On Sept. 30, 1976, the U.S. House of Representatives passed for the first time the Hyde Amendment — a budget rider that banned federal spending on abortion.
That rider is still part of the federal budget, with a Medicaid exception for cases of rape, incest or to save a woman’s life.
Pennsylvania, which has some of the strictest anti-abortion access laws in the country, limits the use of its Medicaid dollars in the same way. Those restrictions were once even tighter.
In the late 1990s, the Women’s Law Project successfully sued to overturn a provision of the Pennsylvania Abortion Control Act that required rape and incest survivors to report the crime to police and identify the assailant in order to use Medicaid for an abortion.
But the state has continued to limit public funding and even insurance coverage for abortions. Abortions aren’t covered in public employees’ plans, for example, and private insurance companies cannot offer Pennsylvania women coverage for most abortions through the state marketplace.
“The ban on public funding for abortion care is without any doubt the biggest barrier to abortion,” Susan Frietsche, senior staff attorney for the Women’s Law Project in Pittsburgh, told The Incline.
While Pennsylvania limits the use of taxpayer money for abortions to certain cases, it does fund so-called crisis pregnancy centers. Since 1997, the state has paid tens of millions of dollars to Real Alternatives to runs its Alternative to Abortion Services Program. Real Alternatives operates a “pregnancy and parenting support services” hotline and gives grants to “pro-life service providers” across the state.
This week, Pennsylvania’s auditor general announced that his office will look into the state’s contract with Real Alternatives, which runs similar taxpayer-funded programs in Michigan and Indiana. The move comes after a Department of Human Services audit raised questions about what Real Alternatives is doing with a fee it takes from providers.
What is Real Alternatives?
Real Alternatives describes itself as a “non-profit, charitable organization that administers … pregnancy and parenting support services.” It has a five-year contract worth more than $30 million from Pennsylvania’s Department of Human Services to provide “free, caring, confidential, and life-affirming alternatives to abortion services.”
The majority of that money comes from the state, while $1 million each year comes from the federal government through Temporary Assistance for Needy Families, which is traditionally used as cash assistance for low-income families. Real Alternatives President and CEO Kevin I. Bagatta was paid more than $234,000 between July 2013 and June 2014, according to IRS records.
Real Alternatives has contracts with 29 organizations in Pennsylvania to provide services, according to an audit released by DHS earlier this year. Real Alternatives’ website lists several Pittsburgh-area organizations as counselors, including Lifeline of Southwestern PA, Genesis of Pittsburgh, Catholic Charities and Pennsylvanians for Human Life/Welcome Little One.
In a deep-dive on crisis pregnancy centers, Cosmopolitan reported in July 2015 on Real Alternatives’ relationship with these vendors:
According to Real Alternatives’ contract with the state, it reimburses a center just $2 each time a woman receives food, clothing, or furniture — a maximum of four times. That’s a $24 cap for an individual pregnant woman’s material needs. Centers may dispense more through donations. Still, the government program gives them the incentive to spend more time providing ideologically driven counseling, which is reimbursed at more than $1 per minute, than they spend providing direct services.
In order for a woman to receive any material support, the program requires that she receive at least 20 minutes of counseling from staff, usually after taking a pregnancy test. Real Alternatives’ contract with the state relies on debunked studies that imply abortion leads to breast cancer and clinical depression. Centers are not allowed to advocate for birth control, much less dispense it. The contract’s directives advise pregnancy-center staff to make an “assessment of the client’s spiritual needs” by asking questions like, “How does your faith impact the choices you make?” (One quarterly report from a center to Real Alternatives refers to clients with the aliases “Mary” and “Joseph.”)
In October of last year, the Pittsburgh Post-Gazette reported that some area nonprofits that receive Real Alternatives funding were giving out “literature [that] includes claims that have been debunked by most researchers.” Real Alternatives, itself, promotes discredited “health consequences of abortion” through its online publication targeted at young people, LoveFacts.Org.
Calls to Real Alternatives were not returned.
The audit’s primary focus, Auditor General Eugene DePasquale told The Incline, will be a concern raised in the DHS audit about how Real Alternatives spends a fee it collects from service providers.
When a service provider makes a claim, Real Alternatives takes 3 percent of that money. According to the DHS audit, Real Alternatives “refused” to let the Bureau of Financial Operations examine where that money went. “RA management stated that the fee is used to fund expenses that are not permitted under the grant agreement, such as travel and other expenses to support the advancement of the program in other states,” the audit said.
DePasquale said he wants the audit “to be as thorough as possible.” But the goal is to have it finished by the spring — before a budget is passed — “so the governor and the legislature can have all the appropriate information before they make decisions about what to do with this contract moving forward.”
Last fall, when DHS told the Post-Gazette it was conducting an audit of Real Alternatives, DePasquale told the paper he had heard concerns that faith-based groups were promoting religion.
“We still are hearing those concerns,” DePasquale told The Incline, adding that his office “will examine if it’s possible” to address these concerns “as part of this audit.”
The state of abortion access
Kim Kir is the associate administrative director of the Allegheny Reproductive Health Center, which offers gynecological care and abortion services.
“We do our best to make it as easy and accommodating as possible,” Kir said, “while at the same time letting [patients] know that these are not our rules, but laws that we have to comply with.”
There are many: Abortion is legal until 24 weeks of the pregnancy except in rare cases; women younger than 18 must get consent from a parent or guardian or seek approval from a judge; a woman must speak to a doctor by phone at least 24 hours before having the procedure, during which she’s given information about fetal gestation and abortion alternatives.
Kir said crisis pregnancy centers “are not straightforward” with patients. Some, she said, will make it seem as if abortion services are offered. “Then when they get them in the door, they simply try to block them from having an abortion,” she said.
Women tell Kir about “constant harassment” from crisis pregnancy centers through texts and calls, she said, and about providers lying about positive STI tests to delay an abortion procedure.
One of the latest tactics Kir’s seen, she said, is the use of vans that provide free ultrasound services.
“Why is the state involved in these places that are deceptive?” she said.
Not all providers who receive Real Alternatives money say they try to conceal their motivations. As the Post-Gazette’s previously reported, “many providers wear their convictions on their sleeve.”
Catholic Charities’ Susan Rauscher told the paper, “We’re so clear on where we stand on abortion that it doesn’t come up.”
What happens next
Pennsylvania’s General Assembly has continued to narrow abortion access in recent years. In the wake of the Kermit Gosnell case, the legislature passed a law that required facilities that provide abortions to meet the same standards as surgery centers, an onerous and unnecessary requirement, according to abortion access proponents.
Last year, Republican state Rep. Paul Schemel introduced a bill that would forbid the Department of Health from supplying funding to family planning providers that perform abortions except in cases of rape, incest or to save the life of the woman. That would mean organizations like Planned Parenthood, which can get public funding for services like cervical cancer and STI screenings, wouldn’t be able to receive any public funds.
There’s also been pushback against these tightening restrictions. In June, Democrat state Sen. Daylin Leach introduced a bill to repeal strict regulations on abortion-providing facilities in Pennsylvania. The move came shortly after the Supreme Court struck down a similar Texas law.
The Women’s Law Project’s Frietsche noted that Pennsylvania’s law differs from Texas’.
“It’s somewhat more flexible,” she said of Pennsylvania’s law. “It also has some of the same very unreasonable features.”
With the Supreme Court’s ruling, Frietsche said that “in the months ahead, it will become clear what, if any [parts of Pennsylvania’s law], can stand.”