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2014 State Legislative Session Report

OVERVIEW

Americans United for Life and AUL Action continue to spearhead state legislative efforts to enact life-affirming laws that build on significant gains over the last three years and that lay the groundwork for future victories in 2015 and beyond. In 2014, AUL’s groundbreaking accomplishments include a new law in Mississippi prohibiting abortions at or after five months of pregnancy based on women’s health concerns and the pain experienced by unborn children and enhanced health and safety requirements to protect women. As many of our 2014 victories show, AUL remains the leading advocate for laws protecting women and girls from the physical and psychological harms of abortion and from the dangerous and substandard facilities and practices that are all too common in America’s abortion industry. To further highlight our work and outline this year’s state-based, pro-life activity, Americans United for Life and AUL Action (collectively “AUL”) provide this “State Legislative Session Report.” 1

AUL Victories

In 2014, AUL’s legal and policy experts helped enact 11 new pro-life measures:

• Alaska enacted a measure restricting Medicaid payments for abortions. Specifically, the law specifically defines “medically necessary abortions” to limit the number of abortions that state taxpayers must pay for under Medicaid. AUL experts consulted with lawmakers on the legislation, and AUL Action drafted a letter analyzing the measure for the Alaska Senate.

• Jackson’s Law, another measure in Alaska, based on AUL’s Unborn Wrongful Death Act and providing a wrongful death (civil) cause of action in the death of an unborn child, is awaiting the governor’s signature.

                                                                                                                         1 This document reports on legislative activity through July 7, 2014.

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• Arizona enacted a measure permitting unannounced inspections of abortion facilities (in certain circumstances) to ensure compliance with the state’s regulations for abortion clinics. AUL experts recommended the amendment to Arizona lawmakers.

• Georgia enacted a measure, based on AUL model language, prohibiting abortion coverage for state employees and in the state’s health insurance Exchange (established in each state under the federal healthcare law).

• Indiana enacted a measure prohibiting insurance coverage of abortion. The new law includes exceptions protecting the mother’s life, guarding against substantial threats to the mother’s health, and applying in cases of rape and incest. The measure is based on AUL’s Abortion Coverage Prohibition Act.

• Mississippi enacted a measure limiting abortions at five months of pregnancy (i.e., 20 weeks) which is substantially based on AUL’s Women’s Health Defense Act. The five month abortion ban is based on the health risks to women caused by a late term abortion and pain to the unborn child.

• Mississippi also enacted a perinatal hospice information requirement, mandating that a woman whose unborn child has received a life-limiting diagnosis be informed of certain supportive services available to her if she decides to carry her child to term. These services include counseling and care from maternal-fetal medical specialists, obstetricians, neonatologists, anesthesia specialists, clergy, social workers, and specialty nurses who focus on alleviating fear and ensuring that the woman and her family experience the life and death of their child in a comfortable and supportive environment.

• On March 6, 2014, Nebraska Governor Dave Heineman signed AUL’s Pregnancy Center Proclamation, supporting the work of pregnancy resource centers.

• Oklahoma enacted a measure based on AUL’s Women’s Health Protection Act and Abortion Providers’ Privileging Act, mandating that abortion clinics comply with comprehensive health and safety standards for women and that abortion providers maintain admitting privileges at a local hospital.

• Oklahoma also enacted a measure drafted by AUL experts which clarifies and strengthens the state’s abortion inducing-drugs safety regulation (also based on AUL model legislation), a previously version of which was invalidated by the Oklahoma Supreme Court.

• Oklahoma further enacted a measure partially based on AUL’s Perinatal Hospice Information Act, ensuring that a woman considering abortion after a life-limiting diagnosis for her unborn child receives information on perinatal hospice services. This measure specifically provides enforcement provisions including a private right of action for the mother, father, or grandparent of the unborn child.

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Importantly, AUL also helped defeat four prominent anti-life initiatives:

• The Colorado Reproductive Health Freedom Act, a state Freedom of Choice Act which was abandoned after significant grassroots opposition. AUL provided legal analysis on the impact of the bill, and AUL Action sent out an Action Alert on the measure.

• Measures legalizing assisted suicide in Connecticut and New Hampshire. • A measure in Washington requiring insurance plans that cover maternity care to also

cover abortion.

Further, AUL experts provided legislative testimony, letters, or other statements:

• In support of Jackson’s Law in Alaska, a wrongful death measure partially based on AUL language.

• Explaining a measure in Alaska restricting Medicaid payments for abortion. • In support of a measure in Idaho requiring abortion providers to maintain admitting

privileges and regulating abortion-inducing drugs. • In support of a measure in Maryland prohibiting abortions at 5 months of pregnancy. • In support of a measure in Missouri based on AUL’s Parental Involvement

Enhancement Act. • Against measures in Nebraska repealing the state’s parental consent requirement and

otherwise weaken existing parental involvement requirements. • In support of a measure in Nebraska requiring abortion facilities to post signs

concerning coerced abortions. • In support of comprehensive health and safety standards for abortion clinics in New

Hampshire. • In support of a measure in Washington requiring parental notice. • Against a measure in Washington that would have required health insurance plans

that cover maternity care to also cover abortion. • In support of a measure in West Virginia prohibiting abortions at 5 months of

pregnancy.

Additional measures of AUL’s success and legislative impact in 2014 include:

• Ten states considered components of AUL’s Women’s Protection Project:2 Alabama, Illinois, Kentucky, Mississippi, Missouri, New Hampshire, New York, Oklahoma, West Virginia, and Washington.

                                                                                                                         2 The Women’s Protection Project is a new AUL initiative launched in response to the well-documented risks of abortion and a nationwide epidemic of substandard abortion care and which spotlights seven pieces of expertly crafted AUL model legislation. For more information about the Women’s Protection Project, please visit http://www.aul.org/wp-content/uploads/2014/01/WWP-full.pdf (last visited July 7, 2014).

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• AUL distributed 854 copies of the Women’s Protection Project booklet in 21 states: Alabama, Alaska, Arkansas, Colorado, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Missouri, Mississippi, North Carolina, North Dakota, Nebraska, New Hampshire, Oklahoma, Pennsylvania, and Wisconsin.

• AUL and AUL Action consulted with legislators and other pro-life allies on 74 life-related legislative measures and initiatives in 32 states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Idaho, Kentucky, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Washington, and West Virginia

• AUL has distributed more than 500 legislative policy guides (containing AUL model legislation) in 29 states and the District of Columbia: Alabama, Alaska, Arizona, Arkansas, California, Colorado, District of Columbia, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, South Dakota, Texas, Virginia, Washington, and Wyoming.

                                                                                                                                                                                                                                                                                                                                                                                                       

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DETAILED ACTIVITY AND ANALYSIS

Newly Enacted State Laws and Adopted Legislative Resolutions

In 2014, at least 56 new life-affirming legal requirements,3 including at least 41 measures related to abortion,4 were enacted. Newly enacted laws and other significant developments include:

Alabama

• Enacted a measure amending its informed consent law to include a 48-hour reflection period (in place of a 24-hour reflection period).

• Enacted a measure requiring proof of relationship between parent(s) and a minor seeking an abortion and also prohibiting coercion.

Alaska

• Enacted a measure restricting Medicaid payments for abortions. Specifically, the law narrowly defines “medically necessary abortions” to limit the number of abortions that state taxpayers must pay for under Medicaid. AUL experts consulted with lawmakers on this measure, and AUL Action drafted a letter analyzing the legislation for the Alaska Senate.

• Jackson’s Law, a measure in Alaska, based on AUL’s Unborn Wrongful Death Act and providing a wrongful death (civil) cause of action in the death of an unborn child, is awaiting the governor’s signature.

Arizona

• Enacted a measure permitting unannounced inspections of abortion facilities (in certain circumstances) to ensure compliance with the state’s health and safety regulations for abortion clinics. AUL experts recommended the amendment to Arizona lawmakers.

• Enacted a measure amending existing abortion reporting regulations to also require abortion providers to report any abortions that result in a live birth.

• Enacted a measure prohibiting a third-party from interfering with parental rights and assisting a minor in obtaining an abortion without the requisite parental consent.

                                                                                                                         3 This count does not include some end-of-life measures enacted in 2014 as the life-affirming impact of these measures is questionable. 4 Moreover, to gauge properly the impact of this year’s state legislative sessions, the component requirements of omnibus abortion-related measures are discussed and have been counted separately.

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Arkansas

• Enacted three measures continuing the state’s policy of not permitting public funding of abortion or abortion referrals in public schools.

Colorado

• Enacted measure creating a civil action for “unlawful termination of a pregnancy.” However, this “one-victim” measure fails to recognize an unborn child as a separate person. (The measure is awaiting the governor’s signature.)

• Continued its policy of not using public funds for abortions. • Appropriated money to its Adult Stem Cells Cure Fund.

Florida

• Enacted legislation amending current law to prohibit post-viability abortions. • Enacted a measure providing that any crime that results in the death of an unborn

child is subject to the same penalties as a crime that causes the death of another and removing viability as the point when a person may be charged with a crime against an unborn child.

Georgia

• Enacted a measure, based on AUL model language, prohibiting abortion coverage for state employees and in the state’s health insurance Exchange (established in each state under the federal healthcare law).

• Appropriated funding for family planning which could possibly go to abortion providers.

Hawaii

• Enacted a unique measure encouraging ethical research and treatments by providing for a leave of absence for stem cell donors.

• Adopted a resolution honoring the State Commission on the Status of Women for, in part, supporting a coercive measure requiring Hawaii’s emergency rooms to dispense so-called “emergency contraception” regardless of religious and moral objections.

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Indiana

• Enacted a measure prohibiting insurance coverage of abortion. The new law includes exceptions protecting the mother’s life, guarding against substantial threats to the mother’s health, and applying in cases of rape and incest. The measure is based on AUL’s Abortion Coverage Prohibition Act.

• Enacted a measure requiring state officials to inspect abortion clinics once a year. • Enacted a measure amending its admitting privileges law to remove the option of

contracting with another physician that has admitting privileges and instead to require that an abortion provider personally maintain local admitting privileges.

Kansas

• Enacted a measure narrowing the state’s “medical emergency” exception for abortion-related laws.

• Enacted a measure which removes any tax benefit for insurance coverage of abortion. • Appropriated $9,000 to its Midwest Stem Cell Therapy Center. (The measure is

awaiting the governor’s signature.)

Louisiana

• Enacted a measure requiring an abortion provider to have admitting privileges at a hospital within 30 miles of the abortion facility.

• Enacted a requirement that requires abortion clinics to post the phone number of the National Human Trafficking Resource Center hotline.

• Enacted a measure requiring that drug-induced abortions and any complications arising from an abortion be reported.

• Enacted a measure requiring that certain informed consent information be provided before abortion including information on psychological risks, human trafficking, and abuse.

• Enacted a measure providing that no individual or organization that performs elective abortions (or an affiliate of that individual or organization) may provide instruction or materials in public schools.

• Governor Bobby Jindal vetoed a measure allowing gestational surrogacy.

Maine

• Governor Paul LePage vetoed legislation which would have expanded Medicaid family planning funding to individuals at or below 200 percent of the federal poverty

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line. While not directly related to abortion funding, the measure would have made more money available to abortion providers.

Maryland

• Maryland enacted (without the governor’s signature) legislation appropriating funds to the Maryland Stem Cell Fund.

Michigan

• Prohibited insurance plans from covering abortions, except by an optional rider. • Adopted a budget bill that allocates $800,000 for a pregnancy and parenting support

services program, which must promote childbirth, alternatives to abortion, and grief counseling.

Minnesota

• Enacted a measure establishing a penalty for injuring an unborn child as a result of operating a motor vehicle in a grossly negligent manner or while under the influence of alcohol or drugs.

Mississippi

• Enacted a measure limiting abortions at five months of pregnancy (i.e., 20 weeks) which is substantially based on AUL’s Women’s Health Defense Act.

• Enacted a perinatal hospice information requirement, mandating that a woman whose unborn child has received a life-limiting diagnosis be informed of certain supportive services available to her if she decides to carry the child to term. These services include counseling and care from maternal-fetal medical specialists, obstetricians, neonatologists, anesthesia specialists, clergy, social workers, and specialty nurses who focus on alleviating fear and ensuring that the woman and her family experience the life and death of their child in a comfortable and supportive environment. Established an umbilical cord blood banking program.

• Adopted three appropriations measures providing that state funds may not be used at state institutions of higher learning for research in which a human embryo is killed or destroyed. (The measures are awaiting the governor’s signature.)

Missouri

• Enacted funding legislation which specifically excludes funding for “abortion services.”

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• Governor Nixon line-item vetoed $500,000 from the state’s alternatives to abortion fund, lowering the amount appropriated to $1,533,561.

• Governor Jay Nixon vetoed a measure amending the state’s informed consent law to require a 72-hour reflection period before an abortion.

Nebraska

• On March 6, 2014, Governor Dave Heineman signed AUL’s Pregnancy Center Proclamation, supporting the work of pregnancy resource centers.

New Hampshire

• Enacted a measure creating a “buffer zone” around abortion clinics, hampering the First Amendment speech rights of sidewalk counselors seeking to offer assistance to women entering or leaving abortion facilities.

New York

• Enacted legislation requiring the state Department of Health to create and maintain a “women’s health initiatives” website that will “promote” the items and services that are required as preventive care coverage under the federal Affordable Care Act. That list explicitly includes all FDA labeled “contraceptives,” including so-called “emergency contraception.” (The measure is awaiting the governor’s signature.)

• New York enacted a measure appropriating funds to the Empire State Stem Cell Research Act.

North Carolina

• Appropriated $250,000 to Carolina Pregnancy Care Fellowship. (The measure is awaiting signature.)

Oklahoma

• Enacted a measure based on AUL’s Women’s Health Protection Act and Abortion Providers’ Privileging Act, mandating that abortion clinics comply with comprehensive health and safety standards and requiring that abortion providers maintain admitting privileges at a local hospital.

• Enacted a measure drafted by AUL experts which clarifies and strengthens the state’s abortion inducing-drugs safety regulation (also based on AUL model legislation), a prior version of which was invalidated by the Oklahoma Supreme Court.

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• Enacted a measure partially based on AUL’s Perinatal Hospice Information Act and ensuring that a woman considering abortion after a life-limiting diagnosis for her unborn child receives information on perinatal hospice services. This measure specifically provides enforcement provisions including a private right of action for the mother, father, or grandparent of the unborn child.

• Enacted a reporting provision in connection with its newly enacted perinatal hospice informed consent requirement.

• Enacted legislation requiring abortion providers to report any incidents of injury or death to the state Board of Health.

• Removed “deaths due to criminal abortion” from a list of “violent deaths” to be investigated.

Pennsylvania

• Adopted budget (awaiting signature) which includes $1,000,000 from the federal Social Services Block Grant to fund alternatives to abortion services.

• Enacted a measure ensuring adequate care for babies determined to have been prenatally exposed to alcohol or illegal substances.

South Carolina

• Adopted a requirement that abortion providers report providers who have hospital admitting privileges and to report abortion complications.

• Adopted a budget bill that continues a long-standing provision that prohibits the state employees’ health plan from covering abortion except when necessary to save the woman’s life or in cases of rape or incest.

South Dakota

• Prohibited sex-selective abortions. • Amended its current law to require an abortion provider to screen women for

coercion and inform them that they cannot be forced to have an abortion because of the child’s gender. The measure requires the posting of signs informing a woman that she cannot be coerced into undergoing a sex-selective abortion and the provision of written material stating that sex-selective abortion is illegal.

• Enacted legislation requiring the state Department of Health to maintain a registry of state “pregnancy help centers.” A center seeking to be listed on the registry must certify that it has a licensed medical director and that the center does not perform abortions, has no affiliation with any organization or physician that performs abortion, and that it does not refer women for abortions. The law excludes agencies that place children for adoption from the registry.

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Vermont

• Repealed its pre-Roe abortion ban. West Virginia

• Governor Earl Ray Tomblin vetoed a measure prohibiting abortion at 20 weeks “post-fertilization” age that also included reporting requirements related to the age of the unborn child.

2014 Legislative Trends

Abortion

• At least 41 states considered more than 270 measures related to abortion. While the measures considered this year were overwhelmingly life-affirming, there was an increase in measures seeking to undermine life-affirming state laws and policies. For example, Vermont repealed its pre-Roe abortion ban, and a number of other states introduced measures seeking to repeal ultrasound requirements or chemical abortion regulations; circumventing requirements that women receive information on perinatal hospice options; or repealing penalties for noncompliance with the life-affirming laws.

• In 2014, Missouri introduced more life-affirming measures than any other state. • At least 20 states considered measures to ban or limit abortions, continuing a multi-

year trend. • Measures requiring that abortion providers maintain admitting privileges at local

hospitals gained traction with 3 states enacting admitting privileges requirements and 11 states introducing such measures.

• A growing number of states considered legislation requiring that a woman receive information on perinatal hospice or related services following a life-limiting diagnosis for her unborn child. All related measures were substantially based on AUL model language.

• Measures limiting state taxpayer funding of abortion and abortion providers and measures limiting or eliminating insurance coverage for abortion remained popular.

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Legal Recognition and Protection of the Unborn

• In 2014, there was a more than 50 percent decline in legislative measures providing legal recognition and protection of unborn and newly born children in contexts other than abortion.

• Measures criminalizing assaults resulting in harm to unborn children or strengthening existing protections for unborn victims of criminal violence continue to be popular with state legislators.

Bioethics and Biotechnologies

• A notable percentage of measures related to biotechnologies considered in 2014 were anti-life. For example, a number of states funded or considered measures to fund unethical forms of research.

• Measures regulating assisted reproductive technologies such as in vitro fertilization and gestational surrogacy continued to receive significant attention from state legislators.

Freedom of Conscience

• Eleven states considered legislation related to healthcare freedom of conscience. In a concerning development, the number of conscience-protecting bills dropped dramatically, to roughly one-third the number considered in 2013, whereas the number of coercive bills nearly doubled.

End of Life

• At least seven states considered measures to legalize assisted suicide, far outpacing those states considering prohibitions or limits on the practice.

Abortion

In 2014, at least 41 states considered more than 270 measures related to abortion. This represents a decreased level of activity from 2013 when 48 states considered at least 360 measures. However, the decrease is not unexpected for several reasons including that fewer abortion-related measures are typically considered during an election year, and that five state legislatures—including pro-life powerhouses North Dakota and Texas—did not hold regular legislative sessions this year. While the measures considered this year were overwhelmingly life-affirming, there was an increase in measures undermining life-affirming state laws and policies. For example, Vermont repealed its pre-Roe abortion ban, and a number of states introduced measures seeking to repeal ultrasound requirements and chemical abortion regulations; undermining requirements that

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women receive information on perinatal hospice; or repealing penalties for noncompliance with the life-affirming laws. Notably, Missouri introduced more life-related measures than any other state—at least 30 measures—most of which affirm the sanctity of human life. Abortion Prohibition and Limitations

At least 20 states including Alabama, Colorado, Florida, Hawaii, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, New Jersey, New York, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Virginia, and West Virginia considered measures to prohibit or limit abortions. Florida enacted legislation prohibiting abortions after viability. Colorado and Florida considered measures prohibiting abortions at any gestational age. Similarly, Minnesota considered a measure prohibiting a physician from charging a fee or receiving any compensation, either directly or indirectly, for performing an abortion, including payments made by a health plan company or a patient’s employer. This, in effect, would have “prohibited” abortions. Missouri considered a measure prohibiting a physician from performing an abortion on a woman for the purpose of providing fetal organs or tissue for medical transplantation to the woman or to others. Conversely, Vermont repealed its pre-Roe abortion prohibition. Similarly, New York considered measures to repeal its (limited) abortion-related restrictions and regulations and weakening its limitations on late-term abortions.

Five-Month Limitations

At least six states considered measures to limit abortion at five months (i.e., 20 weeks): Kentucky, Maryland, Minnesota, Mississippi, South Carolina, and West Virginia. Mississippi enacted a measure limiting abortion at five months based substantially on AUL model language and predicated on concerns for both women’s health and the pain felt by an unborn child.

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West Virginia Governor Earl Ray Tomblin vetoed a measure prohibiting abortion at 20 weeks “post-fertilization” age based on the pain felt by an unborn child. Arizona considered a measure to remove criminal and civil remedies from its (enjoined) five-month limitation.

Bans on Abortion Based on Sex, Race, or Genetic Abnormality

At least 11 states considered measures to ban abortions based on the child’s sex, race, and/or diagnosed genetic abnormality: Kansas, Massachusetts, Missouri, Mississippi, New York, Oregon, Rhode Island, South Dakota, Virginia, Wisconsin, and West Virginia. South Dakota enacted a prohibition on sex-selective abortions, while also considering legislation prohibiting an abortion sought because the unborn child has been diagnosed with Down syndrome. Missouri considered a measure, based on AUL model language, which prohibits an abortion performed solely because of the unborn child’s sex or because the unborn child has been diagnosed with a genetic abnormality or Down syndrome. Similar measures in New York and Rhode Island were also based on AUL model language. Conversely, Arizona considered a measure removing criminal and civil remedies from its sex-selective abortion ban.

“Heartbeat” Bans

At least five states considered measures prohibiting an abortion when an unborn child has a heartbeat: Alabama, Kentucky, Mississippi, New York, and Ohio.

Partial-Birth Abortion Bans

At least three states considered measures to ban partial-birth abortions: Hawaii, Massachusetts, and Rhode Island. Conversely, Arizona considered a measure removing criminal and civil remedies from its partial-birth abortion ban.

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Clinic Health and Safety Standards and Other Abortion Provider Regulations Health and Safety Standards to Protect Women’s Health

At least 13 states including Arizona, Florida, Hawaii, Illinois, Indiana, Louisiana, Mississippi, Missouri, New Hampshire, New York, Ohio, Oklahoma, and West Virginia considered measures mandating health and safety standards for abortion facilities. Arizona enacted a measure providing for unannounced inspections of abortion clinics (under certain circumstances). Similarly, Indiana enacted a measure requiring state officials to inspect abortion clinics once a year. Louisiana enacted a requirement that requires abortion clinics to post the phone number of the National Human Trafficking Resource Center hotline. Oklahoma enacted legislation, based on AUL model language, which specifies comprehensive health and safety requirements for abortion facilities. Illinois considered a comprehensive law which would require that abortion facilities be licensed as surgical treatment centers, was based on AUL model language. Likewise, a measure in New Hampshire requiring comprehensive health and safety standards for abortion facilities and imposing licensing requirements was based on AUL model language. Individual Provider Requirements At least 11 states including Florida, Illinois, Indiana, Louisiana, Minnesota, Missouri, Oklahoma, Pennsylvania, South Carolina, West Virginia, and Wisconsin considered measures delineating qualifications for individual abortion providers. Indiana enacted a measure amending its admitting privileges requirement to remove the option of contracting with another physician who has admitting privileges and to instead require that an abortion provider personally maintain local admitting privileges. Louisiana enacted legislation requiring a physician to have admitting privileges at a hospital within 30 miles of the abortion facility. Oklahoma enacted legislation, based on AUL model language, which requires a physician to have admitting privileges at a general medical surgical hospital within 30 miles of the abortion

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facility and to remain on the premises, in order to facilitate the transfer of emergency cases, until all abortion patients are stable and ready to leave the recovery room. Likewise, Illinois and West Virginia considered legislation, based on AUL model language, requiring that an abortion provider who has admitting privileges at a local hospital be on-site during and after an abortion is performed. Conversely, Arizona considered measures that would allow healthcare providers other than physicians to perform abortions, including a measure repealing a prohibition on physician assistants from prescribing abortion drugs. Similarly, New York considered a measure repealing its abortion-related regulations, including the provision that requires that abortions be performed by physicians, while Wisconsin considered legislation repealing its admitting privileges requirement (which is currently in litigation).

Abortion Reporting At least 15 states including Arizona, Illinois, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New York, Ohio, Oklahoma, South Dakota, and West Virginia considered measures related to abortion reporting. Arizona enacted a measure amending existing abortion reporting regulations to also require abortion providers to report any abortions that result in a live birth. Louisiana enacted a measure requiring that drug-induced abortions and any abortion-related complications be reported. Oklahoma enacted a reporting provision in connection with its newly enacted perinatal hospice informed consent requirement. It also enacted legislation requiring abortion providers to report any incidents of injury or death to the State Board of Health.

South Carolina adopted a requirement that abortion providers report providers who have hospital admitting privileges and to report abortion complications.

Accompanying a provision prohibiting sex-selective abortions, South Dakota amended its reporting requirements to mandate details on the sex/gender of the unborn child and other related information.

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West Virginia Governor Earl Ray Tomblin vetoed a measure prohibiting abortion at 20 weeks post-fertilization age that also included reporting requirements related to the age of the unborn child. Abortion Inducing Drugs and “Telemed” Abortions At least five states including Iowa, Kentucky, Minnesota, Mississippi, and Oklahoma considered measures regulating the provision of abortion-inducing drugs and/or the practice of so-called “telemed” abortions. Oklahoma enacted a measure clarifying and strengthening it abortion-inducing drugs regulation. The provision is based on AUL-drafted language and requires abortion providers to administer abortion-inducing drugs only in the way mandated by the U.S. Food and Drug Administration. On the other hand, Arizona considered measures that would undermine or repeal the state’s chemical abortion regulation (which is currently in litigation). Informed Consent and Informed Consent Enhancements At least 21 states including Alabama, Arizona, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, New Jersey, New York, Ohio, Oklahoma, Rhode Island, South Dakota, Utah, and Wisconsin considered measures related to informed consent for abortion. Measures in Illinois and New York, which provide comprehensive informed consent protections, were based on AUL model language. Louisiana enacted a measure requiring an abortion provider to give certain information to a woman before performing an abortion, such information on psychological risks, human trafficking, and abuse. The state also clarified that informed consent requirements apply to both surgical and chemical abortions. South Dakota enacted legislation requiring that state-prepared, written informed consent materials include information that sex-selective abortions are illegal. Utah enacted a measure amending its informed consent law to create exceptions if 1) the treating physician and one other physician concur, in writing, that an abortion is necessary to avert the woman’s death or a serious risk of substantial and irreversible impairment of a major bodily function; or 2) two physicians who practice maternal-fetal medicine concur, in writing in the patient’s medical record, that the unborn child has a defect that is uniformly diagnosable and uniformly lethal.

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Arizona considered measures which would undermine the state’s informed consent law by removing the 24-hour reflection period; by allowing persons other than a physician (or referring physician) to provide the required information; by removing a provision requiring that information be provided orally and in person; by adding a rape/incest exception (meaning that women who have been raped or abused are not deemed worthy of receiving the informed consent materials); and, by removing criminal and civil remedies for violations of the law. Arizona also considered a measure requiring that any program or organization listed in state-prepared informed consent materials notify clients of all pregnancy-related options including abortion or be forced to post signs stating that it does not provide information about abortion. Similarly, Virginia considered legislation weakening the state’s informed consent requirements by allowing information to be given over the telephone (and not in person) and allowing the information to be given before any tests or exams are provided.

Reflection Periods

At least six states including Alabama, Illinois, Kentucky, Massachusetts, Missouri, and New York considered measures requiring or amending a reflection period (usually 24 hours) before a woman may undergo an abortion. Alabama enacted a measure amending its informed consent law to include a 48-hour reflection period (in place of a 24-hour reflection period). In Missouri, Governor Nixon vetoed a measure amending the state’s informed consent law to include a 72-hour reflection period. Illinois and New York considered requirements for reflection periods which were based on AUL model language.

“Heartbeat” Informed Consent

At least three states including Kentucky, New York, and Ohio considered measures giving a woman the opportunity to hear the heartbeat of her unborn child before an abortion and/or requiring her to be informed whether the child has a heartbeat.

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Anti-Coercion Measures

At least seven states including Illinois, Indiana, Louisiana, Missouri, Nebraska, Rhode Island, and South Dakota considered measures related to coerced or forced abortions. South Dakota amended its current law to require an abortion provider to screen a woman for coercion and to inform her that she cannot be forced to have abortion because of the child’s sex/gender. The measure also requires the posting of signs informing a woman that she cannot be coerced into an abortion. A measure in Illinois, based on AUL model language, would have required that state-prepared informed consent materials have information on abortion-related coercion.

Informed Consent Concerning Prenatal Diagnosis

At least three states including Alabama, Mississippi, and Oklahoma considered legislation requiring that a woman receive information on perinatal hospice or related services following a life-limiting diagnosis for her unborn child. All three measures are substantially based on AUL model language. In a related move, Mississippi enacted a limitation on abortion at five months (i.e., 20 weeks) that specifically excludes an abortion performed or induced on an unborn child who has a severe fetal abnormality if the mother is informed twenty-four (24) hours before the abortion that supportive care is available should she choose to carry her pregnancy to term including, but not limited to, counseling and medical care by maternal-fetal medical specialists, obstetricians, neonatologists, anesthesia specialists, clergy, social workers, and specialty nurses who are focused on alleviating fear and ensuring that the woman and her family experience the life and death of their child in a supportive environment. Oklahoma enacted a measure based on AUL model language that requires information on perinatal hospice before an abortion is performed where the unborn child has received a life-limiting diagnosis. Conversely, Arizona considered a measure which would remove criminal and civil remedies from its current perinatal hospice requirement.

Fetal Pain At least two states including Illinois and Missouri considered informed consent provisions requiring information on the pain felt by an unborn child.

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The measure in Illinois was based on AUL model language. Similarly, West Virginia considered legislation requiring anesthesia to be administered if an unborn child has reached at least seven weeks development.

Ultrasound Requirements At least ten states including Illinois, Kentucky, Massachusetts, Maryland, Missouri, New Jersey, New York, Oklahoma, Rhode Island, and Wisconsin considered ultrasound requirements. Oklahoma enacted a measure requiring an ultrasound evaluation of all patients who elect to have abortions. The measure in Illinois, based on AUL model language, required an ultrasound 24 hours before an abortion if the facility has the necessary equipment. Conversely, Utah enacted a measure waiving its ultrasound requirement if 1) the treating physician and one other physician concur, in writing, that an abortion is necessary to avert the woman’s death or a serious risk of substantial and irreversible impairment of a major bodily function; or 2) two physicians who practice maternal-fetal medicine concur, in writing in the patient’s medical record, that the unborn child has a defect that is uniformly diagnosable and uniformly lethal. Arizona considered a measure that added a rape or incest exception to its current ultrasound requirement. Likewise, Virginia considered measures repealing or weakening its current ultrasound requirement, while Wisconsin considered a measure repealing its ultrasound requirement and replacing with it with a requirement that its written informed consent materials include information about ultrasounds. Parental Involvement and Minors At least 13 states including Alabama, Arizona, California, Florida, Georgia, Hawaii, Kentucky, Massachusetts, Missouri, New Jersey, New York, Washington, and West Virginia considered parental involvement (notification or consent) requirements for abortion and/or enhancements to existing requirements. Alabama enacted a measure requiring proof of relationship between parent(s) and a minor seeking an abortion and prohibiting coercion.

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Arizona enacted a measure prohibiting a third-party from interfering with parental rights and assisting a minor in obtaining an abortion without the requisite parental consent. Missouri considered a measure, based on AUL model language, enhancing the state’s parental involvement law by requiring notarized written consent, proof of paternal identification and relationship to the minor, a post-emergency notification, a venue restriction to the minor’s home venue, and a clear and convincing evidence standard and mental health evaluation in a judicial bypass proceeding. New York also considered a parental involvement provision based on AUL model language, and AUL submitted written testimony supporting a measure in Washington requiring parental notice before abortion. Conversely, Arizona considered a measure removing criminal and civil penalties from its parental consent law, as well as measures which would add an “abortion provider consent” provision—i.e., if the abortion provider receives the minor’s “informed consent,” the minor does not need parental consent or a judicial bypass. Likewise, Nebraska considered a measure weakening the standards used in judicial bypass proceedings, as well as a measure replacing parental consent with parental notice (and removing the criminal penalties for violations of the consent law). Abortion Funding At least 16 states considered measures related to federal and state funding of abortion and/or abortion providers: Alaska, Arkansas, Colorado, Louisiana, Maine, Maryland, Massachusetts, Missouri, New Jersey, New Mexico, Pennsylvania, Rhode Island, South Dakota, Virginia, West Virginia, and Wisconsin. Alaska enacted a measure providing that Medicaid matching funds can only be used for abortions that are permitted under the federal Hyde Amendment. Arkansas enacted three measures continuing the state’s policy of not permitting public funding for abortions or abortion referrals in public schools. Colorado continued its policy of not using public funds for abortion. Maryland determined that it will continue its policy of paying for abortions for women on public assistance (Medicaid).

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Missouri enacted a measure (awaiting signature) prohibiting the grant of “early stage business development grants” to businesses that engage in activities involving “abortion services.” In addition, Georgia appropriated funding for family planning—which could possibly go to abortion providers. Similarly, Hawaii considered a measure that included line-item funding for Planned Parenthood and family planning. In Maine, Governor Paul LePage vetoed legislation which would have expanded Medicaid family planning funding to individuals at or below 200 percent of the federal poverty line. While not directly related to abortion funding, the measure would have made more money available to abortion providers. Utah enacted a measure outlining the fees that abortion facilities (and other entities) must pay the state. A measure in Washington sought to broaden the ability of abortion providers to be reimbursed for “telemed” abortions. Insurance Coverage of Abortion At least 14 states considered measures related to insurance coverage of abortion—within the health insurance Exchanges (established in each state under the federal healthcare law), through private insurance, and/or for government employees: Florida, Georgia, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, New York, Rhode Island, Virginia, Vermont, Washington, and West Virginia.

Georgia enacted a measure, based on AUL language, prohibiting abortion coverage for state employees and in the state’s health insurance Exchange.

Indiana also enacted an insurance coverage prohibition based on AUL language. The measure includes exceptions for the mother’s life, for substantial threats to health, and for rape or incest.

Kansas enacted a measure which removes any tax benefit for insurance coverage of abortion.

Michigan prohibited insurance plans from covering abortions, except by an optional rider.

AUL submitted legal testimony against a measure in Washington that required insurance plans that cover maternity care to also cover abortion.

Virginia considered measures repealing the state’s health insurance Exchange opt-out provision.

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Use of State Facilities and Employees for Abortions At least three states considered measures prohibiting state facilities or employees from performing or assisting in abortions: Louisiana, Missouri, and West Virginia. Louisiana enacted legislation providing that no individual or organization that performs elective abortions (or an affiliate of that individual or organization) may provide instruction or materials in public schools. Abortion Alternatives/Pregnancy Resource Centers At least seven states including Michigan, Missouri, Nebraska, North Carolina, Ohio, South Dakota, and Wisconsin considered 15 measures related to state funding for pregnancy resource centers (PRCs) and/or supporting or honoring their life-affirming mission. South Dakota enacted legislation requiring the Department of Health to maintain a registry of state “pregnancy help centers.” A pregnancy help center seeking to be listed on the registry must certify that it has a licensed medical director and that the center does not perform abortions, has no affiliation with any organization or physician that performs abortion, and it does not refer women for abortions. The law also excludes agencies that place children for adoption from its registry. Nebraska Governor Dave Heineman signed AUL’s Pregnancy Center Proclamation, supporting the work of pregnancy resource centers. A concurrent resolution honoring the work of Pregnancy Care Centers, based on AUL’s model legislation, was introduced in the Ohio House and Senate. Missouri considered legislation specifying that an “alternatives-to-abortion agency” is protected by the constitutions and laws of the United States and Missouri. The measure was a response to increasing attacks on the First Amendment rights of pregnancy resource centers.

Funding for Pregnancy Resource Centers

At least five states including Michigan, Missouri, North Carolina, Pennsylvania, and Wisconsin considered measures funding programs providing alternatives to abortion.

Michigan adopted a budget bill that allocates $800,000 for a pregnancy and parenting support services program, which must promote childbirth, alternatives to abortion, and grief counseling.

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Missouri enacted legislation that included $1,533,561, in funding for alternatives to abortion programs. North Carolina appropriated (awaiting signature) $250,000 to Carolina Pregnancy Care Fellowship. Pennsylvania adopted a budget (awaiting signature) which includes $1,000,000 from the federal Social Services Block Grant to fund alternatives to abortion services. Michigan considered a measure creating a “Choose Life Michigan” license plate. The money raised would have been spent on projects that promote alternatives to abortion including adoption, provide practical support to pregnant women, and provide practical outreach to at-risk populations. Wisconsin considered legislation creating a “Choose Life” license plate, while another measure was introduced creating a “Support Planned Parenthood” license plate.  

Efforts to Regulate Pregnancy Resource Centers At least four states, including Arizona, Missouri, New York, and Rhode Island considered six measures aimed at undermining or stigmatizing the work of pregnancy resource centers. Arizona considered a measure requiring “limited service pregnancy centers” to post signs that they are not licensed medical facilities. Notably, the bill specifically excluded abortion clinics and family planning clinics that refer for abortion from its requirement to provide “scientifically accurate information.” State Constitutional Amendments At least four states including Louisiana, Missouri, New Jersey, and West Virginia considered abortion-related amendments to their state constitutions. State Freedom of Choice Acts Legislators in at least four states including Colorado, New York, Rhode Island, and Vermont considered state “Freedom of Choice Acts” (FOCA) or similar measures protecting the legal “right” to abortion.

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New York’s Women’s Equality Act would have permitted abortion-on-demand, rescinded existing state laws limiting or regulating abortion, and eliminated the possibility of a criminal investigation or prosecution of an abortion provider for causing a woman’s death or injury. State FACE (Freedom of Access to Abortion Clinics) New Hampshire enacted a measure creating a “buffer zone” around abortion clinics, hampering the First Amendment rights of sidewalk counselors seeking to offer assistance to women entering or leaving abortion facilities. Following the U.S. Supreme Court’s decision in McCullen v. Coakley, striking down a 35-foot “no pro-life speech zone” outside Massachusetts’ abortion clinics, the new law has been challenged in federal court. Similarly, New York considered a measure defining taking photographs of people entering or leaving a “reproductive health care service facility” as aggravated harassment in the third degree. Life-Related Resolutions At least four states including Alabama, New Hampshire, Washington, and Wisconsin considered measures related to the rights or “personhood” of the unborn child. Other Abortion-Related Measures Kansas considered measures amending the definition of “medical emergency” in its abortion-related laws and clarifying that “bodily function” does not include mental or emotional functions. Similarly, Missouri considered measures amending the definition of “medical emergency” to specifically exclude psychological conditions. Missouri also considered legislation requiring the written, notarized consent of an unborn child’s father prior to abortion. Conversely, Rhode Island considered legislation repealing a defunct law requiring spousal notice before abortion. Ohio considered requirement to take effect upon the reversal of Roe v. Wade, allowing its Attorney General to seek a declaration or the lifting of any injunction against any previously invalidated abortion-related restriction or regulation. The measure would allow county prosecutors to pursue such actions if the Attorney General declines.

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Oklahoma removed “deaths due to criminal abortion” from a list of “violent deaths” to be investigated.

“Emergency Contraception” At least 10 states considered 24 measures related to so-called “emergency contraception.” This represents a 35 percent decrease from 2013 activity levels. New York enacted a bill (awaiting signature) requiring the state Department of Health to create and maintain a “women’s health initiatives” website that will “promote” the items and services that are required as preventive care coverage, under the federal Affordable Care Act. Such coverage explicitly includes all FDA labeled “contraceptives,” including so-called “emergency contraception.” On the other hand, Missouri considered legislation that would prohibit school-based healthcare clinics from performing or referring for abortion services or providing or referring for contraceptive drugs or devices. New York considered legislation that would require the consent of a parent or guardian before school health services can prescribe or distribute so-called “emergency contraception.” Oklahoma considered legislation that would prohibit minors under the age of 17 from receiving Plan B, a so-called “emergency contraceptive,” without a prescription.

Legal Recognition and Protection of the Unborn At least 16 states considered at least 26 measures concerning the legal recognition and protection of unborn and newly born children in contexts other than abortion. This represents a dramatic decrease from 2013 activity levels, when at least 27 states considered nearly 60 related measures. Fetal Homicide and Assault Eight states considered ten measures related to fetal homicide or assault: Florida, Illinois, Iowa, Massachusetts, Minnesota, New Hampshire, New York, and Pennsylvania. Florida enacted a measure providing that any crime that results in the death of an unborn child is subject to the same penalties as a crime that cause the death of another and removing viability as the point when a person may be charged with a crime against an unborn child. Further, Illinois, Iowa, Massachusetts, Minnesota, New York, and Pennsylvania considered measures protecting an unborn child from the time of conception, while New Hampshire

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considered a measure that would have criminalized the killing of an unborn child after eight weeks development. Conversely, New York considered a measure removing unborn children from the protection of the state’s homicide statute. Minnesota enacted a measure establishing a penalty for injuring an unborn child as a result of operating a motor vehicle in a grossly negligent manner or while under the influence of alcohol or drugs. Illinois considered a measure criminalizing the unlawful delivery of a controlled substance to a woman known to be pregnant or the injecting, inhaling, absorbing, or ingesting any amount of that controlled substance by the woman, if the unborn child dies as a result. “One-Victim” Laws In Colorado, a measure is awaiting the governor’s signature that would create a civil action for “unlawful termination of a pregnancy.” However, this “one-victim” measure fails to recognize an unborn child as a separate person entitled to legal recognition and protection. Pregnant Woman’s Protection Act South Carolina introduced a Pregnant Woman’s Protection Act, which included AUL-drafted legislative findings, but did not include AUL’s operative model language. Wrongful Death AUL’s Unborn Wrongful Death Act, which protects unborn children from conception, is awaiting the governor’s signature in Alaska. Iowa considered a measure extending wrongful death protections to unborn children after viability. A measure was introduced in Colorado that would have made it the only state in the country that does not—at least—permit a wrongful death action to be brought on behalf of a child who is injured in the womb, is born, and later dies. “Wrongful Birth” and “Wrongful Life” New Jersey considered a measure prohibiting “wrongful birth” and “wrongful life” lawsuits.

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Born-Alive Infant Protection West Virginia considered two measures providing protection for infants who survive attempted abortions. Fetal Death Certificates or Certificates of Stillbirth West Virginia considered a measure permitting parents to receive a certificate of stillbirth. The measure also required the issuance of a birth certificate for a baby born alive during an abortion, and a death certificate if the child dies a short time later.

New Jersey considered a measure that would require entering the details of the death of an unborn child occurring 20 or more weeks after gestation in a state electronic birth certificate and perinatal database.

Substance Abuse by Pregnant Women Pennsylvania enacted a measure ensuring adequate care for babies determined to have been prenatally exposed to alcohol or illegal substances. Wisconsin considered a measure providing for evaluations of infants for fetal alcohol spectrum disorders and providing referral for related services and treatment. New Jersey considered a measure including prenatal drug and alcohol exposure in the definition of “child abuse.” Tennessee enacted, and Illinois and Mississippi considered, measures permitting women to be prosecuted for alcohol or drug abuse while pregnant. The measures in Illinois and Mississippi would have also permitted the prosecution of a third-party who intentionally provides controlled substances to a pregnant woman, resulting in injury to or the death of her unborn child.

Biotechnologies

At least 20 states considered more than 70 measures related to biotechnologies. This represents a decrease from 2013 (when approximately 80 measures were considered in 29 states), but replicates results from 2012 (when approximately 70 measures were considered in 20 states). Unfortunately, a significant percentage of this year’s measures were not life-affirming. Human Cloning Only two states – Mississippi and New York – considered measures prohibiting human cloning for all purposes.

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A measure in Mississippi would have established a research committee to examine the state of embryo and cloning research in the state. Destructive Embryo Research Only Oklahoma considered legislation prohibiting destructive embryo research, compared to three states that considered such measures in 2013. However, Missouri considered a constitutional amendment providing that it would not recognize or enforce any federal action legalizing destructive embryo research. Hawaii considered a measure purportedly making the unauthorized use, implantation, or injection of human sperm, ova, embryos, or stem cells a felony; however, the measure allowed for the use of embryos (or stem cells) if there is consent. Fetal Experimentation Florida considered measures prohibiting experimentation on live fetuses; however, experimentation on aborted fetuses would be permitted. Missouri considered a measure providing that a physician cannot perform an abortion on a woman for the purpose of providing fetal organs or tissue for medical transplantation to the woman or another person. Ethical Forms of Research At least seven states including Colorado, Hawaii, Kansas, Mississippi, New Jersey, New York, and South Carolina considered legislation promoting ethical forms of research. Colorado appropriated money to its Adult Stem Cells Cure Fund. Similarly, Kansas appropriated $9,000 (awaiting signature) to its Midwest Stem Cell Therapy Center. Hawaii enacted a unique measure encouraging ethical research and treatments by providing for a leave of absence for stem cell donors. Mississippi established an umbilical cord blood banking program.

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State Funding of Biotechnologies Limitations on Funding of Unethical Forms of Research

At least four states including Mississippi, Missouri, New Jersey, and Oklahoma considered measures restricting the use of state funds for unethical forms of research. Mississippi adopted three appropriations measures providing that state funds may not be used at state institutions of higher learning for research in which a human embryo is killed or destroyed. Among several measures considered in Missouri was a state constitutional amendment maintaining that the state would not recognize or enforce any federal action legalizing or funding destructive embryo research.

Funding of Unethical Forms of Research At least four states including Illinois, Maryland, Minnesota, and New York considered measures funding unethical forms of research. Notably, the measures in Minnesota did not appear to include any limitations on types of research funded. Maryland enacted (without the governor’s signature) legislation appropriating funds to the Maryland Stem Cell Fund. Maryland also considered legislation amending its stem cell research fund to include certain reporting requirements. New York enacted a measure appropriating funds to the Empire State Stem Cell Research Act. Connecticut enacted a measure which seemingly made only technical changes to current funding mechanisms for unethical research. Assisted Reproductive Technologies At least six states including Hawaii, Massachusetts, Missouri, New Jersey, New York, and Utah considered measures related to assisted reproductive technologies (ART). Most of the measures provided for insurance coverage of in vitro fertilization and/or other forms of ART. Utah enacted a measure related to the provision of health insurance coverage for infertility treatment.

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New York considered legislation regulating the process of consent prior to in vitro fertilization. Virginia enacted a measure regulating genetic counselors. Surrogacy At least five states including Louisiana, Minnesota, New Hampshire, New Jersey, and New York considered measures allowing or regulating gestational surrogacy. A Louisiana measure allowing gestational surrogacy was vetoed by Governor Bobby Jindal. Louisiana also considered legislation criminalizing gestational surrogacy or enticing a minor into surrogacy. Similarly, Kansas considered a measure declaring surrogacy against public policy and criminalizing involvement in a compensated surrogacy contract. Embryo Adoption Only two states considered measures establishing or regulating embryo adoption: Massachusetts and Virginia. Human Egg Harvesting New York considered a measure making it unlawful to provide valuable consideration for the “donation” of human eggs for research. The measure would have allowed for payment of “actual expenses.”

Freedom of Conscience

At least 22 measures were considered in 11 states that would impact the freedom of conscience of healthcare providers, institutions, and/or payers. The number of conscience-protecting bills dropped dramatically, to only roughly one third of 2013 level, whereas the number of coercive bills almost doubled. Protective Measures At least four states considered legislation protecting the freedom of conscience of healthcare professionals, institutions, and/or payers: Alabama, Iowa, Missouri, and Virginia. Alabama, one of only three states that do not provide statutory protection for conscience, considered a measure protecting a healthcare provider’s right not to participate in certain services including abortion.

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In response to the coercive federal mandates in the Affordable Care Act, measures were introduced in Iowa and Virginia attempting to provide conscience protections for employers regarding the provision of health insurance that includes abortion, abortion-inducing drugs, and certain contraceptive services. The Missouri House passed a measure protecting individuals and institutions from participating in specific services including abortion, abortion-inducing drugs, contraception (which includes drugs and devices with known life-ending effects, but misleadingly labeled as “contraception”), human cloning, human embryonic stem cell research, and fetal tissue research. Coercive Measures Among the seven states considering coercive measures, at least four states considered legislation that would require pharmacists and/or pharmacies to dispense so-called “emergency contraception” despite religious or conscience objections: Arizona, Missouri, New Jersey, and New York. Hawaii adopted a resolution honoring the State Commission on the Status of Women for, in part, supporting a coercive measure requiring Hawaii’s emergency rooms dispense so-called “emergency contraception” regardless of religious and moral objections. At least three states, including Michigan, New York, and North Carolina, considered legislation purporting to protect employees against discrimination for “reproductive health decision making.” The measures appeared to adopt the disingenuous narrative that employees face potential discrimination or lack of access to contraception stemming from their employers’ religious liberty and conscience claims against the coercive “HHS Mandate” which would require many employers to pay for or facilitate coverage for drugs and devices with life-ending mechanisms of action. In Washington, the House passed the Reproductive Parity Act requiring health insurance plans that cover maternity care to also cover abortion. The phony conscience clause in the measure would require plan providers with religious objections to facilitate abortion coverage for its plan beneficiaries.

End of Life

At least 186 measures concerning the end of life were considered in 2014—a decrease from 2013, when 214 measures were considered.

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Assisted Suicide and Euthanasia At least 11 states including Connecticut, Hawaii, Kansas, Maryland, Massachusetts, New Hampshire, New Jersey, North Carolina, Pennsylvania, Vermont, and Washington considered measures related to assisted suicide. Most of these measures would explicitly legalize assisted suicide: Connecticut (failed), Hawaii (failed), Kansas, Massachusetts (set aside for study), New Hampshire (failed), New Jersey, and Pennsylvania. New Hampshire and Maryland considered measures establishing a study of assisted suicide. New Hampshire also introduced a measure repealing the state’s prohibition on soliciting another to commit suicide. Vermont considered a measure providing immunity to physicians and pharmacists who comply with the state’s new assisted suicide law. Washington again considered a requirement that the physician who signs a patient’s death certificate, when the patient died from assisted suicide, designate that assisted suicide was the cause of death. Conversely, North Carolina considered a measure making assisted suicide unlawful; however, the measure did not provide a criminal penalty. Life-Sustaining Treatments and Futile Care Measures dealing specifically with the withholding or withdrawal of life-sustaining care, particularly nutrition and hydration, were considered in five states this year: Louisiana, Massachusetts, New York, Ohio, and Washington. Louisiana enacted a measure prohibiting the termination of life-sustaining procedures for pregnant women. Massachusetts considered a measure that would forbid any facility from withholding or withdrawing life-sustaining care from a patient or discharging a patient from the facility if there is a reason to believe that such an action is contrary to the patient's religious beliefs. New York considered a measure that would limit the state’s requirement that a healthcare provider continue to provide life-sustaining treatment to a patient at the request of a patient’s surrogate—pending transfer or judicial review— if an adult patient has made a decision about

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the care expressed either orally during hospitalization in the presence of two adult witnesses, at least one of whom is a health or social services practitioner affiliated with the hospital, or in writing. New York considered a measure that would permit some persons with developmental disabilities to make their own decisions concerning life-sustaining care. Ohio considered a measure ensuring that an individual’s statutory priority to decide whether to withhold or withdraw life-sustaining treatment for a relative is forfeited if that individual is charged with causing the terminal condition of his/her relative. Washington considered a measure providing immunity from civil, criminal, and professional sanctions for a healthcare provider or facility that participates in good faith in the provision of medical care or in the withholding or withdrawal of life-sustaining treatment in accordance with the directives contained in a Physician Orders for Life-Sustaining Treatment (POLST) form. Advance Planning Documents (e.g., Advance Directives, Living Wills, Healthcare Powers of Attorney, Do Not Resuscitate (DNR) Orders, Proxies, and Physician Orders for Life-Sustaining Treatment (POLST))5 Again this year, while many states considered measures creating or modifying traditional advance planning documents (e.g., advance directives, Living Wills), the trend of adopting Physician Orders for Life-Sustaining Treatment (POLST) Paradigm programs continued. A POLST program is typically designed “to convert patient preferences for life-sustaining treatment into immediately actionable medical orders” using standardized forms that provide specific treatment orders for cardiopulmonary resuscitation, medical interventions, artificial nutrition, and antibiotics. At least 19 states including Arizona, Connecticut, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, Oklahoma, Tennessee, Vermont, and Washington considered measures related to advance planning documents, with some states considering more than one related measure. This represents an activity level similar to 2012 (18 states), after a spike in 2013 (at least 28 states). Mississippi and Connecticut created POLST programs, while Kansas and Kentucky considered measures establishing POLST programs. Arizona, Hawaii, Illinois, Indiana, New Hampshire, Vermont, and Washington considered measures making modifications to their existing POLST programs. Hawaii’s measure was

                                                                                                                         5 In some states, POLST programs are called by other names (e.g., Medical Orders for Scope of Treatment (MOST)). For sake of simplicity, this analysis refers to all of these programs as POLST programs.

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enacted. Nebraska considered a measure establishing an interim study to evaluate the potential uses of POLST and out-of-hospital “Do Not Resuscitate” protocols. Notably, Arizona considered a measure ensuring that an advance directive or power of attorney takes precedent over a conflicting physician order for life-sustaining treatment. Indiana considered a measure requiring an individual’s treating physician to evaluate an individual’s mental capacity before executing a POLST. Conversely, Hawaii considered legislation that would expand healthcare provider signatory authority to include advanced practice registered nurses. Vermont considered legislation that would permit a surrogate decision maker to provide informed consent for a “Do Not Resuscitate” order, a clinician order for life-sustaining treatment, or hospice care on behalf of a patient, but would not permit the surrogate to consent to assisted suicide. End-of-Life Counseling and Patients’ “Bills of Rights” California considered a measure requiring healthcare providers to inform a patient’s agent (under a power of attorney for health care) when the patient is diagnosed with a terminal illness, and that the patient or the agent has the right to comprehensive information and counseling regarding legal end-of-life options for the patient. Massachusetts considered a measure giving patients certain rights, including the “right to make informed healthcare decisions, including the right to accept or refuse treatment, the right to receive information about palliative care and end-of-life options, the right to formulate advance healthcare directives, and the right to refuse to participate in experimental research.” Pain Management and Palliative Care At least 30 states including Alabama, Alaska, California, Florida, Georgia, Hawaii, Illinois, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, West Virginia, and Wisconsin considered measures relating to pain management and palliative care, with some states considering more than one related measure. The majority of these provisions addressed palliative care and pain management, with other measures addressing the legalization of medical marijuana, tighter regulation of opiates, and nursing home/long-term care facility regulations. Provisions enacted in 2014 include a modification of the physician registration requirements

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under the Alabama Pain Management Act, the establishment of a task force on opioid prescription drug proliferation in Pennsylvania; the establishment of a Palliative Care and Quality of Life Interdisciplinary Advisory Council in Rhode Island; regulations of pain management clinics in Tennessee; support for access to patient-centered and family-focused palliative care in Tennessee; legislation in Vermont to, among other things, establish a pain management advisory council; a measure requesting a study and recommendations by the Louisiana State Board of Medical Examiners concerning over-prescribing of pain medication; a measure in Minnesota to provide improved access to health care delivered by advanced practice registered nurses, and two measures in Ohio dealing with provision of certain medication.