A federal judge on Monday stopped a Trump administration initiative that would have required drug makers to reveal the sticker price of their drugs in television ads.

Under the rule, if a medicine’s list price was more than $35 a month, its list price would have to be stated during the commercial. The challenge opponents say is that a drug’s list price and estimates of what people can expect to pay varies widely depending on coverage.

The rule was blocked hours before it was set to take effect, the latest setback for the White House as Trump administration officials continue to search for ways to pressure pharmaceutical companies into lowering their prices — a proposal made by the Trump administration in the run up to last November’s midterm election.

The decision from U.S. District Judge Amit Mehta in Washington, D.C. ruled that the Health and Human Services Department does not have the regulatory power to make drug manufactures include the cost of drugs in television commercials.

Mehta wrote that in halting the rule, the court was not questioning its wisdom, but rests the issue on the law set by Congress in the first place.

“That policy very well could be an effective tool in halting the rising cost of prescription drugs. But no matter how vexing the problem of spiraling drug costs may be, HHS cannot do more than what Congress has authorized,” Mehta wrote.

Critics pointed out that the rule was toothless, since there was no enforcement mechanism spelled out for when a company did not comply. Instead, the rule relied on the private sector to police itself.

The television-ad rule had the support of both the Trump administration and consumer rights advocates.

That said, patient advocate groups told NPR that while holding drugmakers accountable for prices is welcome, they remained skeptical that drug companies could be shamed, as the administration intended, into lowering their prices.

Last month, groups including drug manufacturers Merck, Eli Lilly and Amgen sued the Trump administration over the rule, arguing that it would violate the companies’ free speech rights.

AARP, which represents older Americans, expressed disappointment on Monday over the court’s ruling.

“Today’s ruling is a step backward in the battle against skyrocketing drug prices and providing more information to consumers,” the group said. “Americans should be trusted to evaluate drug price information and discuss any concerns with their health care providers.”

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In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University’s Berman Institute of Bioethics, was involved in a motorcycle accident that crushed his left foot. In the months that followed, he underwent six different surgeries as doctors struggled first to save his foot and then to reconstruct it.

Rieder says that each surgery brought a new wave of pain, sometimes “searing and electrical,” other times “fiery and shocking.” Doctors tried to mitigate the pain by prescribing large doses of opioids, including morphine, fentanyl, Dilaudid, oxycodone and OxyContin. But when it came time to taper off the drugs, Rieder found it nearly impossible to get good advice from any of the clinicians who had treated him.

“We called everybody, and a bunch of them wouldn’t even talk to me,” he says. “And this includes the pain management team. They would not speak with me, and the message they sent through a nurse was, ‘We prescribe opioids but we don’t help with tapering.’ “

Rieder likens his experiences trying to get off prescription pain meds to a game of hot potato. “The patient is the potato,” he says. “Everybody had a reason to send me to somebody else.”

Eventually Rieder was able to wean himself off the drugs, but not before receiving bad advice and going through intense periods of withdrawal. He shares his insights as both a patient and a bioethicist in a new book, In Pain: A Bioethicist’s Personal Struggle With Opioids.

Interview highlights

On what happened when he tried tapering opioids after an ill-advised consultation with a plastic surgeon, who recommended abruptly reducing his dosage

He didn’t know what he was talking about; that wasn’t his area of expertise. He just tried to think of something that was reasonable — and he would eventually admit this, so this isn’t too much editorializing — but we went home and the next day we dropped the first dose and it immediately sent me into withdrawal. … It got worse over the first few days, and so we start to get really freaked out, because I feel like I’ve got the worst flu I’ve ever had multiplied by some order of magnitude. And I’m thinking, I have an entire month of this to get through. And so [my partner and I] get pretty freaked out.

On why it was so hard to find a doctor to help him taper opioids

I asked myself that question every day, every hour for a very long time. And once I transitioned from being an opioid patient to being an opioid researcher the answer I came to was something like “a lot of doctors don’t know, so this is just a knowledge gap.” So this is probably the best description of my plastic surgeon. He just had no idea how to do this. And that’s understandable, because clinicians — doctors — don’t get a lot of pain education in medical school. It’s not required — a bunch of them get zero — and, on average, you only get a handful of hours. So there’s a knowledge gap for sure.

On being sent to an addiction clinic

We called addiction clinics and they very nicely and very gently said, “Boy, you are not our job. We’re dealing with people who might die from a heroin overdose anytime they get turned away. We’re triaging here. You just took too many pain meds. You just need your prescriber to get you off them.”

On the ways in which money plays a role in opioid use

Opioids are dirt cheap, because a bunch of them have been off patent for decades, and these other sorts of therapies can be really expensive. … A lot of what I was supposed to do to help that pain was physical therapy. Physical therapy stopped getting coverage by my insurance when I turned over the new year. And I no longer hit my deductible, so it was too expensive. So I stopped. Because I was a relatively new faculty member — I couldn’t afford it. And so I keep thinking, well, surely a bunch of other people would also struggle to pay for this.

So there are all of these different methods for handling pain that they could be arrows in the quiver of medicine, but they’re hard. They get covered less. They’re expensive. And so what do we know about opioids? Well, they’re incredibly cheap. Morphine is a couple cents per dose. And they are easy. You give them to the patient, the patient feels better immediately. You give pills to a patient who comes in complaining about pain, they leave happy. So this really led me to investigate this, like, deep system of perverse incentives that have pushed us toward just prescribing opioids instead of doing something more integrative and holistic.

On how opioid dependence is treated as a medical issue, but heroin addiction is treated as a criminal issue

Now we’re all very concerned about the opioid epidemic — when there have been people of color dying from heroin disproportionately for a really long time, and we just don’t talk about it. And we treated them like criminals. That’s a travesty. It’s absolutely tragic. It’s a stain on our response to drugs in this country. My story is not the only one that matters. Stories that look like mine aren’t the only ones that matter. People take drugs for a reason. And whether you started with oxycodone or with heroin, if you were medicating something and it hurt you, and you ended up dying from overdose, your life matters. And we need to just kind of announce that loudly every time we have this conversation.

Lauren Krenzel and Seth Kelley produced and edited this interview for broadcast. Kelley, Bridget Bentz and Deborah Franklin adapted it for the Web.

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Telehealth turned Jill Hill’s life around.

The 63-year-old lives on the edge of rural Grass Valley, an old mining town in the Sierra Nevada foothills of northern California. She was devastated after her husband Dennis passed away in the fall of 2014 after a long series of medical and financial setbacks.

“I was grief-stricken and my self-esteem was down,” Hill remembers. “I didn’t care about myself. I didn’t brush my hair. I was isolated. I just kind of locked myself in the bedroom.”

Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.

Then, Brandy Hartsgrove called to say Hill was eligible via MediCal (California’s version of Medicaid) for a program that could offer her 30-minute video counseling sessions twice a week. The sessions would be via a computer screen with a therapist who was hundreds of miles south, in San Diego.

Hartsgrove co-ordinates telehealth for the Chapa-de Indian Health Clinic, which is a 10-minute drive from Hills’s home. Hill would sit in a comfy chair facing a screen in a small private room, Hartsgrove explained, to see and talk with her counselor in an otherwise traditional therapy session.

Hill thought it sounded “a bit impersonal;” but was desperate for the counseling. She agreed to give it a try.

Coordinator Brandy Hartsgrove demonstrates how the telehealth connection works at The Chapa-de Indian Health Clinic in Grass Valley, Calif. Via this video screen, patients can consult doctors hundreds of miles away.

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Salgu Wissmath for NPR

Hill is one of a growing number of Americans turning to telehealth appointments with medical providers in the wake of widespread hospital closings in remote communities, and a shortage of local primary care doctors, specialists and other providers.

Long-distance doctor-to-doctor consultations via video also fall under the “telehealth” or “telemedicine” rubric.

A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.

Don’t see the graphic above? Click here.

Those survey findings are part of the second of two recent polls on rural life and health conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

The Chapa-de clinic offers telehealth services not only for consultations in behavioral health and psychiatry, but also in cardiology, nephrology, dermatology, endocrinology, gastroenterology and more.

The Chapa-de Indian Health Clinic in Grass Valley, Calif., offers telehealth services for various specialties, including dermatology, gastroenterology and psychiatry.

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Salgu Wissmath for NPR

Hill feels fortunate; she knows most rural health facilities don’t include telehealth services, which means most patients living in remote areas would need their own broadband internet access at home to get therapy online.

And that’s out of reach for many, says Robert J. Blendon, co-director of NPR’s poll and professor of health policy and political analysis at the Harvard Chan School.

The poll found that one in five rural Americans say getting access to high-speed internet is a problem for their families.

Blendon says advances in online technology have brought a “revolution” in healthcare that has left many rural patients behind.

“They lose the ability to contact their physicians, fill prescriptions and get follow-up information without having to go see a health professional,” he says.

Critical care pediatrician James Marcin at UC Davis Children’s Hospital, directs the University of California, Davis, Center for Health and Technology and regularly consults via a telehealth monitor with primary care doctors in remote hospitals in rural areas.

“We’re able to put the telemedicine cart [virtually] at the patient’s bedside,” Marcin says, “and within minutes our physicians are able to see the child and talk with the family members and help assist in the care that way.”

If not for telehealth, Marcin says, the costs of getting what should be routine care “are significant barriers for those living in rural communities.”

“We have patients that drive to our Sacramento offices and they have to drive the night before,” he says, “and spend the night in a hotel because it’s a five-hour trip each way.” And there are additional costs for many patients, he says, such as childcare services, and missed days of work.

With telehealth, “a video is truly worth a thousand words,” he says; it can mean patients don’t have to make costly time-consuming trips to see a specialist.

Though Hill initially had reservations about meeting with a therapist online, she says she’s been amazed by how helpful the sessions have been.

“She gives me assignments and works me really hard,” Hill says, “and I have grown so much — especially just in the last few months.”

Her latest assignment in therapy: writing down positive characteristics of herself. Initially, she could only come up with three: loyalty, compassion and resilience. But the therapist questioned that, and encouraged Hill to consider that there might be more.

Hill says she’s in a ‘super growth” mode these days psychologically, and says the support she’s received in therapy has been key to that. She speaks with a clinical psychologist via a telehealth session twice a week for 30 minutes, and completes assigned homework in between those appointments.

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Salgu Wissmath for NPR

“She wanted 10,” says Hill, who proceeded to work through some other issues and talk more with therapist. “Now I’ve got like 15 at least,” Hill says, “and I keep adding to the list; once I started writing things down, I started really seeing that I have a lot of strengths I didn’t even know I had.”

Attorney Mei Kwong, executive director of the Center for Connected Health Policy in Sacramento, says telehealth services have the potential to remove many barriers to good health care in rural America.

But policies that regulate which telehealth services get paid for “lag way behind the technology,” Kwong says. Many policies are 10 to 15 years behind what the technology is able to do, she says.

For example, high-resolution photos can now be taken – and sent anywhere digitally — of skin conditions that many doctors say are better than “the naked eye looking at the condition,” she says. But the policies on the books of what Medicare, Medicaid and private insurers will pay for often means these services are not fully covered.

That’s unfortunate, Kwong says, especially for underserved communities where there is a shortage of specialists.

Changes are starting to be made in state, federal and private insurance policies, Kwong says. But it’s “slow going.”

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When Mary Kay Gilbert saw her doctor in May for a skin infection on her leg, she wasn’t surprised to receive a prescription for an antibiotic cream.

But Gilbert, 54, a nurse and health consultant, was shocked when her physician clicked on the desktop computer and told Gilbert the medicine would cost $30 on her Blue Cross and Blue Shield plan.

“I was like, ‘Wow — that’s pretty cool that you know that information,’ ” she recalled telling the doctor in Edina, Minn.

Allina Health, the large Minnesota-based hospital network Gilbert’s doctor belongs to, is one of a growing number of health systems and insurers providing real-time drug pricing information to physicians so they can help patients avoid “sticker shock” at the pharmacy.

The pricing tool, which is embedded in each participating physician’s electronic health records and prescribing system, shows how much patients can expect to pay out-of-pocket, based on their insurance and the pharmacy they choose.

It also allows the doctor to find a cheaper alternative, when possible, and start the process of getting authorization for a drug, if the insurer requires that.

The soaring cost of drugs has been front and center in the growing national debate about revamping U.S. health care.

Patients abandon hundreds of thousands of prescriptions each year at the pharmacy, often because of high prices. Studies show that can jeopardize their health and often lead to higher costs down the road.

Such a tool can help consumers — many of whom are also facing increasing copayments and higher deductibles — learn about cheaper options in the doctor’s office.

Still, doctors have been slow to adopt the technology, sometimes because of concerns about getting bogged down in long discussions about drug costs. Humana, for example, introduced its drug pricing tool to its network of doctors in 2015. Today, fewer than 10% are using it, according to Humana officials.

These sorts of pricing tools do have serious limitations. Because price negotiations among insurers, drugmakers and middlemen are often highly competitive and secretive, the tools often don’t have useful data for every patient.

For example, Allina’s works for only about half its patients. The company says that’s because not all pharmacy benefit managers share their data on health plan enrollee costs, and those that do often provide only a fraction of their information.

“It’s a chicken-and-egg thing where doctors don’t use it because they don’t have the data for all their patients, and health plans don’t promote it to physicians because doctors don’t have the technology in place,” says Anthony Schueth, a health information technology consultant in Jacksonville, Fla. “It can be a powerful tool when it works, but at the moment the drivers are not there across the board for widespread adoption.”

At a hearing last month, Sen. Martha McSally, R-Ariz, pressed a top Trump administration health official about why many patients lack access to information on prescription drug prices at their doctor’s office.

“This is America. Why can’t we have this tool available tool now?” she asked. “The data is out there; the information is out there. What is it going to take to make this happen?”

The technology got a boost last month when the Centers for Medicare & Medicaid Services mandated that all Medicare drug plans embed such a tool in their doctors’ electronic prescribing system starting in 2021.

The details of what consumers spend out-of-pocket for drugs is provided by pharmacy benefit managers, or PBMs. They are the middlemen that negotiate with drugmakers on the prices insurers will pay for the medications and which ones the insurers will cover. So a tool’s usefulness is undermined when key PBMs are not included in the listings.

For example, a drug pricing tool sold by Surescripts, which is owned partly by the PBMs CVS Caremark and Express Scripts, includes data from those companies, but not from OptumRx, a PBM owned by insurance titan UnitedHealth. And the OptumRX drug pricing tool includes Optum data but not that of Express Scripts and CVS.

Demetrios Kouzoukas, who heads the Medicare program for CMS, says he hopes the program’s new drug mandate will spark the industry to provide doctors and patients access to a standard pricing tool, regardless of their insurance.

“What we are hoping and expecting is that there will be a standard that’s developed by the industry … so that the tool is available in all the electronic health records, for all the doctors and all patients, and spreads even beyond Medicare,” he told McSally at the hearing.

But cooperation does not seem to be on the horizon, some health industry officials say.

“I don’t see any chance that there will be a centralized system that will connect all of the plans/PBMs with all of the EHR systems currently in use anytime soon,” says Thomas Borzilleri, CEO of InteliSys Health, a health technology company based in San Diego.

Still, the National Council for Prescription Drug Programs, a nonprofit group that helps set guidelines for the pharmacy industry, has been working on standards for a drug pricing tool. John Klimek, a senior vice president of the nonprofit, predicts that by next year doctors across the country will be able to use the same drug pricing tool to look up all their patients’ drug costs, regardless of the insurer.

Even without such a standard in place, doctors and hospitals have an incentive to use the tool that goes beyond saving their patients money: Such a tool can be good for a provider’s wallet, too.

For example, Allina, which owns or operates about a dozen hospitals and dozens of clinics in Minnesota and Wisconsin, gets a set fee from some insurers to care for all of a patient’s health needs. So the doctors and health system all benefit when they can reduce costs and improve patients’ adherence to taking their medication, says Dr. David Ingham, a family doctor also from Edina. He’s one of 600 primary care doctors at Allina using the tool.

“When we prescribe a more expensive medication, we share less revenue from the insurance contract,” he says.

For example, he notes that the tool helped him prescribe inhalers to asthma patients.

“I pulled up one medication I normally use, and it said it would be $240 out-of-pocket, but it suggested an alternative for $20 that was pharmacologically equivalent,” Ingham says. “I sheepishly asked the patient which we should choose.”

Dr. Norman Rosen, a family physician in Orange, Calif., who is employed by Providence St. Joseph Health System, is one of 800 doctors who are testing the Blue Shield of California drug pricing tool this year. Based on the first few months of use, the tool is expected to save patients more than $100,000 in out-of-pocket costs this year, according to the companies.

Without the tool, Rosen says, it would be impossible for him to quickly know what drugs are covered by which insurers and what the copays are. He says he already has saved some patients several thousand dollars a year by changing their blood pressure and diabetes medications.

“It doesn’t take a lot of time, and this can be an important intervention,” Rosen says.

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

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This article was produced in partnership with MLK50, which is a member of the ProPublica Local Reporting Network.

Methodist Le Bonheur Healthcare, the largest hospital system in Memphis, Tenn., said it has suspended “court collection activities” over unpaid medical bills — just days after an investigation by MLK50 and ProPublica (which also appeared on NPR) detailed its relentless pursuit of debts held by poor people and even its own employees.

“We recognize that we serve a diverse community and we are always thinking about how we can do more and serve our community better,” Methodist said in a written statement. “Over the next 30 days we will be reviewing our policies and procedures to ensure we are doing everything possible to provide the communities we serve with the care and assistance they need. Also, we will immediately suspend any further court collection activities during this period.

“As a learning organization that is committed to continuous quality improvement, we want to be absolutely sure that our practices continue to support our mission and vision of improving every life we touch regardless of ability to pay.”

Methodist dropped more than two dozen cases that were set for initial hearings on Wednesday’s morning docket at Shelby County General Sessions Court.

“Currently, Methodist is in the process of reviewing its collection processes,” R. Alan Pritchard, one of Methodist’s attorneys, told General Sessions Court Judge Deborah M. Henderson.

“You are free to leave,” Henderson told one defendant, who looked puzzled, a purse on her shoulder and a folder full of papers in her hand.

Henderson called the names of other defendants whose cases were on the docket.

Again and again, Pritchard said: “Dropped, please, your honor.”

One of the defendants whose case was dropped is Adrien Johnson, who works for the city of Memphis. Methodist sued him this year for an unpaid hospital bill of more than $900.

Reached by phone, Johnson said he believes the hospital bill was for X-rays he had taken while he was covered by his wife’s insurance. Wednesday was his first court date, and after the hearing, he said he wasn’t clear what the status of his debt was.

“I don’t know what they’re doing,” he said. “I need to find out what’s going on.”

From 2014 through 2018, the hospital system affiliated with the United Methodist Church filed more than 8,300 lawsuits, according to an MLK50-ProPublica analysis of Shelby County General Sessions Court records. That’s more than all but one creditor during that five-year period.

One story by the news organizations chronicled the struggle of Carrie Barrett, who makes $9.05 an hour at Kroger, to pay her 2007 hospital bill for $12,019. The bill has ballooned to more than $33,000 due to interest and attorney’s fees.

Another story detailed how Methodist sues its own employees, some of whom make less than $13 an hour, for unpaid bills related to care delivered at its hospitals. Its health plan doesn’t allow workers to seek care at hospitals with more generous financial assistance policies.

Defendants talked about how the lawsuits upended their lives and left them in a position where they would never be able to pay off their debts, which grew from year to year as interest mounted.

With $2.1 billion in revenue and a health system that includes six hospitals, Methodist leads the market: In 2017, it had the most discharges per year and profits per patient, according to publicly available data analyzed by Definitive Healthcare, an analytics company.

Methodist says it has “a hospital in all four quadrants of the greater Memphis area, unparalleled by any other healthcare provider in our region,” plus more than 150 outpatient centers, clinics and physician practices. The system also said it provides community benefits of more than $226 million annually.

The number of lawsuits Methodist files isn’t out of proportion to its size, at least compared to competitor Baptist Memorial Health Care and Regional One Health, the county’s public hospital. But Methodist stands out in other respects.

Its financial assistance policy, unlike those of many of its peers around the country, all but ignores patients with any form of health insurance, no matter their out-of-pocket costs. If they are unable to afford their bills, patients then face what experts say is rare: A licensed collection agency owned by the hospital.

Also, after the hospital sues and wins a judgment, it repeatedly tries to garnish patients’ wages, which it does in a far higher share of cases than other nonprofit hospitals in Memphis. A court-ordered garnishment requires that the debtor’s employer send to the court 25% of a worker’s after-tax income, minus basic living expenses and a tiny deduction for children under age 15.

Methodist secured garnishment orders in 46% of cases filed from 2014 through 2018, compared with 36% at Regional One and 20% at Baptist, according to an analysis of court records by MLK50.

Methodist’s announcement was welcomed by some local lawmakers.

“Methodist has been such a great community partner throughout Shelby County that I’m glad to hear they’re reviewing their process over the next 30 days,” said Shelby County Commissioner Mickell Lowery, whose district includes Methodist University Hospital.

U.S. Rep. Steve Cohen, D-Tenn., said: “I was surprised to read about Methodist Le Bonheur’s billing practices, and I’m glad that the company is re-examining them. … I will continue to monitor this situation and look forward to the company’s assessment.”

But the Rev. Anthony Anderson, a United Methodist elder at Faith United Methodist in Memphis, was more reserved.

“I am still heartbroken, and I say that spiritually,” Anderson said. “It breaks my heart to know that a Methodist-related entity, a hospital, would have these types of practices.”

He welcomed the policy review, but only if it leads to the complete erasure of all outstanding patient debt.

“This debt needs to be wiped away,” Anderson said. “That will be the direction I will be pushing towards as a Methodist — that we don’t burden families with these type of financial penalties.”

New data obtained from Shelby County General Sessions Court shows that Methodist has filed more than 600 new lawsuits this year. Its most recent suits were filed on June 21, days before the MLK50-ProPublica stories were published. Its most recent garnishment order was filed on Tuesday.

Wendi C. Thomas is the editor of MLK50: Justice Through Journalism. Email her at wendicthomas@mlk50.com and follow her on Twitter at @wendicthomas.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

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While abortion bans in Republican-led states dominated headlines in recent weeks, a handful of other states have passed laws to expand abortion access. Maine joined those ranks in June with two new laws — one requires all insurance and Medicaid to cover the procedure and the other allows physician assistants and nurses with advanced training to perform it.

With these laws, Maine joins New York, Illinois, Rhode Island and Vermont as states that are trying to shore up the right to abortion in advance of an expected U.S. Supreme Court challenge. But what sets Maine apart from the other states is how recently Democrats have taken power.

“Elections matter,” says Nicole Clegg of Planned Parenthood of Northern New England. “In 2018, we saw the largest number of women get elected to our legislature. We saw an overwhelming majority of elected officials who support reproductive rights and access to reproductive health care.”

The dramatic political change also saw Maine elect its first female governor, Janet Mills, a Democrat who took over from Paul LePage, a Tea Party stalwart who served two terms. LePage had blocked Medicaid expansion in the state even after voters approved it in a referendum.

Clegg and other supporters of abortion rights have hailed the new abortion legislation as a big win.

“It will be the single most important event since Roe v. Wade in the state of Maine,” Clegg says.

Taken together, the intent of the two laws is to make it easier for women to afford and find abortion care in the rural state.

Nurse practitioners like Julie Jenkins, who works in a small coastal town, say that increasing the number of abortion providers will make it easier for patients who now have to travel long distances in Maine to get the procedure from a doctor.

“Five hours to get to a provider and back — that’s not unheard of,” Jenkins says.

Under the law set to go into effect in September, physician assistants and nurses with advanced training will be able to perform a surgical form of the procedure known as an aspiration abortion. These clinicians already are allowed to use the same technique in other circumstances, such as when a woman has a miscarriage.

Maine’s other new law will require all insurance plans — including Medicaid — to cover abortions and is supposed to be implemented early next year. Kate Brogan of Maine Family Planning says this legislation is a workaround for dealing with the U.S. law known as the Hyde Amendment, which prohibits federal funding for abortions except in extreme circumstances.

“That is a policy decision that we think coerces women into continuing pregnancies that they don’t want to continue,” Brogan says. “Because if you continue your pregnancy, Medicaid will cover it. But if you want to end your pregnancy, you have to come up with the money [to pay for an abortion].”

State dollars, not federal, will pay for the abortions performed through Maine’s Medicaid program (in general, Medicaid is funded by both state and federal tax dollars).

Though the bill passed in the Democratic-controlled Legislature, it faced staunch opposition from Republicans, including state Sen. Lisa Keim, during floor debates.

“Maine people should not be forced to have their hard-earned tax dollars [used] to take the life of a living pre-born child,” Keim says.

Instead, Keim argues, abortions for low-income women should be funded by supporters who wish to donate money. Otherwise, she said during the debate, the religious convictions of abortion opponents are at risk.

“Our decision today cannot be to strip the religious liberty of Maine people through taxation,” Keim says.

Rep. Beth O’Connor, a Republican who says she personally opposes abortion but believes women should have a choice, says she had safety concerns about letting clinicians who are not doctors provide abortions.

“I think this is very risky, and I think it puts the woman’s health at risk,” O’Connor says.

In contrast, advanced-practice clinicians say the legislation merely allows them to operate to the full scope of their expertise and expands patients’ access to important health procedures. The measure also has the backing of physician groups, including the Maine Medical Association.

Just as state laws restricting abortion are being challenged, so are Maine’s new laws. Days after Maine’s law regarding Medicaid and abortion passed, organizations that oppose abortion rights announced they would mount an effort to put the issue on the ballot for a people’s veto.

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