Arkansas was ordered Friday to continue supplying Medicaid dollars to Planned Parenthood of the Heartland, which operates clinics in Little Rock and Fayetteville, for at least the next 14 days.
That was the gist of an order handed down late Friday afternoon by U.S. District Judge Kristine Baker, who heard arguments Thursday on the request for a temporary restraining order to prevent Medicaid patients who use the clinics' services from being denied benefits starting Monday. That's when Gov. Asa Hutchinson's Aug. 14 directive to discontinue Medicaid funding for Planned Parenthood clinics was to begin affecting patients.
Medicaid is a state-administered health care program, funded mostly by federal dollars, for the poor. Hutchinson directed the state Department of Human Services to terminate its Medicaid agreements with Arkansas' Planned Parenthood clinics because "recent revelations" about activities at some out-of-state Planned Parenthood clinics made it "apparent ... that this organization does not represent the values of the people of our state."
Hutchinson was referring to edited video clips, released by the anti-abortion group Center for Medical Progress, of conversations between Planned Parenthood executives, doctors and staff members about money they expected to receive for providing fetal body parts for medical research.
The governor's directive prompted three women who use the Little Rock clinic to file a lawsuit Sept. 11 alleging that his action violated federal Medicaid laws and the U.S. Constitution, particularly the First and 14th amendments. The Medicaid Freedom of Choice Provision states that Medicaid enrollees may seek family-planning and other preventive health services from a participating provider of their choice and have those services covered by Medicaid.
The women are backed by the American Civil Liberties Union of Arkansas, whose director, Rita Sklar, said Friday in a statement, "This ruling comes on the heels of federal courts blocking similar efforts across the country. To date, two federal courts of appeals, the seventh and ninth circuits, have blocked similar laws enacted in Indiana and Arizona, and the Supreme Court declined to review both of those rulings. We are confident in the merits of this case and hope the federal courts will ultimately rule on the side of women who rely on Medicaid programs for basic, preventive health care."
Baker's order provides only immediate, temporary relief. She said Thursday that she may consider a request for a preliminary injunction before the 14-day temporary restraining order expires. A preliminary injunction, which would require presentation of evidence beyond affidavits and exhibits already filed, likely would prevent the state from discontinuing Medicaid funding until the case is resolved.
Suzanne Baca, chief executive officer of Planned Parenthood of the Heartland, also known as PPH, said in a news release issued after Baker's ruling, "For our patients, this isn't about politics -- it's about staying healthy and building a future."
Judd Deere, spokesman for Arkansas Attorney General Leslie Rutledge, said she "respectfully disagrees with Judge Baker's decision. It should be noted, however, that this decision is just the beginning of the litigation process."
Similarly, Hutchinson released a statement saying, "As governor, I disagree with the court's decision. Ethical conduct by Medicaid providers is a relevant factor for the state to consider. Hopefully, the court or a higher court will reconsider the preliminary decision once the facts are fully developed. It is disappointing that a judge appointed by President [Barack] Obama does not give sufficient weight to the morally repugnant conduct of Planned Parenthood displayed in a series of recently released videos."
Jerry Cox, president of the Family Council in Arkansas, said in a release that "what we're talking about is the state's freedom to decide to whom it will and will not give taxpayer dollars."
In her 19-page written order, Baker noted that Planned Parenthood of the Heartland has operated health centers in the two Arkansas cities for more than 30 years. She noted that the clinics provide family planning services to men and women, including contraception and contraceptive counseling, screening for breast and cervical cancer, pregnancy testing and counseling, and early medication abortion, the latter of which isn't covered by Medicaid, "in virtually all circumstances."
In addition, Planned Parenthood of the Heartland operates a pharmacy that allows patients to have their birth control prescriptions automatically refilled.
Baker cited statistics from Planned Parenthood of the Heartland that during the 2015 fiscal year, it provided about 1,000 health care visits and filled more than 1,100 prescriptions for more than 500 women, men and teenagers insured through Medicaid in Little Rock and Fayetteville. Almost 40 percent of its Little Rock patients and 15 percent of its Fayetteville patients were covered by Medicaid in 2014, according to the statistics.
Without an injunction, the plaintiffs argued, patients covered by Medicaid will lose access to services and their provider of choice, and be left with few or no adequate alternative providers, Baker said. She cited Planned Parenthood of the Heartland's fears that if it is forced to stop providing care through the Medicaid program, "a dire situation will become critical. The remaining providers will be simply unable to absorb PPH's patients, leaving those patients without access to crucial medical services."
In considering the harm that would come to the three women and Planned Parenthood of the Heartland without a restraining order, Baker agreed that the organization would lose revenue it would be unable to recover and the women would see their relationships with the clinics disrupted, causing reduced access to family-planning services in violation of their statutory rights.
She said the state "has provided the court with no record evidence demonstrating that the alleged other providers are willing to accept additional Medicaid patients in sufficient numbers to account for all patients likely displaced by [the state's decision], that any one of these other providers provide all of the services offered by PPH at one location, or that any one of these other providers provide the medication abortion services" that Planned Parenthood of the Heartland provides.
The state has not shown "that these alleged other providers are able to render the same services the Jane Does and other Medicaid patients have been receiving from PPH," she said, referring to the three unidentified women who are plaintiffs.
Baker said the state also failed to address the difficulty of patients getting timely appointments with other providers, which she said is especially important "when family planning and reproductive health care needs are at issue."
Baker also found that the potential harm to Planned Parenthood of the Heartland and the Jane Does outweighs the immediate interests and potential injuries to the state's pursuit of public policy objectives.
She said the plaintiffs' questions about the legality of Hutchinson's directive also show a likelihood of succeeding at this stage of the case.
Metro on 09/19/2015
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