Governor Says Medicaid Funding Decision For Abortions Would Be Tough, But He Could Make It

DES MOINES – Gov. Terry Branstad jumps at the chance to tell you he can make tough decisions.

Those decisions have included in his five terms as Iowa’s chief executive granting executive clemency to convicted felons, including commuting the life sentence of convicted murderer Rasberry Williams last year; approving Medicaid funding for an organ transplant that was considered to be experimental; and bringing state spending under control.

Yet, one decision that state law says he has to make has eluded him: whether or not to reimburse University of Iowa Hospitals and Clinics for Medicaid-funded abortions.

The decision would have been difficult but he would not shirk the responsibility for making it, Branstad said in an IowaWatch interview this week, on July 7, 2014. He declined, as he has in other interviews over the past year, to say what his ultimate decisions would be.

“I am pro-life and all human life is valuable and should be protected,” Branstad, a Republican seeking another term as governor, said in the interview. However, “I don’t want to speculate on something before I would have to deal with it.”

Last year, the Legislature gave the governor the power to decide whether or not to approve or decline reimbursement for Medicaid-funded abortions.

But in the slightly more than 12 months the law has been in effect, the governor hasn’t had to make these decisions. UI Hospitals and Clinics, where low-income abortions are performed most often, decided not to bill the state the $41,378.06 for the 20 abortions performed by doctors there from July 1, 2013, through July 7, 2014.

“The reason was just to keep us out of the politics of this issue,” university spokesman Tom Moore said.

Branstad has held firm since the law was passed on not tipping his hand on what he would do if a reimbursement request were sent to him. “I think it depends upon the unique and individual circumstances of each case,” he said.

Branstad said he would carefully examine and consider each reimbursement request on a case-by-case basis. “A thoughtful process would be to try to get all of the facts and all of the information, which means you would need to spend a great deal of time,” he said. “You would need to try to get all of the information from the doctors and from the hospital.”

John Hedgecoth, press spokesman for state Sen. Jack Hatch, Branstad’s Democratic gubernatorial opponent in the fall election, said Hatch would try to change the requirement that the governor sign off on Medicaid-funded abortions. He said UI Hospitals and Clinics doctors or any other medical practitioner should be able to make medical decisions without someone at a high level of government having final say over funding.

“Senator Hatch does not believe that is the best administrative process to be used and would like to keep the governor’s office out of those decisions, if possible,” Hedgecoth said.

Branstad stopped short of saying he was relieved about not having to cast judgment on a reimbursement case but said that doing so would be difficult because it would be about life and death. “I make a lot of tough decisions, but do I like to have to make a lot of touch decisions? No. But that’s part of the job,” he said.

“I do respect the fact that we have to abide by the laws. And we have court decisions that impact, you know, what legally we can do.”

The fountain entrance to the University of Iowa Hospitals and Clinics shown on July 10, 2014.

Lauren Mills/IowaWatch

The fountain entrance to the University of Iowa Hospitals and Clinics shown on July 10, 2014.

As he has done previously, Branstad referred to a decision he had to make in the 1980s to allow a waiver to allow a Medicaid-funded organ transplant. Medicaid did not fund the procedure at that time. Branstad said he carefully reviewed the circumstances and decided to approve Medicaid expenditure for the procedure, which resulted in saving the patient's life.

In 1984, during his first term as governor, Branstad waived Medicaid regulations to allow funding that covered a liver transplant for Thuy Pham, at the time a dying University of Iowa student. Pham was eligible for Medicaid payments, but at the time, the state of Iowa only allowed Medicaid funding for kidney and cornea transplants.

Jenifer Bowen, executive director of Iowa Right to Life, said she supports Branstad’s views but also the decision by UI Hospitals and Clinics officials to refrain from billing the state for the Medicaid-eligible abortions that were performed.

“We were optimistic that it would help stop taxpayer funding of abortion, and … we’ve seen it actually work,” Bowen said.

But officials from Planned Parenthood of the Heartland were not so willing to subscribe to Branstad’s thoughts on this matter.

“It is disappointing to think that the governor would choose to not consider the difficultly of playing politics with a woman's health care decision before he has to ‘deal with it,’” Angie Remington, public relations manager, wrote in an email to IowaWatch.

This IowaWatch story also was published in The Hawk Eye (Burlington, IA).

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