Will she or won't she? Strictest abortion ban in the U.S. awaits Iowa Gov. Kim Reynolds' signature

With a middle-of-the-night vote that followed hours of heated debate, Iowa Republicans have approved a measure that would ban most abortions in the state and give the state the strictest abortion law in the nation.

The move came in the final days of the legislative session, after mounting pressure from the Legislature’s most ardently anti-abortion corners to pass the so-called heartbeat bill before adjournment. It was accompanied by legislative threats and predictions — even hopes — the resulting law will be challenged in court.

Senate File 359, if signed into law, would ban nearly all abortions after a fetal heartbeat is detected. That can occur about six weeks into a pregnancy and often before a woman realizes she’s pregnant.

The House narrowly approved the bill 51-46 late Tuesday night. It immediately advanced to the Senate, where Republicans approved it with a vote of 29-17 at about 2:30 a.m. Wednesday.

The legislation now goes to Gov. Kim Reynolds, a Republican. She has not said whether she will sign it into law.

"When we get the bill, we have our team sit down and we review it," she told reporters. "Sometimes, there’s things in there we weren’t anticipating or didn’t know about. And so we take the time, whoever the policy person is in that area, and the team goes through it," the governor said. "Then we make the decision.”

Senate threatened to hold up budget

The Iowa Senate approved a similar fetal heartbeat ban earlier this year, but action stalled in the House, where Republicans struggled to muster the 51 votes necessary to pass the bill.

In an effort to force the House into action, Sen. Rick Bertrand, R-Sioux City, said a group of Republican senators had threatened to withhold their votes on critical budget bills needed to end the 2018 legislative session.

“There is a group of us that were more than willing to sit here until July 1,” he said, noting the date by which a new budget must be enacted in order to fund state government.

House leaders, attempting to get more of their members on board, brokered a deal on an amendment that created exceptions to the ban for some cases of rape and incest.

The amendment garnered them enough votes — but no more — to pass the bill at about 11 p.m. Tuesday. Six Republican representatives voted against the bill.

Democrats throughout the process called the legislation "frightening," "extreme" and "unconstitutional."

“Tonight, Republicans, you have once again made a choice: a choice to debate legislation that devalues the bodies and decision-making skills of Iowa women and girls,” said Sen. Janet Petersen, D-Des Moines. “None of you went to medical school, yet you Republican politicians are making dangerous medical decisions. This bill tells Iowa women and girls that forced pregnancy is more important than their health and well-being.”

Iowa law currently bars most abortions after 20 weeks, which already is among the strictest abortion bans in the country.

Hope to overturn abortion legalization

But many Republicans said they felt the time is right to pass legislation that could advance to the U.S. Supreme Court and pose a challenge to Roe v. Wade, the 1973 landmark case that found women have a constitutionally protected right to abortion.

The Supreme Court has declined to hear similar cases in recent years. But as states continue to pass legislation restricting abortions and President Donald Trump appoints more conservative federal judges, abortion opponents are increasingly optimistic.

“This law, if signed, I believe could very well be the very bill that overturns Roe v. Wade,” said Sen. Jake Chapman, R-Adel.

More: Republicans hope a challenge to Iowa's fetal heartbeat bill will overturn Roe v. Wade. How would that work?

More: If it gets challenged, who would pay for Iowa to defend its 'fetal heartbeat' abortion ban?

Sen. Matt McCoy, D-Des Moines, criticized Republican efforts to pass legislation that would inevitably face court challenges.

“Here we are, at 1:05 in the morning, pushing a bill that has absolutely no constitutional chance of ever passing muster,” McCoy said. “Where it’s been tried, it’s been quickly struck down by the courts — but (only) after extensive and expensive lawsuits.”

What the bill does

The bill requires physicians to conduct an abdominal ultrasound to test for a fetal heartbeat on any woman seeking an abortion. If that heartbeat is detected, a physician cannot perform an abortion.

Previously, the legislation allowed exceptions to that ban only in cases of "medical emergency," which was defined as a situation in which the life of the woman was in danger.

Republicans on Tuesday amended the bill to also allow exceptions if:

the woman was raped and reports the rape to a law enforcement agency, a public or private health agency or a family physician within 45 days;

the woman was the victim of incest and reports the issue to a law enforcement agency, a public or private health agency or a family physician within 140 days;

"not all the products of conception are expelled" following a spontaneous miscarriage;

a physician certifies that the fetus has an abnormality that, in the physician’s "reasonable medical judgment," is incompatible with life.

Rep. Mary Wolfe, D-Clinton, noted that physicians would not be tasked with confirming reports of incest or rape that are made by women seeking abortions. She also questioned whether the state should be requiring victims of violence to report crimes within a certain time frame.

“That is a good message to be sending to the children of Iowa that, 'You know what? If you’re scared and you don’t know what to do and you finally get the guts to go to your mom or your dad and tell them what happened but it’s 50 days after you were raped instead of 45, you’re stuck with that baby because the Iowa Legislature decided you needed to accept responsibility for coming forward,' " she said.

Rep. Shannon Lundgren, a Republican from Dubuque and the bill's floor manager in the House, said those requirements would allow justice to be served.

“We need to do everything in our power to encourage young women ... to come forward and tell people that they’ve been raped so that we can bring that perpetrator to justice," she said.

Rep. Steven Holt, R-Denison, said he disagreed with the exemptions because they water down the intent of the legislation.

"I do not agree with the exceptions in the amendment, for I believe that all unborn lives matter and that all unborn lives should be protected," he said. "However, I will vote to protect most of the unborn and we will continue to work to protect all unborn children."

Criminal penalties for doctors?

The bill no longer includes civil or criminal penalties for the physician, as some previous versions had.

And although it includes specific language granting women legal immunity, it does not do the same for physicians.

That led some Democrats to question whether a physician could be charged with murder if somebody later questioned whether the abortion he or she performed met the definition of a medical emergency.

"The courts, I can tell you, will likely interpret this as an intentional omission," said Rep. Todd Prichard, D-Charles City. "They will review that and say that the Legislature had a choice, and they chose not to provide immunity for doctors. This is extremely dangerous."

He called it a "glaring and perhaps purposeful" omission from the bill that could frighten doctors who want to provide legal abortions.

Rep. Chip Baltimore, R-Boone, disagreed, saying the bill does not make an unborn child a "person" and an abortion would not meet the statutory definition of murder.

Training could be threatened at OB-GYN residency program

Democrats said the legislation could negatively affect the University of Iowa Carver College of Medicine and Iowa Obstetrics and Gynecology Department.

Josh Lehman, senior communications director for the Iowa Board of Regents, said in a statement the program is required to provide family planning training "including all forms of contraception and training in the provision of abortion, if the student so chooses."

"If this law was passed, limitations on abortions in Iowa would eliminate the ability to meet training requirements," he said.

School leaders have said they would likely have to arrange out-of-state training options for students if the university could no longer do so on its own.

Rep. Mary Mascher, D-Iowa City, warned the changes would reduce the numbers of qualified OB-GYNs across the state.

"This change would result in a weakened program affecting all Iowans who seek all types of obstetric and gynecological care, not just those seeking to end a pregnancy," she said. "Fewer well-qualified obstetricians and gynecologists, as well as physicians from other specialties, will choose to train and live in a state that appears to devalue the practice of medicine. Patients will lose access to critical life-sustaining services.

Rep. Jon Jacobsen, R-Treynor, said the implication the program would lose its accreditation amounts to "scare tactics," arguing there are other ways for the school to meet its accreditation standards.