Health Care & Wellness
How Medicaid Stakeholders Should Be Thinking When Implementing HRSN Covered Benefits
September 27, 2024 | Megan Barton, Brock Ingmire
June 6, 2023 | Bill Kramer
Key Takeaways:
A year ago this month, the U.S. Supreme Court released its ruling in Dobbs v. Jackson Women's Health Organization, shifting major policy decisions around access to abortions to the states. The past year has been a whirlwind of trigger laws, ballot measures, state court decisions, and blue states enacting explicit protections around abortion access and red states adding new restrictions. It’s undoubtedly been a challenge for patients, health care providers, and employers to keep up with the developing patchwork of state laws surrounding reproductive health care.
As you can see in the map below, about half the states have enacted abortion restrictions, which are either in place now or are on hold as the judicial branch decides the laws’ constitutionality. Abortion procedures remain available in the other half of states, most of which provide explicit protections for access to abortion procedures. State courts will be a major factor in how this map is shaped going forward, but today we want to focus on the actions state legislatures have taken this year on reproductive health policy.
We forecasted that reproductive health care would be a top legislative priority for state lawmakers this year, especially in states that had little or no abortion restrictions in place and had the political makeup and will to pursue new restrictions, which we identified as Nebraska, Florida, North Carolina, and South Carolina. Each of these states enacted new restrictions this year, although, notably, none successfully pursued a full ban on abortion procedures from conception.
Although each of these states had the political makeup to enact new restrictions, the rad was not as smooth as lawmakers might have thought (it rarely is). But Florida had the smoothest path to enacting new restrictions this year. After securing new supermajorities in both chambers of the legislature, and with the support of Gov. DeSantis (R), fresh off a dominating reelection campaign and with eyes toward the presidency, lawmakers introduced a 6-week abortion ban when they convened the legislative session in March and the governor signed the bill into law a month later.
On the other hand, lawmakers in Nebraska and South Carolina were met with more intraparty resistance than their colleagues in Florida and, as a result, proponents of stricter abortion restrictions were forced to compromise in order to pass any restrictions at all. In South Carolina, the back-and-forth between members of the House and Senate had been ongoing since a failed special session late last year where the House insisted on a full ban, while the Senate insisted it only had the votes for a 6-week ban. Members stood their ground throughout this year’s legislative session until the final days when the House indicated they’d relent and pass a 6-week ban. It took a special legislative session to get it done, but the governor signed a 6-week ban late last month.
Similarly, Nebraska lawmakers thought it was only a matter of time before their own 6-week ban became law. However, a determined minority party was able to filibuster every bill that came before the unicameral this year, significantly slowing down legislative progress. And once the 6-week ban came up for a vote, a last-minute abstention by a GOP member caused the bill to fail to overcome a filibuster. But after quick negotiations and procedural maneuvering, lawmakers amended a compromise 12-week abortion restriction into a different bill and enacted it into law late last month.
Finally, supporters of new abortion restrictions in North Carolina had a higher bar this year as they needed at least one Democrat to join them in voting for new restrictions after the GOP came one seat short of securing a veto-proof supermajority. But in a surprising move, a member of the House switched parties in April from Democrat to Republican, giving Republicans the needed supermajority to override Gov. Cooper’s (D) veto pen. Subsequently, lawmakers quickly passed a 12-week abortion ban, the governor vetoed the bill, and the thin GOP supermajority stuck together to override the veto and enact the 12-week ban into law last month.
How does all of this action change the map above? Before the new laws, Nebraska, North Carolina, and South Carolina allowed abortion procedures up to 20 weeks of pregnancy and Florida allowed abortion until 15 weeks. Florida and South Carolina will (if courts agree) switch to 6 weeks and Nebraska and North Carolina will switch to 12 weeks. But that’s where the courts step in. Nebraska’s bill went into effect immediately and so did South Carolina’s — except the day after enactment, a state judge blocked the South Carolina bill until the state supreme court can rule on it. North Carolina’s bill goes into effect on July 1. And Florida’s bill won’t go into effect until 30 days after the state supreme court rules on the 15-week abortion restriction law already in place.
So while the major legislative action to enact new abortion restrictions this year is likely finished, the courts will continue to rule on whether these and other restrictions are constitutional and blue states will continue to enact laws to protect abortion access in their own states. We expect reproductive health care issues to be a major priority for state lawmakers for the foreseeable future.
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September 27, 2024 | Megan Barton, Brock Ingmire
September 5, 2024 | Mary Kate Barnauskas
August 29, 2024 | Brock Ingmire