UnityPoint says Iowa unfairly barring all of its clinics from new family planning program

One of Iowa’s biggest health systems contends the state is improperly barring all of its hospitals and clinics from participating in a new family planning program because a few of them occasionally perform abortions.

UnityPoint Health says many of its hospitals and clinics do not offer abortions, and it contends they should be allowed to offer publicly financed birth-control services to moderate-income Iowans.

State administrators disagree. They say a new state law barring abortion providers from the family planning program means no clinic, hospital or health-care provider affiliated with the UnityPoint system may participate.

The controversial law was passed last spring by legislators who oppose abortion, and it was signed by then-Gov. Terry Branstad. The new family planning program, which is financed solely by the state, replaces a Medicaid program that allowed participation by agencies that provide abortions.

Most of the legislative debate focused on participation by Planned Parenthood of the Heartland, which is Iowa’s largest abortion provider. But the Department of Human Services, which runs Iowa's family planning program, said it informed legislators last spring that the bill they were contemplating also would bar participation by UnityPoint and by the University of Iowa hospital and clinic system. Those health systems don’t provide elective abortions, but they do perform some abortions in cases of “fetal anomalies.”

“Legislation that retained the ability for family planning services program funds to be expended for procedures terminating a pregnancy in the case of a fetal anomaly was discussed during the 2017 legislative process. This ‘fetal anomaly’ exception was not contained in the final bill that was passed and enrolled,” Merea Bentrott, a policy adviser to the department, wrote to a UnityPoint executive in July.

Bentrott was responding to a letter from UnityPoint Vice President Sabra Rosener. Rosener noted that many UnityPoint hospitals, clinics and physician practices are owned by separate corporations. They are affiliated with the health system but not owned by it, Rosener noted. “Clearly, UnityPoint Health is not one ‘provider’ under this structure, nor should it be treated as a single entity or provider under the (family planning) statute.” Those that don't provide abortions should be eligible to continue participating in the program, she argued.

The Register obtained the correspondence from the Department of Human Services.

Department administrators said at a recent Human Services Council meeting that they consulted with the Iowa attorney general’s office, which agreed that under the new law, all clinics and hospitals affiliated with UnityPoint should be barred from the family planning program.

A spokeswoman for UnityPoint declined comment on the situation, other than to say the health system is continuing to talk to the Department of Human Services about the dispute. Thirty-two Iowa hospitals are members or affiliates of UnityPoint, which is based in West Des Moines. The system also has scores of clinics and doctors' practices in the state.

Critics of the new law predicted it would severely limit access to birth-control services, especially in rural areas. That could lead to more unintended pregnancies and more abortions, they said. Critics also noted that the new rules meant the state, which has substantial budget troubles, had to forego $3 million in federal Medicaid money. That’s because the national Medicaid family-planning program doesn’t let states exclude abortion providers.

Planned Parenthood announced in June that it was closing clinics in Bettendorf, Burlington, Keokuk and Sioux City because of the loss of about $2 million in public family planning money under the new law.

Supporters have predicted plenty of other health-care providers would step in to offer family-planning services that qualify for the state payments. Department of Human Services administrators have promised to closely monitor the availability of services and the number of Iowans using them.

Sen. Mark Costello, an Imogene Republican who managed the bill on the Senate floor last spring, said this week that he was not familiar enough with UnityPoint's structure to comment on whether some of its hospitals and clinics should be treated as separate organizations under the new law.

Costello said he's confident there will be enough other providers to serve the needs of Iowans participating in the program. He said he and other abortion opponents in the Legislature would consider fixing problems with the law, but would hesitate to let UnityPoint back in if any of its hospitals provide abortions. "We would like to put pressure on them to not do any at all," he said.

Jodi Tomlonovic, executive director of the Family Planning Council of Iowa, said she and other critics of the bill testified to legislators last spring that it would apply to UnityPoint and the University of Iowa. "Since they were insistent that they wanted to exclude abortion providers, and that they were not interested in changing the language, I have to assume that this was their intent," she wrote in an email to the Register.

Approved family planning providers under the new program include several Mercy hospitals and clinics around the state. The system is affiliated with the Catholic Church, which opposes many forms of birth control. A Mercy spokesman told the Register in July that the system’s health-care providers may prescribe methods such as hormone pills for medical purposes, such as to control irregular periods, but are not supposed to prescribe them for the purpose of preventing pregnancy.