BLOOMBERG BUSINESSWEEK: Regulating Away Abortion: How State Governments Are Running Providers Out of Business

7/23/2019 BLOOMBERG BUSINESSWEEK: Regulating Away Abortion: How State Governments Are Running Providers Out of B

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How state governments are runnin

Photographs by Agnes Thor


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AYON

ortion providers out of business

By Esm E. Deprez


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January 2011, Michigan State Senator Ricknes, a former sheri from Grand Ledge,troduced legislation that would dramati-lly raise the costs of providing abortionsthe state. Senate Bill No. 54 would require

tal remains to be cremated or buried sep-ately from other medical waste and make

oncompliance a felony punishable by up toree years imprisonment or a ne of up to,000, or both.Soon after the bill was introduced, Rene

helian, a petite 61-year-old who opened herst abortion clinic in suburban Detroit in76, called every funeral director and cre-ation company in the metropolitan area toe if theyd be willing to handle fetal remainsom her clinics. Most told her no. When shenally found one willing to comply with theuidelines, the quoted price was $250 per dis-osalwhich would nearly double the cost ofost abortions at her clinics and was wayore than most patients could aord. If thenes bill as initially proposed were to becomew, Chelian calculated, she and other abor-on providers might go out of business.

Intimidation, harassment, and the threatviolence used to be Chelians biggest pre-cupations. Her photo is posted on anti-ortion websites, her home has been reg-arly picketed, and one of her clinics was

nce doused in butyric acid, a clear, color-ss liquid that smells like 1,000 people

ned up and threw up, she says. In recentars, however, the main threats to abortionoviders have come not from noisy picket-s and protests but from regulations passedstatehouses across the U.S. Requirementsat abortion providers be regulated more

ke hospitals than doctors oces may shut-r most, if not all, clinics in Virginia, Kansas,nd Pennsylvania. A Mississippi law man-ates that abortion doctors secure admit-ng privileges at local hospitals, and couldrce the states last surviving clinic to closedoors. Instead of seeking to ban abortion

utright, which would violate the Supremeourts 1973 ruling inRoe v. Wade, anti-abor-on groups are pushing laws that wouldake it too expensive for providers to remainoperation.If someone woke me up at 2 a.m. and

ked me whats the greatest threat to pro-

ders today, these laws would be the firsting Id say, says Carole Joe, a reproduc-

ve health sociologist at the University of Cal-ornia at San Francisco whos chronicled theortion industry for the past 35 years.

he headquarters of Northland Family Plan-ng are located in the Detroit suburb of West-nd, in a standalone one-story building sepa-ted by parking lots from a GameStop and ank. On a cold morning in early January, Che-n is trying to decipher how newly passedgulations will aect her business. She takescall on her iPhone from a representativeom a medical waste company that Chelianorries will face pressure from anti-abortiontivists to drop her as a client.

I dont want them to start harassing you,she says. Do you have any vehicle you canpick up in that doesnt have your name? Yes,the man replies. I mean, its your businessand you have to do what you have to do, but Idont want to lose you as a contractor becauseyou had the name on your truck. She hangsup. Without medical waste pickup, were in

trouble, she says.Its one of the rst times in months that

Chelian has been in her office. Unpackedboxes from a 2010 renovation surround herdesk. For the past two years, Chelian delegat-ed payroll and other clinic-running duties toemployees while she logged some 11,544 milesin her dark gray Ford Explorer driving to andfrom Michigans capital, Lansing, to lobby law-makers and participate in rallies against a hostof anti-abortion proposals.

Chelian grew up in inner-city Detroit,the oldest ofve children born to a Syrian-Lebanese Muslim father and an Irish Catho-lic mother. In 1966, at the age of 15, she hadan illegal abortion. Her father accompaniedher to a parking lot where they were blind-

folded and taken to a nearby warehouse. Fo$2,500, a man packed her uterus with gauzto induce labor, and after some complications, she passed the pregnancy on the toileat home. She now guesses she was about 1weeks along. It was decades before she tolanyone about the experience, which providemotivation for her career. I dont want m

daughters or any other woman to be facewith that, she says.

In 1976, having taken some nursing clases, Chelian was working as an assistant to aabortion doctor and felt she could run thingbetter. She envisioned a model that oereemotional counseling to women undergoinabortions. She and her husband, Eddie, a policeman at the time, opened Northland usintheir life savings of $100,000. Shes since expanded the business to three clinics in thDetroit area. In 2011, Northlandsve doctorperformed nearly a quarter of the 23,366 reported abortions in the state.

In virtually any other context, a taxpaying small business owner like Chelian, whemploys 36 people and has invested million

A new Michigan lawrequires recoveryrooms in abortionclinics to have80 square feet offloor space per bed

To comply with regulations,Chelian may need to build anew janitors closet

Chelians clinics billed$3.5 million last year, yetshe still took a small loss


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f dollars into her 37-year-old enterprise,ould be praised by politicians as the back-one of the American economy. In placeshere abortion is accessible, its partly be-

ause people like Chelian recognize it as ausiness opportunity. Chelians clinics hadoss revenue of $3,520,576 for scal 2012

ut lost $1,818, according to their accoun-nt. Even so, Chelian and her husband, who

versees security and nances at the clinics,arned $203,000 last year in salary. They

ve in a 6,500-square-foot home in the up-ale neighborhood of West Bloomeld, nearhere Mitt Romney grew up.

My husband and I worked our ass otoake sure we paid for our kids college edu-

ation, she says. And yet Chelian has dealtith challenges that few others in the health-

are eld must face. She spends thousandsf dollars annually on security guards andas hired private detectives to monitor op-osition groups plans. She has had two leasenewals denied and was evicted once be-

ause of protests staged outside her clinics.Wary of her image when she testies in Lan-

ng, she removes the 2-karat diamond en-agement ring her husband gave her morean 40 years ago, lest she fuel a perception

f herself as a proteering abortionist.

n Dec. 28 last year, Michigan Republicanovernor Rick Snyder signed an omnibus billombining multiple abortion-related mea-ures. It was the culmination of two yearsebate about whether and how abortionhould be regulated in the state. The nal lawrohibits doctors from prescribing medica-on abortion, a chemically induced miscar-

age, via webcama practice used in someates to expand access to rural communitieshere doctors arent physically present. Thew also requires that patients be screened ensure they werent coerced into getting

n abortion. Providers who advertise outpa-ent abortion services and perform 120 orore surgical abortions per year must now

e licensed as freestanding surgical outpa-ent facilities.

Anti-abortion groups lauded the bills pas-ge. Licensing and inspecting abortion clin-s for health and safety standards will servebetter protect those women who, regret-

bly, choose the path of abortion, said Re-ecca Mastee, a policy advocate at Michigansatholic Conference.

At the same time, the legislation signedy Snyder represented a victory of sorts forbortion rights advocates. They succeeded inrowing out or diluting provisions such as a

an on abortions beyond 20 weeks and a re-uirement that abortion doctors have person-liability coverage of at least $1 million. Thetal remains disposal measure introducedthe state Senate was modied to allow thecineration of fetal tissue along with otheredical waste, and reduced the penalty for

oncompliance to a civil ne of $1,000.The most threatening part of the new leg-

lation is the need to conform to hospital-

like standards, says Chelian. One stipulationrequires abortion clinics to install specialgooseneck scrub sinks. Another says recov-ery rooms must provide 80 square feet ofoor space per bed, three feet between each,and one lavatory for every six patients. Corri-dors must have a minimum width of six feetChelian estimates most are currently closerto ve, which is large enough to t a stretch-er. Unless she can successfully attain waiversfor such things, Chelian estimates the needed

renovations would cost more than $1 million,an expense she says she cant aord.

Chelians clinics perform 19 abortions perday on average. If patients are required toremain in recovery for at least three hours,with a physician present the entire time, thatnumber would be cut in half, which couldforce Chelian to raise her rates. Many cli-entsoften minorities, poor, and unedu-catedalready have difficulty scraping to-gether the $325 that most abortions (up to12 weeks gestation) cost. That price subsi-dizes the costs of pap smears, contraceptionsuch as birth control pills and condoms, and

other services that make up the majority ofher business, she says.

Denise Burke, the lead author of regu-lations at Americans United for Life, whichhelps to write legislation like Michigans,argues that the courts have never stipulatedthat abortions must be aordable or that pro-viders ought to earn a prot. To underscorethe point, she cites the high courts ownwords in the landmark Planned Parenthoodv. Caseyin 1992, which upheld states rightsto restrict access: The fact that a law whichserves a valid purpose, one not designed

to strike at the right itself, has the inciden-tal eect of making it more dicult or moreexpensive to procure an abortion cannot beenough to invalidate it. Charmaine Yoest,the president of Americans United for Life,points to the 12 women who died from abor-

tion in 2009 and examples oflthy clinicdiscovered in Kansas and Pennsylvania aproof that all abortion care must be morclosely regulated. That argument is echoeby Jones, the sponsor of Michigans fetal remains bill. What we have done is make safer environment for all women in Michgan, he says.

Federal data show abortion to be one othe safest medical procedures in the U.Sposing less risk of death than getting a pen

cillin shot and 14 times safer than carryina pregnancy to delivery. Anyone who talkabout the dangers of abortion is just blowinsmoke, says David Grimes, former chief oabortion surveillance at the Centers for Disease Control and Prevention and a leading researcher and abortion provider. These kindof regulations do nothing to advance womens health. All they do is drive up the cost ocare and cause women to delay, which driveup the risks.

Under the Obama administration, abortiorights proponents have won signicant ba

tles on the national level, ghting back atempts to cut ofunding to Planned Parenhood and eliminate the Aordable Care Actrequirement that most health plans covecontraception free of charge. But abortiofoes have made unprecedented headwaat the state level. After Republican gains istatehouses in the 2010 midterm electionslawmakers in 24 states passed a record 9provisions that restrict access to abortioservices, according to the Guttmacher Insttute, which researches and compiles data oreproductive health. Thats nearly triple th

old record set in 2005 and a sixfold increasover 1985.Abortion providers say the laws hav

made their business more arduous and sliceinto their earnings. By 2008, the latest yeafor which Guttmacher has data, the numbeof providers, which includes doctors oces and hospitals, had fallen 38 percent fromtheir 1982 peak, to 1,793. Independent, forprofit clinics like Chelians are where thmajority of abortions in the U.S. are performed. But they lack the lobbying musclefundraising capabilities, and public fundinof Planned Parenthood, the countrys singl

largest abortion provider, and are thus morvulnerable to regulation. Many of the 2indies that have closed in recent years saits because theyve been run out of businesby or forced to merge with Planned Parenhood aliates, and 19 more say theyre iserious trouble, according to an informasurvey conducted by independent providersDemand is also declining: The abortion ratfell in 2008 to its lowest level since 1974, according to Guttmacher, due in part to moreective contraceptives.

That financial squeeze on providers ilikely to continue. Legislation pushed babortion opponents increasingly targets thsupply side of abortion (the provid-ers) over the demand side (patients),

THESE KINDS OFREGULATIONSDO NOTHINGTO ADVANCE

WOMENSHEALTH. ALL

THEY DO IS DRIVEUP THE COST OF

CARE AND CAUSEWOMEN TO DELAY,WHICH DRIVES UP

THE RISKSDavid Grimes,

former chief of abortion surveillanceat the Centers for Disease Control

and Prevention


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Documents

BLOOMBERG BUSINESSWEEK: Regulating Away Abortion: How State Governments Are Running Providers Out of Business