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Impossible Choice: Despite onerous restrictions already in place, women's health options are coming under fire again 

"The increased burdens ... have the potential to drive women out of state or underground."

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It's not like getting an abortion in Pennsylvania was easy before. Just ask Janet, who more than a decade ago found out she was pregnant, at age 17. 

State law requires parental consent if a minor wants an abortion, unless a judge bypasses the requirement. But Janet, who grew up around Erie, couldn't tell her parents. And so she and her boyfriend cobbled together $450 from paychecks from Walmart and washing dishes, and had friends drive her to a clinic in nearby Buffalo, N.Y. When she spoke to a counselor about the decision to abort, "Basically I told the woman, ‘I'm 17, I've got all these plans. I'm going to college. This can't happen,'" says Janet, who spoke on condition of using an alias. 

"I just felt like it was something I had to do."

Today, Janet and her boyfriend are married, living the life she hoped for — and pregnant with a child she says they can now support and are more prepared to raise. But at her high school, where sex education consisted of little more than being told about puberty, many of her classmates weren't so lucky. "Even ninth-graders were having babies," Janet recalls. "That's scary stuff."

 Some didn't finish high school, let alone make it to college.

"It was just a matter of who had the money to do what," Janet says.

And women's-rights advocates fear that, after years of an already difficult status quo, Republicans are seeking to put women like Janet in even more dire straits. 

Pennsylvania's Abortion Control Act was passed in 1989. In 1992, a U.S. Supreme Court decision upheld most of its provisions and it became effective in 1994.  Once that ruling was handed down, observers note, things quieted down on Pennsylvania's legislative front.

"For years any abortion-related issues were really confined to fighting about family-planning appropriations," says Sue Frietsche, a senior staff attorney with the Women's Law Project who is also counsel for Allegheny Reproductive Health Center. "For many, many years the dominant strategy we saw was a stealthy incremental strategy — deny as hard as you can that what you're doing is taking health care away from women. .... That strategy has clearly been supplanted by an openly radical strategy."

Over the past two years, the General Assembly debated a number of abortion-related bills, including one requiring a mandatory, invasive ultrasound. Another bill, meanwhile, reclassified abortion facilities as ambulatory surgical facilities. The latter bill passed, which has forced clinics to undergo costly renovations to comply with new standards.

Kim Evert, president and CEO of Planned Parenthood of Western Pennsylvania, says that complying with those rules cost $325,000 for the agency's Downtown clinic. It's not clear yet how much that will increase the cost for patients. "We're looking at that right now because our costs have gone up significantly," Evert says. "This is budget time, [we're] trying to figure that out."

Meanwhile, new legislation being drafted in Harrisburg might ensure that many women will continue bearing the higher costs entirely on their own. 

Two measures, Senate Bill 3 and House Bill 818, are being crafted to preclude new state-run health-insurance exchanges from covering abortion. The exchanges, which are due to be created by 2014 under President Barack Obama's health-care reform, are intended to offer insurance to Pennsylvanians who can't get insurance through an employer. 

Republicans say they are trying to preserve the status quo. 

"Obamacare prompted this," says Joe Pittman, chief of staff for SB3's sponsor, Indiana County Republican Don White. "If Obamacare were not law and the exchanges were not coming into place, we wouldn't be having this conversation."

Pittman says SB3 is intended to enforce existing bans that bar tax dollars from being used to pay for abortion except in cases of rape, incest and danger to the life of the mother. 

"We're not setting any new standards here," says Pittman. Consumers can purchase a policy outside of the exchange if they wish, he adds.

That's unrealistic, say critics. 

Planned Parenthood officials say that 80 percent of private insurance companies offer abortion coverage, making the measure a departure from the status quo. 

"There is no one who offers and no one who will buy a separate policy for abortion," says state Sen. Daylin Leach, a Philadelphia-area Democrat. "You don't buy kidney-stone insurance. No one predicts what they are going to have."

Democrats are countering the legislation. House Bill 818, a measure identical to White's bill, passed in the House on April 23. It is now before the Senate, where state Sen. Jay Costa (D-Forest Hills) says Senate Democrats will introduce two amendments. One change will allow abortion to be covered when a pregnancy poses a threat to the mother's health — not just to her life, as the bill is currently written. Democrats also want to allow individuals to purchase a policy covering abortion on the insurance exchange provided that the policyholder covers any related administrative fees.

Such a change, Costa says, would be "consistent with the intent of no taxpayer dollars going toward abortion," Costa says. 

Pitman says White opposes the changes. Such amendments, he says, are unworkable. "Despite best efforts to describe this as private insurance, it is not." And if lawmakers want to amend the bill, he says, they should amend the entire Abortion Control Act to make sure the rules remain uniform.

In any case, says Evert, the legislation suggests that "clearly there's been a change in the political climate. What we're seeing is the anti-choice side feeling very empowered."

In fact, White's bill isn't the only one worrying advocates and pro-choice legislators. Republican state Rep. Matt Baker — who spearheaded the legislation requiring costly clinic renovations last year — has introduced a package of bills dubbed "the rights of conscience bills."

The bills would, among other things, allow insurance plans offered either by the state or private employers to drop coverage for contraception, sterilization procedures or abortifacient drugs or devices if it's against their conscience. The package also includes legislation that would require any insurer offering a plan to provide duplicate policies with one not offering coverage of contraceptive methods, sterilization procedures or abortifacient drugs or devices.

Citing scheduling conflicts, a spokeswoman for Baker said the representative would not be able to answer City Paper's questions via email. But in a March 4 co-sponsorship memorandum, Baker wrote to his colleagues that he was introducing the measures because he believes "that the rights of conscience are being impeded by a Government who requires that employers, employees and governmental entities support, through use of tax dollars and insurance premiums, devices and procedures which violate their religious beliefs and conscience."

Republicans say that while Obama's health-care overhaul is motivating much of the new legislation, another factor is the case of Dr. Kermit Gosnell, who has been on trial for running an abortion clinic that authorities called a "house of horrors" in Philadelphia, performing late-term abortions in deplorable conditions. (As this issue was going to press, the Gosnell verdict was being read by jurors and the doctor had been convicted of several counts, including three counts of first-degree murder for the death of three live infants, and involuntary manslaughter of a patient.)

 "I don't think there was ever really a lull in pushing protecting life. ... But it got added emphasis after the Gosnell case," says Stephen Miskin, spokesman for the Pennsylvania House Republican Caucus.

That case, says Miskin, "opened the eyes of many people. Was Gosnell the exception ... or was what happened in Philadelphia commonplace in other places?"

But opponents of the bill say such restrictions will result in more cases of women having to go to unscrupulous providers like Gosnell. 

"An increase in cost of abortion care, coupled with the decrease of licensed providers in Pennsylvania, has the potential to create a market for illegal and dangerous clinics to operate under the radar and put women's lives in danger," says Rebecca Cavanaugh, spokeswoman for Planned Parenthood of Western Pennsylvania. Cavanaugh says clinics work with clients to ensure they receive services via a sliding scale and foundation support, "but the increased burdens placed on women have the potential to drive women out of state at best ... and underground at worst."

But with Republicans controlling both the legislature and the governor's mansion, choice advocates acknowledge that they are on the defensive. 

"The idea that women can't make decisions for themselves without the input of men is how the world is supposed to work according to these people," Leach says. "Now they have a governor willing to go along with it."

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