Testifiers question need for proposed Nebraska requirements for abortion pills

LINCOLN — Advocates for a Nebraska legislative bill that would add new steps women must take to access abortion pills said they want to make using the pills safer for pregnant women.

Opponents testifying during the public hearing Thursday for Legislative Bill 512 said the goal of the measure by State Sen. Rick Holdcroft of Bellevue is to reduce the use of the drugs.

LB 512 does not outright ban or directly restrict mifepristone or misoprostol, the typical two-drug regimen for a medical abortion. But it adds several required steps.

It would require women to see a doctor three to 14 days after being given the pill, in addition to before, which state law already required. It would require testing for an ectopic pregnancy. 

The bill also would require doctors to estimate and document the gestational age of the pregnancy before the pill is given and to report information about the use of the pill to the state.

Purpose and late changes

Part of the screening requirement had been aimed at ensuring whether the woman’s blood type requires offering women an additional treatment to reduce the likelihood of future miscarriages. 

But Holdcroft told the Health and Human Services Committee that he introduced a white-copy amendment to remove that blood screening because medical practices have moved away from the value of that type of testing. 

He said his goal is to make sure no place acts the way he perceives some abortion clinics have, by providing abortion pills without proper oversight. The Nebraska Department of Health and Human Services investigated a clinic in Bellevue for providing abortion pills without the proper licensing, he said.

“No matter how any of us feels about the issue of abortion, we can all agree that no pregnant woman should ever be neglected or endangered by a careless abortion provider,” Holdcroft said.

Risks detailed

Abortion-rights groups and medical professionals supportive of reproductive rights said the result of the new restrictions and requirements on the use of abortion pills is aimed at reducing the ease of use.

While Nebraska law requires in-person dispensing of abortion pills, some women still obtain them online from out-of-state sources. Opponents argued that the bill’s additional restrictions could push more women toward darker corners of the internet to seek out pills, which they said would likely increase risks. 

Some also said they fear the state or federal government knowing what they were doing.

Critics of how the pill is used said the ease with which abortion pills can be obtained online makes enforcing time-tied abortion bans like Nebraska’s difficult to enforce.

They want the bill to more strictly and explicitly clarify that the pills cannot be ordered and delivered independently of a local medical provider. The law today requires pregnant patients to have an ultrasound and be administered the drug by a doctor in person.

Data incomplete

Supporters argued they cannot accurately track complications like excessive bleeding and ineffective or incomplete abortions from the abortion pills without requiring a follow-up appointment. They say they want to close the data gap on medical abortions, particularly any going untracked today. 

Nebraska law today prohibits most abortions after 12 weeks gestational age, with legal exceptions after that for the life of the mother or for rape or incest.

Voters in November passed a state constitutional amendment cementing current law as the latest an abortion could happen, banning abortions after the first trimester of pregnancy.

The way the amendment was written left room for state lawmakers to restrict abortion further, up to a full ban, so Holdcroft’s bill would be legal, if approved.

Gov. Jim Pillen and some in the administration of President Donald Trump have embraced the anti-abortion movement’s focus on tightening restrictions on medical abortions.

Some abortion opponents opposed LB 512 on Wednesday, fearing that its language might somehow codify the legality of medical abortions in Nebraska beyond the scope of the bill.

Divide among conservatives

Teresa Fondren of Abolish Abortion Nebraska said her God equates abortion with murder. She says she opposes LB 512 and all forms of abortion, including medical abortion. She said she doesn’t want to make it safer.

“This bill plainly treats abortion like health care, which can be regulated, rather than murder,” she said.

State Sen. John Fredrickson of Omaha apologized to the crowd of testifiers for the all-male HHS Committee not having at least one member who knows what it means to be pregnant.

State Sen. Merv Riepe of Ralston, a swing vote on abortion bills, questioned why the measure appeared worded broadly enough to affect more than the state’s two abortion clinics.

“Why wouldn’t you limit this piece of legislation to just abortion centers?” Riepe asked.

Holdcroft said he wrote the bill to limit the reach to abortion providers. Riepe said the language of the bill risked reaching accidentally into miscarriage care and other medical care.

Doctors who testified argued that the pills commonly prescribed for chemical abortions can be used during miscarriage care, and are sometimes prescribed for that purpose.

Holdcroft said the bill would hold no woman responsible if she does not attend the follow-up exam. It aims consequences at physicians, and Riepe said that might create liability concerns.

“What my bill does is it tries to establish a standard of care for chemical abortions,” Holdcroft said. “That’s all it is.”

Tesmer testifies

Dr. Timothy Tesmer, Nebraska’s chief medical officer, represented Pillen’s support for LB 512. He said the state would like to know more about complications.

The lack of follow-up appointments and U.S. Food and Drug Administration research on potential complications like bleeding and infection show the need for more information and data on what the drugs do to pregnant women.

He said the Nebraska Department of Health and Human Services can’t say much about the impacts of the drugs HHS says were responsible for 82% of Nebraska abortions in 2023.

Under questioning from Fredrickson about the medical safety of one drug used in medical abortions, Tesmer said, “I’d have to say it’s safe to use … in the right or proper context.” 

Marion Miner of the Nebraska Catholic Conference said the church would prefer no abortions, but they would rather see a minimum standard of care than see pregnant women die or be injured.

“You screen for ectopic pregnancy,” Miner said in his testimony. “You schedule a follow-up afterward. You report complications. It’s that simple.”

Sandy Danek, executive director of Nebraska Right to Life, said her group opposes abortion but backs LB 512 because “supporting the woman who participates in an abortion is not an approval of the procedure.”

OB-GYNs push back

Dr. Elizabeth Constance, a maternal-fetal specialist testifying for the Nebraska Medical Association, pushed back on the bill, saying it stepped the Legislature once again in between patients and the best care physicians can provide.

She said she runs a fertility clinic in Omaha and said the same medications used to terminate pregnancies can also be used to help with miscarriages and ectopic pregnancies.

“Requiring in-person follow-up does nothing to help patient safety,” Constance said. “But it does put an unnecessary and undue burden on our patients, particularly those from rural communities who may have to travel several hours.”

Constance said requiring reporting of heavy or adverse bleeding misunderstands what the drugs do, because “every single person” who uses the drug will have “heavy bleeding.”

Adelle Burk, senior manager of public affairs for Planned Parenthood North Central States, said her group opposes LB 512 because it is “unnecessary government overreach.”

Burk said there is no medical reason to require the follow-up appointment. She said the reporting process is designed to make life more difficult for clinics.

“LB 512 creates a one-size-fits-all political mandate that doesn’t consider the patient’s individual needs,” she said. 

State Sen. Ben Hansen of Blair asked Burk if her organization might be more willing to be neutral on the bill if the mandated visit and reporting requirements were tweaked.

Burk said changes could make the bill “better,” but she stopped short of saying the organization would support it.

Political motivations?

Dr. Emily Patel, an OB-GYN speaking in her personal capacity, called LB 512 a “thinly veiled attempt” to make abortion care harder for patients to obtain and more difficult for medical professionals to provide.

She said that if safety were the priority, the bill would regulate the drug for all uses, not just some. She said research shows erectile dysfunction pills are riskier and less regulated.

“Let me be clear, LB 512 will not improve patient safety or help outcomes,” she said. “It is about controlling women’s reproductive choices.”

Taylor Givens-Dunn of I Be Black Girl called LB 512 a “direct attack on reproductive autonomy” that she said could disproportionately impact people in poverty and people of color. 

“It undermines the doctor-patient relationship and disregards the expertise of medical professionals,” she said.

Bailey Joy Annenson of the League of Women Voters of Nebraska said she and her partner are deciding where and whether to have a family and that state laws like LB 512 will have an impact.

She said the risk of having fewer maternal care doctors is a very real risk for young professionals deciding where to locate and where to raise young families.

Holdcroft and Riepe agreed at the end of the hearing that they need HHS to do a better job holding wayward providers accountable. The committee took no immediate action on LB 512.