editor’s note: This article was corrected to reflect the clinic Marler visited was Blue Mountain Clinic in Missoula.

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Nicole Girten
Nicole Girten

Nicole Girten is a reporter for the Daily Montanan. She previously worked at the Great Falls Tribune as a government watchdog reporter. She holds a degree from Florida State University and a Master of Science from the Medill School of Journalism at Northwestern University.