AUGUSTA — The Maine Legislature took another step toward expanding access to abortion Tuesday, with the House of Representatives approving a bill that authorizes nurse practitioners and physician assistants to perform abortions.

The 74-58 vote, largely along party lines with Republicans in opposition and Democrats in support, will now go to the state Senate, where Democrats also hold the majority, for a vote that will likely be taken later this week.

Supporters of the bill, which is also backed by Gov. Janet Mills, a Democrat, said the measure will provide women, especially those in rural Maine, with more access to abortion services without having to travel to one of 20 clinics in Maine that offer abortions. Licensed physicians offer surgical and medication abortions at clinics in Portland, Augusta and Bangor, and medication abortions up to 10 weeks gestation are available at 18 clinics where doctors connect with patients via videoconference.

Maine lawmakers moved to broaden access to abortion for the second time in one week even as states such as Kentucky, Ohio, Georgia and Alabama have approved some of the most restrictive abortion limits in years – some in an apparent attempt to trigger a challenge to the landmark 1973 Roe v. Wade Supreme Court decision that protects women’s access to abortion. Last week both houses of the Maine Legislature passed a bill that requires the state to fund abortion under its Medicaid program and obligates private insurers to include abortion among pregnancy-related benefits.

Denise Tepler, D-Topsham, one of the bill’s co-sponsors, said in a floor speech that many women support the bill because it allows them to seek abortion services from the primary health care providers with whom they already have a longstanding relationship.

“A provider who may have delivered her baby, counseled her on test results or helped her determine a course of action to improve her health,” Tepler said.  “I think we can agree that a woman should be able to seek medical care, including an abortion, from a provider she trusts and with whom she has an established relationship.”

She pointed out that leading medical groups, including the Maine Medical Association and the American College of Gynecologists and Obstetricians, support granting abortion service authorization to advanced practice clinicians.

“APCs already provide a wide range of reproductive health care procedures that are similar to or more complicated than abortion,”  Tepler said. In New England, both New Hampshire and Vermont already allow advanced practice clinicians to perform abortion services, she said.

But opponents questioned whether nurse practitioners have the necessary level of training and skill, compared to a physician.

“This bill will not ensure safe access to health care because a life is taken every time an abortion is performed,” said Rep. MaryAnne Kinney, R-Knox, who described her own experience with a miscarriage and related medical procedure performed by a doctor 11 years ago.

Kinney said she almost hemorrhaged to death during the miscarriage and procedure, and she wonders if she would have survived had she been in the care of an nurse practitioner instead of a physician. Kinney said she appreciates having access to a physician assistant for her physicals and other medical needs, but that care is often in consultation with a doctor.

Tepler and other supporters of the bill said that numerous studies have shown that there is no increased risk in abortions when an appropriately trained advanced practice clinician performs the procedure or provides a woman with abortion medication and the appropriate follow-up medical care.

“I am not inferior to an MD in any procedure in my scope of practice that I am allowed to do, in that area we are considered equally,” said Rep. Anne Perry, D-Calais, who is also a family nurse practitioner. Perry said the measure is important for women in rural Maine who have to travel long distances to obtain abortion services from a doctor.

She said state law already gave advanced practice clinicians a broad range of authority to provide medical care to their patients, including the ability to prescribe medication and perform complex procedures, with risks that are comparable to or greater than those associated with abortion.

“Maine law prohibits under the threat of criminal prosecution anyone, other than a licensed physician from providing these services,” Perry said. “In a rural state like Maine, the role of APCs is essential to a health care system.”

The vote Tuesday was praised by abortion rights advocates in Maine, who noted that the bills could be significant in a year in which the legislatures in at least two other states had passed measures adding restrictions or effectively banning abortions.

“It’s a gesture of support for each Mainer’s right to make their decisions about abortion, including seeking care from their trusted provider,” Alison Bates, a nurse practitioner with Planned Parenthood of Northern New England said in a prepared statement. “And in light of the recent bans on safe and legal abortion in other states, today’s vote is a reminder of Maine’s commitment to safe abortion care, without added or medically unnecessary burdens.”

The bill’s primary sponsor, House Speaker Sara Gideon, D-Freeport, also issued a statement supporting the vote Tuesday.

“If we increase the number of these providers in Maine, then we are making real gains towards equitable access to health care for all women who need an abortion,” Gideon said. She said Maine would join not only Vermont and New Hampshire in eliminating the physician-only restriction, but California, Montana and Oregon as well.

“Doing so in Maine will allow women to receive the care they need from a provider they trust, eliminate the financial and logistical hurdles they face today, and bring down both the health risk and financial cost,” Gideon said.

The bill will now head to the Maine Senate, where it faces additional votes.

 

 

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