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.

The Missouri Legislature has approved a law to stop its Medicaid program, known as MO HealthNet, from paying Planned Parenthood for medical services for Medicaid patients.

The decision follows a court ruling which found not reimbursing Planned Parenthood through Medicaid goes against Missouri's constitution.

Emily Wales, president and CEO of Planned Parenthood Great Plains, said they have joined forces with Planned Parenthood St. Louis Region and Southwest Missouri and stand behind providing health care to those who need it. She argued the Legislature is causing confusion despite a clear decision from the highest court.

"Despite the court's repeatedly ruling that 'defunding' Planned Parenthood health centers is unconstitutional, lawmakers continue to deny critical care like birth control, cancer screenings, wellness exams and STI testing and treatment from the patients who need it," Wales stressed.

According to the Missouri Family Health Council, Planned Parenthood health centers serve nearly half of patients who rely on family planning safety net providers in the state. Planned Parenthood Great Plains and St. Louis Region Southwest Missouri will continue serving patients and is looking for alternative solutions for funding.

The new law also blocks Planned Parenthood from being a recognized provider in the state's Medicaid program. Wales pointed out it could hurt health care for people who rely on the safety net.

"There are not enough other providers in the health care safety-net system to absorb Planned Parenthood's patients," Wales pointed out. "At Planned Parenthood, we'll continue to do everything we can to serve our patients, no matter what."

Planned Parenthood Great Plains provides health care to more than 30,000 people in 13 health centers across Missouri, Arkansas, Kansas and Oklahoma. The St. Louis Region and Southwest Missouri chapter has been serving for more than 90 years.

The U.S. Supreme Court is set to hear oral arguments today in a case about whether patients have access to emergency room abortions in states banning the procedure.

Idaho v. United States could determine if providers can perform medically necessary abortions for women experiencing complications under decades-old rules known as the Emergency Medical Treatment and Labor Act.

Dr. Polly Wiltz, a second-year emergency medicine resident at University Hospitals in Cleveland, said she is worried about her ability to care for patients who need abortions, if protections end.

"We are putting ourselves at risk for allowing legislators -- allowing people who do not have medical training -- to pick and choose which procedures, which life-stabilizing treatments and medications can and cannot be applied in the emergency department," Wiltz pointed out. "It's infringing on patient rights."

The Center for American Progress said pregnant patients with severe complications who are denied abortions could develop severe sepsis requiring limb amputation, uncontrollable uterine hemorrhage requiring hysterectomy, kidney failure requiring lifelong dialysis, hypoxic brain injury and other severe conditions.

Wiltz added most of the patients with pregnancy complications coming into the hospital lack access to routine OBGYN-related care.

"Regarding pregnancy related complaints, I see first trimester pregnant patients every single day," Wiltz noted. "In my shift, I have caught ectopic pregnancies that have ruptured."

Hospitals made up 33% of the facilities providing abortions in 2020, according to data from the Pew Research Center. Last fall, a majority of Ohio voters chose to approve a constitutional amendment, "Issue 1," establishing a statewide right to abortion and reproductive care in the aftermath of the Roe versus Wade decision.


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By Mary Anne Franks for Ms. Magazine.
Broadcast version by Alex Gonzalez for Northern Rockies News Service reporting for the Ms. Magazine-Public News Service Collaboration

People end up in emergency rooms for a variety of reasons. They’re having trouble breathing. They’ve suddenly developed chest pains. They’re bleeding uncontrollably. They’ve fallen off a roof, they’ve crashed their car, they’ve overdosed, they’re suicidal, they got stabbed in a fight, they got shot by police.

Some people who need emergency services are poor, or have no insurance, or are in the country illegally, or have committed a crime. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), they are all entitled to receive emergency care. This law is based on a simple principle: Hospitals shouldn’t be allowed to let people die based on who they are, how much they can pay, or what they have done.

On April 24, the Supreme Court will hear oral arguments in Moyle v. U.S., a case that will determine whether individual states are allowed to exclude a single group from this basic protection: pregnant women. The state of Idaho claims that it has the right to forbid pregnant women and girls—and only pregnant women and girls—from receiving emergency care that could save their lives.

How, and why, would a state want to do this?

First, the how: In 2022, the Supreme Court ruled in Dobbs that forced childbirth does not violate the Constitution. This allowed Idaho’s 2020 “Defense of Life Act,” a draconian anti-abortion law, to go into effect. According to the law, anyone who performs an abortion faces imprisonment of up to five years in prison. Healthcare professionals who perform abortions will also have their professional licenses suspended or revoked permanently.

This puts the state law directly in conflict with federal emergency care law. EMTALA requires Medicare-funded hospitals (which most hospitals are) to provide medically necessary stabilizing treatment to any patient with an “emergency medical condition.” An emergency medical condition is one that, in the absence of immediate medical attention, is likely to cause “serious impairment to bodily functions,” “serious dysfunction of any bodily organ,” or otherwise puts the health of the patient “in serious jeopardy.”

Pregnancy complications are a common reason for emergency care visits, and the medically necessary stabilizing treatment necessary to prevent serious injury or death to women and girls experiencing those complications sometimes includes the termination of the pregnancy.

Given that an abortion is sometimes the only medical treatment that will prevent death or serious bodily injury to women, a more accurate title for Idaho’s abortion law would be the “Let Women Die Act.” But as seen in the majority decision in Dobbs and the arguments propounded recently by the Alliance Defending Freedom in the mifepristone access case, forced birth proponents are rarely candid about their necropolitical agenda. Defenders of Idaho’s law instead feign outrage at the suggestion that the law will kill women, pointing to the law’s exception for abortions performed by a physician who “determined, in his good faith medical judgment and based on the facts known to the physician at the time, that the abortion was necessary to prevent the death of the pregnant woman.”

Idaho insists that the law’s exception for abortions necessary to save the life of the mother means that there is no conflict between it and federal law. But as the Department of Justice pointed out when it sued to stop the Idaho law from being enforced with regard to EMTALA’s requirements, federal law requires emergency medical care necessary to prevent serious injury, not just death. The federal law does not authorize the withholding of essential medical treatment to patients who are only close to, but have not yet arrived, at death’s door.

What is more, as countless medical professionals have attested, the line between serious bodily injury or death is rarely precise. It is often difficult, if not impossible, to predict the exact moment that a serious medical condition becomes a life-threatening one.

As the National Women’s Law Center detailed in its amicus brief in the case, “No clinical bright line defines when a patient’s condition crosses the lines of this continuum. At what point does the condition of a pregnant woman with a uterine hemorrhage deteriorate from health-threatening to the point that an abortion is ‘necessary’ to prevent death? When is it certain she will die but for medical intervention? How many blood units does she have to lose? One? Two? Five? How fast does she have to be bleeding?”

The recognition that serious bodily injury and death are so closely related as to be nearly indistinguishable has long been reflected in U.S. law. At common law, a person could be convicted of murder not only if he intended to kill but also if he intended to inflict “grievous bodily injury.” The law of self-defense generally allows a person to use deadly force when facing an imminent threat of death or serious bodily harm, not only to herself but to others.

Significantly, Idaho’s self-defense law specifies that a person is not required to wait for the danger to become fully apparent before acting: “The defense of self or of another does not require a person to wait until he or she ascertains whether the danger is apparent or real. A person confronted with such danger has a clear right to act upon appearances such as would influence the action of a reasonable person.”

Unless, of course, the person in danger is a pregnant woman.


Mary Anne Franks wrote this article for Ms. Magazine.