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Senators Reopen Debate on Abortion Regulations

UPDATED: The Texas Senate Health and Human Services Committee is expected to hear from hundreds of witnesses Monday on legislation that would tighten regulations on abortion procedures, providers and facilities.

A hearing on Senate Bill 1 is shown on July 8, 2013.

Updated, 10:30 p.m.:

After hundreds of abortion opponents rallied outside the Texas Capitol to show their support for proposed abortion regulations, state Sen. Jane Nelson, R-Flower Mound, announced that more than 3,800 people had registered a position on Senate Bill 1 throughout the day.

"I appreciate the passion, the courtesy and the thoughtfulness of everyone who participated," Nelson, chairwoman of the Health and Human Services Committee, said in a statement. "Given the strong feelings on this issue, it was important to me that we took the time necessary to hear from everyone who showed up to have their voice heard."

The hearing is still running. People were required to input their position on SB 1, which would enact tighter regulations on abortion procedures, providers and facilities, before 9 p.m. Only those who registered a position before 11 a.m. will be allowed to testify, and public testimony is expected to end after midnight.

Original story:

For many Texas senators, Monday’s Health and Human Services Committee hearing was the first opportunity to discuss proposed abortion legislation since Sen. Wendy Davis’ much-publicized filibuster in the first special session.

As committee members started the hearing by debating points of a measure that would tighten regulations on abortion procedures, providers and facilities, they also prepared to hear testimony late into the night — and possibly into the early morning — from as many as 2,000 witnesses. 

State Sen. Bob Deuell, R-Greenville, vice chairman of the committee, said that in the first session, "20 senators had their votes suppressed on the floor," adding that "those 20 senators represent over 16 million Texans." He set out two pairs of children's sneakers, which he said he would leave out throughout the hearing as a reminder of "those who will never get to testify."

Senate Bill 1 and its companion, House Bill 2, would ban abortion at 20 weeks post-fertilization and recognize that the state has a compelling interest to protect fetuses from pain; require doctors performing abortions to have hospital admitting privileges within 30 miles of the facility; require doctors to administer the abortion-inducing drug RU-486 in person, rather than allow the woman to take it at home; and require abortions — including drug-induced ones — to be performed in ambulatory surgical centers.

(This Tribune interactive compares the proposed abortion regulations with laws passed in other states.)

The House will consider HB 2 on Tuesday. Senate Health and Human Services Committee Chairwoman Jane Nelson, R-Flower Mound, indicated that the committee would wait to vote on that version of the legislation, which means it’s likely that the legislation would reach the Senate floor for debate on Thursday. If the House and Senate approve the same version of the legislation, it could reach Gov. Rick Perry’s desk for final approval by the end of this week.

Nelson said that every person who registered to give oral testimony before 11 a.m. would get to speak for two minutes. But if there were any outbursts from the public, one warning would be given before she would ask public safety officers to clear the committee room and end the hearing. Senators debated the bill for roughly an hour before they began listening to public input. Nelson later added that given the number of people registered to testify, if each spoke for two minutes, public testimony would last 16 hours.

Sen. Judith Zaffirini, D-Laredo, pressed SB 1 author Glenn Hegar, R-Katy, on amending the bill to include an exemption from the 20-week ban for women with pre-existing psychological conditions and redefining the “substantial medical evidence” the bill cites to “some medical evidence” or just “medical evidence.” Hegar rejected all of those changes.  

Sen. Carlos Uresti, D-San Antonio, asked about including an exception for cases of rape and incest. Hegar responded that there is no exception after 24 weeks, so he did not see the need to have one at 20 weeks.

Zaffirini also asked Hegar what the bill did to reduce levels of unwanted pregnancy and inquired why it did not specifically address sex education. Hegar said the bill is not “a funding mechanism for women’s health” and that sex education is not on the call for this special session.

Sen. Royce West, D-Dallas, debated with Hegar over whether it is realistic to require that abortion providers have admitting privileges at hospitals within 30 miles of the clinic. 

Nelson opened public testimony by allowing a panel of subject experts to testify.

The 20-week ban on abortion could withstand a constitutional challenge in court, said Carter Snead, a constitutional law professor at University of Notre Dame. Previous rulings by the U.S. Supreme Court allow states to create laws to regulate abortion, as long as it does not create an undue burden on women’s access to abortion, he said, and states cannot ban abortion before the point of viability, because at that point, the court argued, there’s a second life that state law can attempt to protect.

“What the fetal pain law does, is actually provide a new line … that actually is arguably stronger than the viability rationale,” said Snead. “The notion of a being that can experience pain is a very strong rationale for establishing a second person.”

Lawmakers may evaluate medical evidence that fetuses can feel pain at 20 weeks and legislate based on that evaluation, he said.

Matthew Romberg, an obstetrician and gynecologist from Round Rock, said he does not know of substantial evidence indicating fetal pain at 20 weeks of gestation. 

Nelson asked Romberg whether he could say for certain that fetal pain does not exist. He said he could not.

“It doesn’t matter what I think. It doesn’t matter what y’all think,” Romberg said. “It matters what my patient in the room thinks.”

"We have over 40 years of safe abortion on record in Texas,” said Amy Hagstrom Miller, the chief executive officer of Whole Woman’s Health, which operates five facilities that perform abortions in Texas, including one ambulatory surgical center.

Hagstrom Miller said the existing regulations on abortion clinics are more effective than the ambulatory surgical center requirements in SB 1, as they require more frequent state inspections and have very specific quality assurance requirements for abortion procedures. In comparison, the ambulatory surgical center requirements are more generic, said Hagstrom Miller, and most do not apply to abortion procedures.

"Abortion is one of the safest procedures in medicine," she said. She described how surgical abortions are a five- to 10-minute procedure done under local anesthesia without an incision.

Ellen Cooper, an expert witness from the Department of State Health Services, said that abortion clinics are inspected at least once a year, while ambulatory surgical centers are inspected every three to six years.

“Generally speaking, compared with the other facility types, I have not been aware of any particular concerns” associated with abortion clinics, she said, and later added, “There’s no reason for me to believe that one is safer than the other.”

Researchers with the Texas Public Policy Evaluation Project — a three-year study at the University of Texas at Austin evaluating the impact of the 2011 cuts to family planning financing in Texas — issued a policy brief detailing the impact of the legislation on five areas of the state that do not have an abortion clinic that meets the ambulatory surgical facility standards.

In the Rio Grande Valley, more than 2,634 women received an abortion in 2011 at one of two medical clinics, according to the policy brief, but if the law were to pass, those women would have to travel to San Antonio at least two times, adding 16 hours of travel to obtain the procedure.

Because only six of the state’s 42 existing abortion facilities meet the existing ambulatory surgical center standards, the policy brief states that women in the metropolitan areas near Beaumont-Port Arthur, Corpus Christi-Kingsville, El Paso, Midland-Odessa and the Rio Grande Valley would have to travel on average more than 16 hours for two round-trip visits to obtain an abortion. That would increase the costs of obtaining an abortion, and require women to take more time off from work or school, according to the researchers. If there are fewer facilities, women will also be forced to wait longer for an appointment, the researchers add, and later-term abortions are associated with a higher risk of complications.

“Faced with these obstacles, some women may instead choose to try to self-induce their abortion, a phenomenon that we are already observing in the state,” states the policy brief. “We do not doubt that the proposed restrictions would reduce the number of legal abortions carried out in these regions, but we are deeply concerned about the increase in self-induced abortions and increase in later abortion that will almost certainly follow in the wake of these restrictions.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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