Alaska judge strikes down law further defining what constitutes medically necessary abortions



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JUNEAU, Alaska — A state court judge in Alaska ruled Thursday that a law further defining what constitutes a medically necessary abortion for purposes of Medicaid funding is unconstitutional.

Superior Court Judge John Suddock ordered that the state be blocked from implementing the law, passed last year, and a similar regulation, finding both violated the equal protection clause of the Alaska Constitution.

"This ruling, if upheld, means as a practical matter that virtually all indigent Alaskan women seeking abortions will receive state Medicaid funding," he wrote.

The Alaska Supreme Court has held that the state must pay for medically necessary abortions if it pays for other procedures deemed medically necessary. The regulation and law sought to further define what constitutes a "medically necessary" abortion.

Supporters of the measures have said the state should not be required to pay for elective abortions.

In his decision, Suddock said an unwanted pregnancy is a crisis for any woman and for an impoverished woman without recourse to an abortion, the crisis "may be extreme," noting that indigent women often face stressors such as homelessness, addiction or domestic violence. He wrote that the added stressor of an unwanted pregnancy with no recourse to an abortion "can create clinically significant mental distress such that a Medicaid abortion is medically necessary."

The lawsuit was brought by Planned Parenthood of the Great Northwest, which hailed the decision.

"Every Alaskan woman, regardless of income, should be able to make the pregnancy decision that's best for herself and her family," Chris Charbonneau, CEO of Planned Parenthood of the Great Northwest and the Hawaiian Islands, said in a release. Charbonneau applauded Suddock for "striking down these cruel restrictions on women's health and rights that violate the Alaska constitution."

The state was reviewing the decision and would evaluate its options, Department of Law spokeswoman Cori Mills said by email.

The law defined medically necessary abortions as those needed to avoid a threat of serious risk to a woman's life or physical health from continuation of a pregnancy. That could mean a serious risk of death or "impairment of a major bodily function" caused by one of 21 different conditions, such as coma, seizures and epilepsy.

It also included a more general category: "another physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy that places the woman in danger of death or major bodily impairment if an abortion is not performed."

The regulation is similar but also included consideration of psychiatric disorders.

Suddock said the law seeks to limit Medicaid funding to high-risk, high-hazard situations while failing to address serious but "less-than-catastrophic" health detriments. It also would deny funding in cases involving fetal anomalies, even situations "where a delivered infant will suffer an inevitable and at times painful death," or women dealing with mental illness or addiction, he wrote.

Medicaid funds a wide range of services but abortions for poor women would be subject to another level of scrutiny, he said.

Medicaid will pay $9,000 in routine prenatal care and $12,000 in routine delivery expenses for a pregnancy where a low-income woman decides to carry to term "in the face of significant risks," he wrote.

But under the law that was challenged in this case, "it cannot pay $650 for the same poor woman who is unwilling to bear those risks and who exercises her constitutional right to terminate her pregnancy. The court is aware of no other context where Medicaid engages in such a relentlessly one-sided calculus," he wrote.

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