Testimony of Nancy Stanwood, MD, MPH Board Chair, Physicians for Reproductive Health Submitted to the House Judiciary

Committee Subcommittee on the Constitution and Civil Justice January 9, 2014 Physicians for Reproductive Health (Physicians) is a doctor-led national advocacy organization that uses evidence-based medicine to promote sound reproductive health policies. A large number of the doctors Physicians represents practice in the field of obstetrics and gynecology, but many are pediatricians, fertility doctors, family physicians, cardiologists, neurologists, radiologists, and others. Physicians unites the medical community and concerned supporters. Together, we work to improve access to comprehensive reproductive health care, including contraception and abortion, especially to meet the health care needs of economically disadvantaged patients. Physicians welcomes the opportunity to submit testimony on H.R. 7, misleadingly named the No Taxpayer Funding for Abortion Act. This dangerous bill would effectively ban insurance coverage for abortion, even to protect a womans health. This could put access to abortion out or reach for countless women. A womans health insurance should meet all her health needs and cover a full range of medical procedures, including abortion. H.R. 7 would decimate private insurance coverage for abortion by raising taxes on individuals and businesses to discourage coverage. H.R. 7 also codifies harmful riders that already deny scores of underserved women insurance coverage for abortion. If enacted, millions more women could be deprived of coverage for abortion. Moreover, H.R. 7 contains very limited exceptions that are inadequate to protect a womans health. This bill ignores the very real situations women face and, if enacted, would have a devastating impact on their ability to access safe and legal abortion care. Every day my colleagues and I treat women who are able to use their insurance to obtain needed medical care. Sadly, we also see patients without the financial resources to pay for an abortion. For a woman to be able to make a real decision based on whats best for her and her family, she needs to be able to afford her care.

In my practice, I had a patient, Carol 1, who was excited to give birth to her first child. Her husband, a Marine, was serving in Afghanistan. They received health insurance through the military. Sadly, in Carols second trimester, she learned that her baby had anencephaly; it would be born without a brain. After much deliberation, she and her husband decided to terminate the pregnancy. They were shocked to learn that their health insurance would not cover the abortion and would only cover a situation in which Carols life was in danger. 2 Her husband was outraged, telling me, Im over there defending my country, and they wont even take care of my family? The law treated this family terribly during a time of great stress and need. Under H.R. 7, other families would be forced to repeat Carols painful experience. I remember Melissa, the youngest in a large tight-knit family and a high school Reserve Officers Training Corps (ROTC) graduate, who was 19 years old when she went to enlist in the Marines. The intake testing revealed that she was pregnant. She had been careful to use condoms with her boyfriend, but the condoms had failed. Melissa was clear about her plans for the future, which included starting a family once her military career was well established. She and her mother were fortunate not to have to worry about insurance coverage for her care, as their private insurance covered the procedure. This allowed Melissa to pursue her dreams and serve our country. Dr. Douglas Laube of Madison, Wisconsin, immediate past board chair of Physicians, had a patient, Beth, who was pregnant with her first child and looking forward to becoming a mother. Three months into her pregnancy, she developed dangerously high blood pressure. Without an abortion, Beth might have suffered a stroke or kidney damage. She made the decision to end her pregnancy. Beths medical condition is just one of many that can complicate pregnancy. But H.R. 7 would leave women like Beth without insurance coverage for abortions necessary to protect their health. Physicians consulting medical director Dr. Anne Davis of New York cared for a patient named Liza, who had insurance through her low-wage job at a hospital. Liza was married with two children, and became pregnant while taking the pill. Although it was an unintended pregnancy, Liza and her husband wanted to have the baby. But then Lizas husband lost both of his jobs. They decided to have an abortion. Because of complicated health circumstances, Lizas abortion cost $10,000an amount that would have destroyed her familys already strained finances if they had been required to pay out of pocket. Fortunately, her insurance covered the procedure. Physicians Leadership Training Academy Fellow Dr. Kristina Tocce of Denver treated a patient with a complicated pregnancy. An ultrasound showed that her patient Consuelas fetus was not developing kidneys. Most infants with this problem do not live more than a few hours. Also, Consuelas placenta was covering the opening of her cervix. This condition, if left untreated, can result in life-threatening bleeding during delivery and requires a cesarean section. Conseula and her husband wanted to terminate the pregnancy, but her insurance was through Medicaid. Because Consuelas medical condition did not endanger her life, she did not qualify for abortion coverage under Medicaids life exception. Out of pocket, her abortion would have cost more than $4,000, an impossible sum. Consuela continued to carry her pregnancy and suffered tremendous emotional turmoil. Six weeks later, her fetus died in utero. The legislation under consideration would force women all over the country into situations like Consuelas.

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Please note that all patient names are changed to protect confidentiality. In 2012, federal law was changed to allow coverage in instances of rape and incest.

In Seattle, Dr. Deborah Oyer saw a patient, Allison, a 34-year-old mother of three with an unintended pregnancy. She was still deciding whether to continue her pregnancy when she learned her youngest child had leukemia. She and her husband quickly realized that they could not have another child at that time. Allison needed to take leave from work and stay at the hospital with their daughter for medical treatments. Her husband needed to stay at home, two hours away from the hospital, to work and care for their two other children. Fortunately, Washington State Medicaid covered her abortion. But Allison and her family would have faced great hardship if they had had to pay out of pocket. Access to affordable insurance that covers abortion is essential for women and their families. For these real women and their families, the decision to have an abortion was made after consultation with their health care providers and consideration of all the issues involved. Abortion was a critical medical procedure that protected their health as well as the well-being of their families. H.R. 7 threatens millions of American women by trying to make insurance coverage for abortion impossible to obtain. Health insurance should take care of women; not abandon them. If H.R. 7 were passed, real women like Beth, Melissa, Liza, Consuela, Allison, and Carol would suffer as a result. It is critical to the lives and health of American women that this bill be defeated. Please vote against H.R. 7.