Missouri's supplemental budget bill signed into law Thursday includes a provision to block patients who rely on Medicaid from accessing Planned Parenthood health centers.

Federal Medicaid law protects patients' rights to choose their providers, including Planned Parenthood.

Michelle Trupiano, executive director of the Missouri Family Health Council, noted because of the Hyde Amendment, Medicaid cannot cover abortions, but Planned Parenthood provides a wide array of family planning and reproductive care, from birth control and STI testing and treatment to cancer screenings and other preventive services.

"The safety net is already at capacity and stretched very thin, it can take weeks for patients to get an appointment, and we need all the providers working together to meet the needs," Trupiano observed. "All this ideological attack does is further the disparities that already exist in Missouri."

Trupiano pointed out family planning and reproductive-health providers saw more than 40,000 patients in Missouri in 2021, and more than half were at Planned Parenthood.

Last year, the Missouri Supreme Court struck down a similar attempt to defund Planned Parenthood in the budget bill, and advocates say litigation will be filed again this time.

Trupiano stressed there are many steps the Legislature could take to improve access to reproductive-health care. She urged them to support and promote Medicaid expansion, so everyone has access to the full range of services they need, including family planning.

However, she added lawmakers have been working to undermine expansion, even though it was passed by voters as a constitutional amendment in 2020.

"And then more specific to ways to improve reproductive and sexual health," Trupiano outlined. "We would love to see the expansion of postpartum coverage for folks who have recently given birth that they don't get kicked off of Medicaid 60 days after they have given birth."

The supplemental budget bill, much of it using federal money, funds Medicaid for the rest of the fiscal year, which ends in June, and includes $1.9 billion for local public school districts, nearly $100 million for nonpublic schools, more than $400 million for child care and more than $200 million for school food programs.

Support for this reporting was provided by The Carnegie Corporation of New York.

With only four weeks left before the state's voter-registration deadline, advocacy groups say they are sounding the alarm on a ballot initiative which would ensure abortion is not considered a constitutional right.

Michael Muller, campaign manager for Protect Kentucky Access, said Amendment 2 would create a new section with language explicitly stating to protect human life, nothing in the Constitution shall be construed to protect a right to abortion or require the funding of an abortion.

Muller said as written, there would be no exceptions for the life of the mother in cases of rape or incest. He also pointed out there are a variety of situations such as miscarriages, which are medically classified as abortions.

"This would really put doctors in a very perilous position," Muller contended. "Between the life of the mother in those scenarios not being protected under the Constitution."

Supporters of the measure argued the change is needed to protect the sanctity of life, and maintained the language does not ban any type of abortion but instead allows elected officials to regulate abortions.

Kentucky's voter-registration deadline is Oct. 11, and the state's Primary Election is on Tuesday, Nov. 8, with polls open from 6 a.m. to 6 p.m. Early voting begins Nov. 3.

Muller noted he worried the measure would further reduce access to reproductive health care in regions of the state already struggling with a low availability of providers.

"So this is very, very reckless and will be one of the absolute most dangerous things in a state where 73 of us 120 counties already don't have a practicing OB-GYN," Muller pointed out. "This will turn us into a greater health care desert."

Kentucky is among around a dozen states with trigger laws that went into effect after Roe v. Wade was overturned by the Supreme Court earlier this summer.

According to a recent NPR/Marist Poll, registered Democrats and independents said inflation and abortion are their top issues of the midterm election cycle.

U.S. Sen. Catherine Cortez Masto, D-Nev., and her Republican challenger, former state attorney general Adam Laxalt, are accusing each other of distorting their respective positions on abortion.

This week, a group of pro-choice Latinas slammed Laxalt and his surrogates for claiming that Cortez Masto supports abortion "up until the moment of birth." They said she, in fact, supports Nevada's current law that allows the procedure up through 24 weeks.

Geoconda Hughes, an Intensive-Care Unit nurse practitioner in Las Vegas, spoke at the news conference organized by the Cortez Masto campaign.

"It is extremely frustrating when politicians spread lies," she said, "deliberately ignoring that some women's lives are at risk or when women are victims of sexual violence."

In a recent op-ed, Laxalt praised the Supreme Court decision to overturn Roe v. Wade and said he would support restricting abortion to the first 13 weeks of pregnancy. He has called that decision a "historic victory for the sanctity of life," but said he respects Nevada voters' decision to keep abortion legal and does not support a national ban. He is endorsed by anti-abortion groups in the state.

Susie Martinez, secretary-treasurer of the Nevada AFL-CIO, said Laxalt is trying to have things both ways.

"If you care so much for children," she said, "how about you go visit foster homes? How about you go empty the orphanages? And just remember: stay out of my reproductive rights."

Cortez Masto supports unfettered access to contraception. As attorney general, Laxalt defended the right of a Catholic charity to refuse to cover contraception for its employees and signed an amicus brief supporting pharmacists in Washington state who did not want to dispense the so-called "morning after" pill.

In about a month, the Pennsylvania General Assembly revisits a controversial proposal with five separate amendments to the state Constitution. Groups that oppose Senate Bill 106 are using the next few weeks to rally their forces.

SB 106 could deny the right to abortion care and funding in Pennsylvania without exception. Another potential amendment would tighten rules about voter ID at the ballot box.

Laura Nevitt - executive director of the Keystone Progress Education Fund - said in the meantime, groups like hers are reaching out to voice concerns about SB 106, particularly the prospect of an abortion ban.

"The work now is just about educating people about what this constitutional amendment actually would do," said Nevitt, "why it is not good for the people who live in Pennsylvania, and making every effort and attempt possible to prevent it from getting on the ballot."

Democrats say GOP lawmakers are using the constitutional amendment process because they know the governor would veto standard legislation about these issues.

But this method also means the resolution has to survive two legislative sessions before the amendments could be put on the ballot for a public vote. The second session begins September 12.

The Pennsylvania Coalition Against Rape also strongly opposes SB 106 and predicts if it's passed, it would be used to block individuals' access to abortions, even in cases of rape or incest.

Donna Greco - public policy and legislative affairs director for the coalition - said their view is that it violates bodily autonomy and reproductive freedom. But for now, she said, a person still has the right to get an abortion.

"Currently, abortion is still legal and protected in Pennsylvania," said Greco, "as well as the range of reproductive healthcare, contraception, emergency contraception. So right now, those services are still legal here throughout the Commonwealth."

Gov. Tom Wolf already filed a lawsuit to protect reproductive rights in the Commonwealth. He contends the amendments are "constitutionally invalid."

The Senate Republican Caucus countered that Pennsylvania voters should be allowed to decide these issues.