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Fiscal panel advances contraceptive bill despite IUD, Medicaid concerns

Sen. Shelli Yoder, a Democrat from Bloomington, speaks in committee on Thursday, Feb. 29, 2024. (Leslie Bonilla Muñiz/Indiana Capital Chronicle)

INDIANAPOLIS (INDIANA CAPITAL CHRONICLE) — A dispute about whether birth control causes abortions — along with fallout from a pricey Medicaid forecasting error — colored debate over a bill meant to help women on Medicaid access long-acting contraceptives.

A finance-focused Senate committee on Thursday advanced the proposal promoting subdermal birth control implants but declined to similarly push intrauterine devices (IUDs). The devices were removed in January after a dispute about whether they’re abortifacients.

That split House and Senate Democrats are on the bill. The Senate Appropriations Committee leader also balked at the projected sticker price.

Rep. Rita Fleming, an obstetric hospitalist from Jeffersonville, filed House Bill 1426 to require that hospitals offer long-acting, reversible contraceptives to women on Medicaid, or who are eligible for it, after childbirth. The state would reimburse hospitals for the service.

Indiana Medicaid already covers insertion and removal of long-acting, reversible contraceptives. The legislation requires a conversation about the implant and product stock for those who want one.

Fleming, a Democrat, said about 30% of women don’t return for postpartum check-ups, and that percentage is higher for women who don’t get prenatal care. That’s why, she said, her legislation used birth as a “window of opportunity to offer these women reliable birth control.”

The mandate would begin July 1, 2024 and would expire June 30, 2025, under an amendment Sen. Ryan Mishler, R-Mishawaka, brought Thursday. Lawmakers would have to reauthorize it during next year’s budget-centric legislative session.

Mishler, who’s long expressed concerns on the state’s growing Medicaid costs, has kicked cost-saving efforts up a gear following a $1 billion forecasting blunder. He chairs the Senate’s appropriates panel.

Fleming’s bill could cost the state from $10,000 to nearly $90,000 dollars, according to a fiscal analysis by the nonpartisan Legislative Services Agency.  That’s based on the 2024 subdermal implant service fee of $93.41. Indiana’s Medicaid program reimbursed nearly 40,000 live births in 2022, according to the analysis, but a fraction of patients are expected to take the state up on the offer. The state and federal government split Medicaid costs.

Sen. Shelli Yoder, D-Bloomington, argued that the bill is a “minor” expense — the state’s last biennial budget totaled $44 billion — and said she expected to be “in the same place … fighting for access to birth control” next year.

Legislation sparks contraceptive-rights fears

House Bill 1426 sailed through the House on a bipartisan vote of 94-4, and was set for a smooth ride through the Senate.

Upon switching chambers, however, Fleming’s legislation was mired in controversy stemming from a change made weeks earlier. Rep. Cindy Ledbetter, R-Newburgh, amended the legislation in the House’s Public Health Committee to specify that hospitals must discuss a subdermal implant with patients — leaving out IUDs as a required discussion topic.

Ledbetter said she brought the amendment because Indiana Right to Life raised concerns that IUDs induce abortion, Mirror Indy reported. Both hormonal and copper IUDs block sperm from fertilizing an egg, thus preventing pregnancy, according to the Yale School of Medicine’s clinical practice arm.

Contraceptive-rights entities sounded the alarm.

In a letter to Statehouse Democrats, Planned Parenthood Alliance Advocates of Indiana said it was concerned anti-abortion sentiment was “infiltrat(ing)” the legislation and called the absence of IUDs a “slippery slope of anti-science … attacks on contraceptives.”

In a rare show of disunity with their House counterparts, Senate Democrats have pushed to require physicians to talk about all long-acting, reversible contraceptives, like IUDs. Yoder offered an amendment Thursday striking language specifying subdermal implants; it failed along party lines.

House Democrats maintain that the legislation would require that physicians talk about subdermal implants, but that they could still bring up other contraceptive types if they choose.

Fleming, in a letter, to her Senate Democrat colleagues, wrote that IUDs have a one-in-seven chance of falling out if inserted immediately birth. They’re also contraindicated in women with sexually transmitted infections, uterine infections and more, she added.

But not all women can use hormonal birth control, Yoder noted Thursday. She observed IUDs are the most popular long-acting device among the general public.

“My concern is creating this two-tiered system of what hospitals will be having on hand to provide to women who’ve just given birth,” Yoder said. She said she’d attempt the amendment again on the Senate floor.

A spokesperson confirmed that, in contrast, the House Democratic caucus won’t fight to change the legislation.

“We want a version of the bill that can pass both chambers and get signed into law,” the House Democrats spokesperson said. “If subdermal implants is that, that’s a win in our book.”

Anti-abortion concerns also remain

The state’s most prominent anti-abortion group, said it wasn’t behind the subdermal-only edit, but still wasn’t a fan of the legislation.

Indiana Right to Life President Mike Fichter said his organization is “taking no position” on the bill, but does have concerns with IUDs.

“While the intended action of some devices or drugs may be to prevent fertilization, there remains the concern that some will cause the death of an embryo after fertilization has occurred,” President Mike Fichter said in a statement.

One lawmaker went further on Thursday.

Sen. Liz Brown, R-Fort Wayne, argued the bill could harm reproductive rights.

She said it was “overbearing” to “suggest that these women — who, for whatever reason, are a little less financially secure — that we absolutely don’t want them to have children anytime soon.”

Brown also expressed concerns over product waste.

“We are presuming that we can coerce all the women who happen to be on Medicaid, or (who are) eligible, we can coerce them into doing this immediately,” Brown said. “And if we don’t, then that inventory can expire”

Fleming said hospitals could return devices near expiration to manufacturers in exchange for a new device. And she defended her intentions, telling Brown, “This is not about coercion for any patient. We offer it to patients, and they eagerly accept it.”

Brown additionally asserted that hospitals can already choose to offer new mothers contraceptives. Fleming countered that just 1% of women on Medicaid have postpartum birth control plans.

Groups for and against contraceptive use have critiqued the legislation’s exclusive applicability to people on Medicaid. Indiana lawmakers don’t have authority over most health plans, but they do have control over the state’s Medicaid program.