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The Honolulu Advertiser
Posted on: Saturday, June 2, 2001

State to cover costs of abortion pill

By Jessica Webster
Advertiser Staff Writer

Hawai'i will circumvent federal restrictions on money for abortion programs in the next few weeks when the Department of Human Services begins using state dollars to cover the cost of providing the so-called abortion pill for poor and disabled women.

The Bush administration recently notified states that it will only pay for the abortion pill mifepristone, better known as RU-486, to end a pregnancy in situations of rape, incest or when a woman's life is in danger — the same restrictions placed on federal money for surgical abortions.

State DHS Director Susan Chandler said QUEST, the federal and state-financed managed care program in Hawai'i, will not dip into federal money to cover the costs of RU-486 in any cases.

Hawai'i will cover the costs of RU-486 for all QUEST participants who request it, as it does for surgical abortions. There are no estimates as to how much state money will be used.

"We just see these as medical services," said Chandler. "And I think any way we can support women so that they have healthy reproductive lives is one of our goals."

There were 3,941 abortions performed in Hawai'i last year. State Med-QUEST administrator Reuben Shimazu declined to say how many of those abortions were covered for QUEST clients. The six QUEST health plans — the Hawai'i Medical Service Association, Queen's Medical Center, Kaiser Permanente Medical Care Program, AlohaCare, Straub and Kapiolani Health — said they did not have the numbers available.

Nonprofit organizations such as Hawai'i Right to Life and other opponents of abortion have characterized the use of RU-486 as "killing the unborn." However, no one has come to the forefront in the legislative arena to argue against using state money for abortion in Hawai'i — a challenge raised in the past two years in states such as Washington, Illinois, California, Colorado, Nebraska, New Mexico, South Carolina and New Jersey.

State Rep. Bob McDermott, R-32nd ('Aiea, Salt Lake, üliamanu), who opposes abortion, said he thinks the issue has become a losing battle in Hawai'i.

"Ever since the Republican Party changed its plank a few years ago to support abortion, with the exception of partial-birth abortion, there are no movements to block something like state abortion funding. I don't see it, and it doesn't seem to be on anyone's mind."

Since 1977, restrictions on the use of federal Medicaid dollars for abortion services have been imposed through the Hyde Amendment. Later amendments to Hyde allowed for abortion to be paid for under circumstances of rape and incest, or when the mother's life is in danger.

Chandler said federal financing is difficult to apply to state Medicaid or Hawai'i's QUEST program because women are not mandated to report if they were raped or victims of incest when seeking an abortion. Thus, Hawai'i is one of 19 states that opts to use state money to pay for abortions within and beyond the restrictions of the Hyde Amendment.

RU-486 will be first available at Family Planning Centers of Hawai'i in mid-June, and later at some small clinics and private practices across the state. Of the six QUEST health plans, more than half will refer clients to Family Planning Centers of Hawai'i or another clinic for the pill.

State Rep. William Stonebraker, R-15th (Kalama Valley, Portlock), has proposed legislation to ban RU-486 for girls 16-years-old and younger, and said he will possibly address the money issue next session.

"I'm unsure that we've really done enough research on the effects this has, especially on the psychology of young girls."

The staff at the Family Planning Centers of Hawai'i has participated in extensive training and preparation for the arrival of RU-486, said executive director Barry Raff.

"This option will be counseling-intensive," said Raff. "We wouldn't think that teens would be good candidates for this, but more for someone who is mature — in their 20s — and who understands the ramifications. It's not like taking a pill and it's done. It's two or three visits.

"But we think offering the additional choice is positive. If two women or 20 or 100 utilize it, it's just giving them another choice."

Beverly Morton, director of clinical operations, said women will have to know quickly if they are pregnant because RU-486 is only available up to 49 days of a pregnancy. The pill induces effects similar to a miscarriage, and there is significant cramping and bleeding, Morton said.

Patients are given mifepristone while they are at the clinic. A few days later, they must take misoprostol, which causes the uterus to contract and empty, inducing an abortion. Women must return to the clinic for a follow-up appointment to make sure the abortion is complete. If it isn't, a surgical abortion must be performed.

"We don't think this will be something that's used in huge numbers, but I think everyone agrees that it is good to have another choice for treatment," she said.

The abortion pill will cost about $500, compared with $425 for a surgical abortion.

More information on RU-486 in Hawai'i is available at Family Planning Centers of Hawai'i, 589-1149.