On August 27, Alaska Superior Court Judge John Suddock struck down a state law and similar regulation requiring abortion practitioners to explain why they thought an abortion was “medically necessary” before they could receive compensation for the procedure from Alaska’s public funds.
As in other states, Alaska is subject to the long-standing federal law — the Hyde Amendment — which stipulates that federal dollars can only fund abortions in cases of rape, incest or to preserve the mother’s life. But if none of those conditions apply abortion practitioners in Alaska have been able to simply claim that an abortion was “medically necessary” and the state would then pay for abortions of low-income women on Medicaid. The state aimed to require abortion practitioners to cite specific reasons as to why they thought the abortion was “medically necessary.”
In his opinion Judge Suddock said the statute and regulation violate equal protection guarantees in the Alaska Constitution by requiring abortions to be deemed “medically necessary” in order to qualify for Medicaid coverage, while similar restrictions are not imposed on other pregnancy related services covered by Medicaid.
Judge Suddock explained that “for all practical purposes” his ruling empowers an abortion practitioner “unfettered physician discretion” in determining whether an abortion is medically necessary and thereby eligible for state-funded Medicaid reimbursements.
The State of Alaska has not yet determined whether it will appeal the decision.
The history of state-funded abortions in Alaska dates back to an Alaska Supreme Court ruling in 2001 that required the state to pay for “medically necessary” abortions, when the procedure did not qualify for federal reimbursement under the Hyde Amendment.
Alaska now pays for roughly 700 abortions a year through the state’s Medicaid program for low income women. Abortion practitioners simply checking a box marked “medically necessary,” but with no explanation as to why. The result is that no federal dollars pay for Alaska abortions. Instead, the state foots the bill. The cost to Alaska has been about $450 per abortion, which works out to $315,000 annually, according to former Alaska Health Commissioner Bill Streur.
The law that Judge Suddock struck down included a list of “medically necessary” reasons used in other states that have designed similar limits on state-funded abortions.
The Alaska regulation required that abortion practitioners submit a form indicating at least one of 21 possible conditions as to why an abortion was deemed “medically necessary.” To receive reimbursement from the state, abortion practitioners had to affirm that the abortion was “to avoid a threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function.” The regulation also permitted the state to fund abortions that are performed to avoid “another physical disorder, physical injury, physical illness, including a physical condition arising from the pregnancy, or a psychiatric disorder that places the woman in imminent danger of medical impairment of a major bodily function.”
The law was never implemented, as it was temporarily blocked in 2014 by the Alaska Superior Court and then ultimately struck down.