States could ban abortion pill for Medicaid enrollees, experts say
Abortion clinics have shuttered and state laws to ban abortion have already taken effect following the Supreme Court's decision to overturn Roe v. Wade Friday.
That has put a spotlight on FDA-approved abortion pills as a potential option. However, it isn't clear cut if all women will have access.
Despite U.S. Attorney General Merrick Garland's reassurance Friday that states could not ban FDA-approved abortion pills, questions remain about whether those on Medicaid could be denied access.
In fact, there are already a number of states that have created laws to circumvent the FDA's recent policy change to make access easier by mail, which affects the broader population. And a 2019 Government Accountability Office (GAO) report showed that at least 14 states were not covering the pills "despite the requirement to do so under federal law."
Garland said that "the FDA has approved the use of the medication Mifepristone. States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy."
The pills account for 54% of all abortions in the U.S. today. Vulnerable populations like minorities and poorer women and girls stand to be impacted the most by the Supreme Court decision.
Some states might be able to deny the pill to Medicaid enrollees. While federal funding does not cover abortions, it allows termination of pregnancy as a result of incest or rape, or if it endangers the life of the mother — a caveat known as the Hyde Amendment.
Still, some states have already executed trigger laws that would exclude even these protections.
And even as some of the country's largest companies are putting into effect new policies to aid in access to abortions, including travel, that still leaves some women and girls vulnerable.
To that extent, the Department of Health (HHS), which oversees Medicaid, is weighing transportation options for those who may not be able to otherwise access it. Until then, the pills are the focus of the Biden administration.
At a media briefing Tuesday, HHS Sec. Xavier Becerra said the Biden administration will be enforcing the law and defend its legal authorities.
"What that translates into depends on what states try to do," he said.
A spokesperson for CMS told Yahoo Finance that the agency is "closely reviewing the Supreme Court’s ruling and how it will impact the Medicaid program."
The pills
Mifepristone is the FDA-approved abortion pill, and is followed by doses of Misoprostol, in order to complete a medical abortion. This can be done with assistance from a medical professional, but doctors say it can also be done alone — which might be helpful in states with new bans in place.
The generics are available and used for a variety of medical diagnoses outside of abortion, and misprostol is on the World Health Organization's list of essential medicines.
Danco and Pfizer manufacture the pills in the U.S. Danco has said it has ample supply on hand in the event of a surge post-Supreme Court decision. Pfizer (PFE) did not return a request for comment.
Experts say it remains unclear how vulnerable women — who are also at greatest risk for poorer health and more likely to be in need of additional assistance programs — will access the pill if states determine they have the authority to limit access for Medicaid enrollees.
Medicaid's role
Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure said in a statement Friday that she will "continue working to maintain and expand access to the full range of reproductive health care services across the lifespan—that includes IUDs, emergency contraception, oral contraception, other forms of contraception, and abortion care within our legal authority."
But Brooks-LaSure did not expand on what falls within the agency's legal authority, which impacts more than 80 million women and girls. Multiple requests for comment were not returned to Yahoo Finance.
In part, the new FDA rule that allows Mifepristone to be available via telehealth and mail order could help, according to Kaiser Family Foundation experts.
But the question of where FDA's authority regulate a drug starts and ends, and where states' authority to regulate abortion starts and ends, is at stake, according to KFF's Laurie Sobel.
The pills "are at that intersection," she said.
Sobel noted that the Supreme Court's majority opinion's didn't mention the pill, but the dissenting justices did.
"After this decision, some States may block women from traveling out of State to obtain abortions, or even from receiving abortion medications from out of State," they said.
"And no one knows where it will end," Sobel said.
Follow Anjalee on Twitter @AnjKhem
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