“Momnibus” bill addition urges women with nonviable pregnancies against abortion

A bi-partisan omnibus bill aimed at lowering Kentucky’s soaring maternal mortality and morbidity rates is nearly law.

But a last-minute committee substitute to add the requirement that health care providers recommend women with nonviable pregnancies should consider carrying those pregnancies to term rather than get abortions has rankled Democrats.

The committee substitute was added during the Senate Standing Committee on Health Services Thursday, but the whole of the last-minute change was not made public or discussed at length at the meeting.

Some Democrats on the committee who voted in favor of the new bill told the Herald-Leader they didn’t realize how extensive the bill substitute was. The bill has otherwise had strong bipartisan support throughout the working group that produced the measure and so far this legislative session, earning a recent vote in the House of 90-0.

House Bill 10 from Rep. Kim Moser, R-Taylor Mill, known as the “momnibus” bill for its many components pertaining to pregnant and new moms, would do the following:

• Establish pregnancy as a “qualifying life event” to be covered by Medicaid

• Require Medicaid to cover lactation consultation services and the cost of breastfeeding equipment, telehealth services related to maternity care and participation in an in-home program for treatment of substance use disorder.

• Allow pregnant women on private insurance the option to buy into temporary insurance to cover pregnancy.

• Maintain the emergency Lifeline for Moms Psychiatry Access Program under the Cabinet for Health and Family Services to allow health care providers expedite referrals for patients needing behavioral health services.

This lifeline builds off a five-year $750,000 grant the state had been awarded to do just that. If providers “identify a mental health need, they would be able to call a hotline and get immediate access to mental health treatment, and then a referral if necessary” for their patient, Moser told the committee Thursday.

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The bill would also push public health department staff working in the home-visit program known as HANDS — health, access, nurturing development services — to offer education on safe sleep and lactation counseling and assistance. Under the bill, the Cabinet will also study Doula programs and their benefit to populations most at risk for poor perinatal outcomes.

Year over year, Kentucky has one of the highest maternal mortality rates. Nearly all maternal deaths within the first year of pregnancy are preventable, and more than half are caused by addiction-related issues, Moser has said.

Generally, the goal is to strengthen wrap-around services for this population to lower these rates and to ensure mothers and their children are afforded the best care in Kentucky, said Moser, a former nurse who chairs the House Health Services Committee.

It was in that committee’s meeting earlier this month that three Democrats walked out in protest over the contents of a bill that were slipped into House Bill 10 on Thursday.

Under House Bill 467, or the “Love Them Both Part II Act” from Rep. Nancy Tate, R-Brandenburg, all hospitals, birthing centers, maternal fetal medicine providers and midwives “shall provide or make referrals to a perinatal palliative care program, or perinatal palliative care support services” if a patient’s pregnancy is nonviable, and it would be covered by insurance.

This program, according to Tate and her bill language, is to offer “alternatives to pregnancy termination.”

One of the lawmakers who walked out was Rep. Lindsey Burke, D-Lexington, who has shared her own experience of terminating a nonviable pregnancy. She called Tate’s bill an “insult to grieving parents everywhere.”

Tate said her bill is a “very compassionate piece of legislation that gives us the opportunity to support women and their families physically, mentally, spiritually, emotionally and financially.”

A nonviable pregnancy is one in which the fetus is diagnosed with a condition or anomaly that will lead to their death, either in utero or shortly after birth.

In these situations, as the Herald-Leader has reported, termination is one of the handful of options considered the standard of care health care providers present to patients with nonviable pregnancies.

With abortion still illegal in Kentucky except in medical emergencies, women with nonviable pregnancies that don’t immediately threaten their health must drive out of state for those services.

Palliative care for babies born with fatal conditions already exists in hospitals across Kentucky, according to doctors who’ve spoken with the Herald-Leader, though not all hospitals have a formalized program.

Moser added much of the wording from Tate’s bill to House Bill 10 on Thursday, which would also require the Cabinet to maintain a list of perinatal palliative care programs and services providers on its website.

She said Friday morning that the point is “just that the hospital shall give the patient and family the option of receiving this care,” not to necessarily pressure women one way or the other.

In the meeting Thursday, she told committee members that “perinatal palliative care” had been added to two sections of the bill, but not all members had seen the committee substitute by the time votes were taken.

Sen. Cassie Chambers Armstrong, D-Louisville, voted in favor of House Bill 10 in committee on Thursday before realizing what the committee sub called for.

Chambers Armstrong, who was part of the working group that produced House Bill 10, said she had not seen the committee sub by the time the meeting started.

“I did not realize this bill had been added, and I certainly would’ve had a lot more questions had I realized it,” she said Friday morning. “We did not know at the time we were voting for (that) bill.”

“I very much support the maternal health provisions in the bill, and I want those to pass. The ones that expand access for pregnant women to insurance, to lactation support, to Doulas, to mental health treatment. Those are really important provisions that will save lives,” Chambers Armstrong said.

And if women with nonviable pregnancies wish to carry to term, it’s important to meet that need, she said.

“But what is cruel about the law in the state of Kentucky right now is that’s the only choice that the law offers to women in these impossible situations,” she added. “We should also be providing them information about the medical standard of care, which is allowing for termination in cases where a pregnancy is nonviable.”

The bill’s provisions seemingly encouraging “women who are pregnant with nonviable pregnancies to stay pregnant, I think that is a cruel provision. I can’t support that.”

House Bill 10 next heads to the Senate for floor votes, one of the last steps before passage.

This story may be updated.