Two lawmakers scramble to push bills providing grants to abortion clinics

Two Democratic state senators are trying to secure funding for reproductive health clinics that provide abortion services before time runs out in the 2024 legislative session. And the success of one bill may help with the financial support of the other.

The landscape for abortion access has changed drastically across the United States following the overturning of federal abortion protections in 2022.

While Gov. Wes Moore (D) has billed Maryland as a “safe haven” for those seeking abortions, some pro-abortion lawmakers are looking to expand access to abortion services and seeking ways to protect abortion clinics from vandalism or acts of violence.

And the two bills come at a time when access to abortion measures is in question again, as the U.S. Supreme Court is considering a case that could severely restrict a drug commonly used in medical abortions called mifepristone.

Sen. Ariana B. Kelly (D-Montgomery) is sponsoring SB 947 which would attempt to tap funds that insurance carriers are required collect, by federal law, if they cover abortion services.

Under the Affordable Care Act, insurance carriers that cover abortion services are required to collect a $1 premium per member per month.

Those funds are collected in a “segregated” pool that can only be used for abortion services, because public funds are not permitted to pay for abortion services except in extreme cases involving rape, incest, or in the case of a life-threatening pregnancy.

But Kelly says that there’s funding left over that has not been used, and she hopes her bill will direct potentially millions of dollars to expand access to abortion.

Her bill would use that funding to help expand abortion access across the state and provide abortion coverage for those without insurance.

“It’s not that they’re not covering abortion care, it’s just that it doesn’t cost as much as the federal law requires,” Kelly explained.

“So it’s (SB 947) going to allow us to provide abortion care for people who don’t have insurance or for people who can’t use their insurance because of domestic violence reasons.”

But Kelly’s bill has run into some obstacles. SB 947 has language that would help fund security measures for abortion clinics, but that might lie outside the scope of the purposes of the “segregated funds.”

Kelly sought advice from the Maryland Attorney’s General office for guidance on the matter.

Assistant Attorney General Natalie R. Bilbrough replied to Kelly on March 21, saying that from a federal compliance level, “those premiums can be used only to pay for abortion services” that are prohibited to be paid for using federal funds, which are most abortions.

Therefore, the security funding measure likely lies outside of the scope of how the funds can be used. Kelly says she’s working on an amendment to remove the language about bolstering security for clinics and clarify that the money would be used only for what is federally permissible.

“We want to make sure not to be using this money directly for security purposes,” Kelly said.

However, there is a separate Senate bill focused on bolstering security measures at reproductive health care clinics that provides abortions.

‘Fund swap’

Sen. Sarah K. Elfreth (D-Anne Arundel) is sponsoring SB 975 which allows the Maryland Department of Health to issue grants to bolster security measures at abortion clinics.

The bill would create the Reproductive Health Care Clinic Security Grant Program to be administered by the Governor’s Office of Crime Prevention and Policy.

The goal is to provide grants for abortion and reproductive health clinics to make security improvements, including security cameras, alarms, perimeter lighting and panic buttons.

But Elfreth’s bill would not mandate $500,000 out of general funds. It just says the governor “may” appropriate $500,000 to the Reproductive Health Care Clinic Security Grant Program for the 2026 fiscal year.

Which is where Kelly’s bill comes in.

The state of Maryland covers the abortion costs for residents on Medicaid, a federal-state health care plan, in which states share some costs, to cover low-income households. Although federal funds are not permitted to go towards abortion services, states can choose to use state funds to help cover abortion for low-income individuals.

Kelly proposes that the leftover money targeted in her legislation could free funds currently being used to cover abortions for Medicaid recipients, and that money could be used to fund Elfreth’s bill.

“Since Maryland already pays for Medicaid abortions, we can do a fund swap,” Kelly said. “So that we can send the money to Medicaid, and then that money that we would be sending to Medicaid can go to whatever abortion related programs we want, including Senator Elfreth’s bill.”

But that would require that both Elfreth’s and Kelly’s bills pass both chambers before the final day of the session, which is less than two weeks away.

“It is getting late,” Kelly said. The Senate Finance and Budget and Taxation committee both need to approve Kelly’s bill before it goes to the Senate floor, then it would still need consideration by the House.

Elfreth’s bill is awaiting a vote on the Senate floor, but the legislation has been postponed twice. It is scheduled to be discussed on the Senate floor April 2.

Sen. Sarah K. Elfreth (D-Anne Arundel). Photo by Danielle E. Gaines.

“Everyone agrees that we have a major and a rising problem when it comes to…an increase of violence and threats of violence to abortion providers. I think everyone is in agreement to the need for this fund,” Elfreth said. “The bills, and how they relate to Senator Kelly’s bill, I think there is a piece of this where, if there is a funding mechanism outside of the general fund… I think that’s part of what’s being worked out right now.”

To complicate matters, Kelly recently announced her departure from the Maryland Senate to lead the Maryland Commission for Women. She would not be able to lead the bill from a legislative position next year if SB 974 is unsuccessful this year.

“That is true, although I will be continuing to work with the Commission for Women, and these issues are not going away,” she said. “I am much more worried about making sure we get this program implemented with a friendly presidential administration. That is the timeline that concerns me the most.”

Kelly said that she hopes the legislation will pass while there is still an abortion-“friendly” federal administration under President Biden.

“I think it is really, really important that we work with… our federal partners to figure out how we can make sure this money is utilized for the purpose it was intended for, which is access to abortion care.”

Elfreth is hopeful that the bills get through, despite the time crunch.

“I have to be an optimist in this work,” Elfreth said. “A majority of the folks in the General Assembly are pro-choice, are completely behind this  concept. Those seeking abortion care and those providing abortion care feel safe and secure in actually accessing it.”

“It’s just how we work out how those two bills work together, and it just takes some time to do that,” she said. “It takes negotiations, it takes patience. But I am optimistic based on the value of the bills.”

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