Transcripts For CSPAN3 Hearing 20240703

Is just under two hours. Senator whitehouse good morning. I call this committee to order. We have multiple committees on which we serve in the senate and from time to time its important to go check in at another committee to get in the queue properly and so senator grassley will be along. Ill make my opening statement, yield to him and then ill introduce the first three witnesses. Senator grassley will introduce a witness, senator lee will introduce a witness and then well proceed. We are here today to discuss womens rights, their right to bodily autonomy. Their right to set the course of their own life. And their right to economic freedom. I hear often that the Budget Committee should only be concerned with debt and deficits but any serious conversation about debt and deficits must also analyze threats to Economic Growth and stability. Debt and deficits do not occur in a vacuum. Welcome. The result from the they result from the fiscal decisions that we make and from what we do that strengthens or that weakens our economy. Reproductive rights, it turns out, are intrinsically tied to eeconomic opportunity. Reproductive justice is Economic Justice. Restricting one, restricts the other. As professor myers, the leading economist in this space will testify today, we can measure the economic harms from dismantling roe v. Wade, especially in already marginalized communities. The Dobbs Decision triggered an immediate crisis for millions of women as antiquated state bans snapped back into place, and some states implemented new restrictions on reproductive freedom. Our witnesses, Hallie Phillips and dr. Spun, will explain how the draconian state laws put patients, their families and physicians into heartbreaking situations. About 25 million women of reproductive age live in states with severe restrictions on abortion. Most in states that failed to expand medicaid and already had higher rates of maternal death. Black women are disproportionately affected as many li in Southern States with the worst reinstructive policies, with existing structural barriers to care, and with alreadyhigh rates of pregnancy related complication and death. Dr. S, too doctors, too, lose their freedom to Practice Medicine as they are trained, delivering patientcentered, evidencebased care. I hear from rhode island ob gyns about their colleagues in other states being put in impossible positions. With the lives of women and babies but in jeopardy. For a great many reasons, often deeply personal and harrowing, one in four women seek an abortion before age 45. One in four. That freedom to decide if and when to have a child affects a womans life trajectory and her familys Financial Security. At the pivotal as the pivotal turn away study found, women who were forced to carry a pregnancy to term were four times more likely to li in poverty. The reverse holds true too. Reproductive freedom and choice including abortions and contraception lowered Maternal Mortality, increases womens earnings, increases the probably that women attend college, and boosts local economists. Local economies. Freedom turns out to have economic value. In planned parenthood v. Casey, these economic values were part of he courts holding. The court said, the ability of women to participate equally in the economic and social life of the nation have been facilitated by their ability to control their reproductive lives. Economists and researchers have since quantified the damage of state abortion restrictions to local and state economies. And the correlation is easy. The more extreme a states restrictions, the more its economy suffers. A new study estimates that state abortion restrictions cost the National Economy on average 173 billion per year. Inover turning roe and casey, a small rightwing majority of a captured Supreme Court inserted the government into the personal life decisions of millions of women. Removing that freedom, never minding those consequences. This is a court with members on a mission. Next may be the ability to take mifepr sirvetion tone a 15eu6 and effective medication. Next could come the right to take contraception. Even in vote roe fertilization is under the gun. If reelected, trump could abuse executive power to remove mifepristone from markets or try to prevent abortion medications or contraceptives from going through the federal mail. The republican effort to ban mail order medication could cause even larger economic damage than dobbs. Generations of women fought for the freedom to make their own personal decisions, they fought and they won. And their victory brought economic gains in which we all share. But now, extremists are trying to to undo it all, leaving young women and girls in america with fewer rights than their grandmothers. Women and girls have lives worth respecting and protecting and no one should be forced to carry a pregnancy to term against their will. Stripping women of this freedom casts a long shadow over their lives, and over their families lives, and it costs a long shadow over our economy as well. Congress should safeguard access to abortion and contraception and codify roe into law. This is something women should decide, its just not the governments business. I will now turn it over to Ranking Member grassley. Senator grassley good morning, mr. Chairman. Im sorry i missed the last three hearings because i couldnt be here. Senator whitehouse its great to have you back, to be healthy enough to be back and participate in hearings again. Senator grassley we are tackling a very serious topic this morning. Abortion above all. Is a moral and legal issue. Abortion is not an issue that lends itself to being looked at solely through an economic lens. After all, life is priceless. Theres a reason this committee historically hasnt delved into this issue. Its not an issue easily distilled down to dollars and cents. Typical of budget issues that this committee normally works on. In fact, it is rather dehumanizing. The chinese communists are the best example of this, when they instituted the one child policy. Targeting female babies to external nation. And they did this thinking it would help their economy. But look what happened. Now the chinese realize its backfiring and hurting the economy. I think right now we just saw statistics, there are no longer theyre no longer the largest population country in the world, being supplanted by india. Look at western nations like our own. Were also realizing we need more people to sustain the economy, and protect social security. I guess thats one reason that were the most immigrant welcoming nation by taking one Million People legally every year into our country. So yes, having and raising children has costs. But so does abortion on demand and the culture that lacks respect for life. That said, here we are. Im prolife. Profamily. Prowoman. These views are not in conflict. Were the alternatives to abortion where the alternatives to abortion exist in all but the rarest circumstances. Numerous programs at the federal, state and local levels are available to help women, children, and families in need. To better assist families, congress should focus on reforms that increase coordination between all the federal programs we have. Congress should simplify access to these programs. It should reduce duplications, promote work, or education. And eliminate marriage penalties in our tax laws. For years, ive been championing supporting moms and kids. Ive worked to support, improve our adoption and foster care systems. Ive long been a strong supporter of taxes and laws to promote adoption and reduce Financial Burdens associated with adopting a child. As thenchairman of the tax writing finance committee, now 20 years ago, i helped shepherd the bipartisan tax relief package that included muchneeded updates on the adoption tax credit. Additionally im a member of the Congressional Coalition on adoption and founder and cochair of the Senate Caucus on foster youth and have worked for years to improve policies and support for those who open their hearts and homes to children in need. Im also an advocate of the maternal infant and Early Childhood Home Visiting program, which serves many mothers and children across iowa and other states. Its critical we support the most vulnerable in our society and this program has been a successful tool to improve though life of atrisk families. This congress ive introduced the bipartisan healthy moms and babies act with senator maggie hasan. The bill is a culmination of my work as finance Committee Chairman where i solicit ideas from senators and stake holders including Iowa Health Care providers on ways to improve maternal childcare. The public is debate manage abortion issues following the Supreme Court Dobbs Decision. Today this committee will hear from two witnesses who can tell us about the types of programs supporting pregnant women and families. We all will also hear how folks on our local communities stand up by their neighbors to let them know that they arent alone and coco and do have options. Thats the type of message everyone can get behind. Thank you, mr. Chairman. I thank the witnesses, all of our witnesses, for appearing today. Senator whitehouse thank you, senator grassley, and again, welcome back. Our first witness today, professor Caitlyn Myers of middleberry college. Shes an applied microeconomist who uses statistical methodologies to measure the causal effects of reproductive policies on demographic, health, and economic outcomes. Her work has been published in leading journals in economics and public policy. She maintains and distributes data on Abortion Access to researchers and the public through the Abortion Access dashboard and open science framework. Professor myers, thank you for being here. Next well hear from dr. Lela zahadi spung, a Board Certified ob gyn and maternal fetal medicine fa six in colorado. She received her bachelors degree in biology and psychologist from the university of georgia and medical degree from emery university. She serves as a member of the smfm Reproductive Health committee and member of the Education Committee through the society for Family Planning. Welcome. Then well hear from mrs. Allie fail lips. Shes a lifelong tennessean, a mother, and an activist. She shared her heartbreaking abortion story online and Drew International attention. Turning her pain into passion shes dead kayed her time to speaking out and fighting back. Mrs. Phillips, we appreciate you very much taking the time to join us. I will now turn to senator lee and Ranking Member grassley to introduce their witnesses. Senator grassley i have the privilege of introducing an iowan from story county, iowa. Ms. Tamara call. M. S. N. And r. N. Shes a shes executive director of a Medical Clinic in ames, iowa. Its a fully licensed Community Care clinic that provides professional medical Services Including consultations, well women care, pregnancy testing, ultrasound, Health Education referrals. Obira employees board sert did certified ob gyn physicians, registered nurses, nurse paradecisioners, medical assistants and support staff. She holds a bachelors degree in nursing and masters degree in Public Health nursing from the university of kansas. Im also pleased to welcome ms. Calls daughter to our hearing as well. Thank you both for being here. Senator lee thank you, mr. Chairman, Ranking Member grassley. Its an honor and privilege to introduce my friend leslie ford as one of our witnesses today. Leslie is an adjunct fellow at the American Enterprise Institutes Center for opportunity and social mobility. And shes also the president of an entity called ford policy solutions. And member of the state of virginias department of social Services State board of social services which is authorized to adopt and recommend policy solutions on various social programs within the commonwealth of virginia. Shes personally served in the white house as a domestic policy adviser. And a special assistant to the president from 2018 to 2020 working on reforms to social safety net programs and also the administrations antipoverty agenda. But most importantly, it is a great opportunity for me to endorse to introduce her, and endorse her, because shes a former member of my staff. Shes served as policy adviser in my office where she oversaw the policy portfolio on Health Education, labor and pensions and work on the development of a whole lot of health and social safety policy bills and amendments, helped put together Ground Breaking legislation in a number of areas including education reform, welfare reform, just to name a few. Shes of course moved on and become a thought leader and someone who has contributed to meaningful and prudent welfare reforms and antipoverty measures. I look forward to hearing from all our witnesses, but especially ms. Fords. Senator whitehouse thank you very much. Professor myers, please proceed. Thank you for the opportunity to testify today. Im the john g. Mccullough professor of economics. I study the effects of contraception and abortion on economics. Im not here as an activist. Im presenting facts on the ways in which reproductive policy is economic policy. Women make up half the of the labor force. Their introduction into the work force has boosted the economy by 40 . The decision of whether or when to become a mother is the single largest economic decision of their life. Men and womens earnings track mostly right up through parenthood. But then there is a gap. Even after the kids grow up and leave home. It is exacerbated by the lack of paid family leave and high cost of child care. Of course none of this implies that women, men and society dont benefit greatly from children. Im a mother of four. And for a time in my life i was the widowed single mother of preschool aged children. I have no doubt motherhood reduced my own economic productivity. Im also sure its entirely worth it for me and a decision id make again. But thats the point. The tradeoffs and decisions about whether and when to become a parent are inherently personal and closely tied to our economic lives. And even the best laid plans of mice and men and lets add women can go awry. Abortion is a common Reproductive Health care need. Before dobbs, nearly one million pregnancies ebbed in abortion each year. Thats about 20 of all estimated pregnancies. At that rate, a quarter of women will obtain an abortion in their lifetime and when they do, women are often in precarious and vulnerable situations. Most are young mothers. Nearly three quarters are lowincome. More than half report a disruptive life event like loss of a job or housing instability. The most frequent reason women cite for seeking an abortion relate to their finances, aspirations and ability to care for other children. This brings me to a key point. Access to contraception and abortion empowers women to plan their economic futures. Expansions in reproductive autonomy have gone hand in hand with womens economic progress. The enter ducks of the Birth Control pill in 1960 followed by the legalization of abortion in the early 1970s accompanied a period of social and economic change marked by women gaining greater education, strengthening attachments to the labor pors, entering new occupations and increasing their earnings. We all know that correlation isnt necessarily causation but in this case it is. Ample evidence from multiple Research Teams uses tools that isolate and measure the effects of reproductive autonomy. The legalization of abortion rewrote womens lives. It reduced teen motherhood by one third and reduced teen marriages by one fifth. It reduced the Maternal Mortality of black women by 30 to 50 . It allowed women to compete their education and increase their earnings. And in doing so it improved the lives of children, reducing the numbers living in poverty and numbers experiencing abuse or neglect. As they grew into adulthood these children themselves had higher rates of college graijuation, lower rates of single parenthood. Its notas though the salience of Abortion Access has gone away. One study finds as a result of being denied a wanted abortion, women experience a 78 increase in past due debts and a 71 increase in negative credit reporting. States enacting abortion bans have affected a quarter of women. The arch affected woman faces a journey of more than 300 miles one way. If any of my kids needed health care 300 miles away id have them there tomorrow but not everyone is in such a privileged position. I know many people coming up with the money, child care and multiple days off work is just not possible. You dont need to rely on anecdotes. The data tell us that nearly a quarter of people in ban states seeking abortions do not find a way to obtain one. This is especially true for young people and people of color. And even those who can make the trip, poims have been restricted. The first set of bans have ruled this 20,000 births that would not have occurred absent state bans. These children were likely born into some of the poorest and most economically Fragile Families many of which contain other childrens as well. Right now dobbs is a life story. If Abortion Access were further restricted if congress were to enact a national ban, wed begin to play the 1970s in reverse, watching a reduction in womens capacity to fully participate in the nations economy. To conclude, however one feels about the ethics of making contraception and abortion aborn accessible, theres no denying the policies affect the economic lives of women and their families. Reproductive autonomy is linked to economic opportunity. Senator whitehouse thank you. Doctor . Good morning, chairman whielthouse, Ranking Member grassley and december distinguished members of the committee. I am a Board Certified fellowship trained obstetrician gynecologist, maternal fetal medicine and complex Family Planning physician. I perform genetic testing, perform deliveries and provide abortion care. Im here today as a fellow with Reproductive Health. Im also a fellow with the American College of obstetrics and gynologist. Im a brown woman who passes as white. A first generation wildchild of imgrants. I grew up in the southeast and cared for that community in the majority of my career. I became a doctor because of my commitment to care for people without judgment throughout the course of their lives. Whether im caring for someone who is ready to build a family, already parenting, grieving a loss or caring for someone who does not want to be pregnant. All of my patients have something in common. Theyre making thoughtful decisions about their health and well being and deserve High Quality Health Care regardless of who they are and where they live. I want to be clear today that abortion is lifesave, necessary, Compassionate Health care and should be available throughout preagen in nancy. I have had the honor of caring for a number of families who needed abortion for a number of reasons, all of them medically necessary. I walked that journey with them and they were thankful to be able to access abortion care in their community. Ive heard from these families later that theyve had pregnancies that led to healthy babies at the right time in their lives. Unfortunately, the Dobbs Decision wreaked havoc on the lives of people seeking care and the physicians who are doing their best to care for their communities. This is also true for myself and maymy family. After finishing my fellowship at Washington University in st. Louis i moved back to the south. I found i was the only physician able to perform abortion care. I was caring for miscarriages and devastating circumstances for my entire community. Following the courts decision, tennessees abortion ban went into effect. This ban did not have any exceptions. Not even for lifethreatening more thans and imposed severe criminal penalties. It became very clear quickly that i could no longer provide the care that my patients needed and deserved without facing significant risks to myself and my family. In one of the hardest decisions i have ever had to make, my family and i decided to move quuns ben, to colorado. The reality is im not alone. Many providers have been forced to shift care or services they provide, relocate or cease offering care altogether. As a physician in colorado, i am seeing firsthand the consequences of this moment and they are farreaching. Im able to provide care based on patients and i decide together is safest and healthiest for their lives without political interference but so many patients who travel to us dont have that option at home. As states continue to ban abortion, patients are having to travel farther and farther distances from their homes and communities. Not only for their abortion care but for all types of while aepl grateful to care for these people who made it to us, you cant help but think of all the people we know who have been forced to remain pregnant and dont have the means and resources to pay for the travel, childcare, additional time off from work, or keep up with the increased costs as they are pushed later into pregnancy. We know from precent data that already thousands of people have been forced to remain pregnant since the Dobbs Decision. This is dangerous given for the mortality in our country and especially for people of color. We know the consequences of people denied abortion, even before the Supreme Court decision it was difficult for many people to access this care. People who are denied abortion fall into poverty, increase their debt, and have worse Financial Security for years following their abortion denial. Inability to access abortion care have severe consequences. And this is especially true for black and indigenous people. We cannot forget how collective Economic Security benefits all of us and abortion care restrictions harm our communities as a whole. Despite these threats, i am unwavering in my commitment to support people in my home and community in whatever way i can. It shouldnt be this way. People should be able to get care in their own communities in a manner best for them with the people they trust. I urge you to listen to the stories being told today by people who provide and access abortion care. I help this helps you understand that abortion care is not an isolated political issue. And how access harm all of us and the people we love. Thank you for having me. Chair whitehouse thank you very much, dr. Mrs. Phillips, please proceed. Mrs. Phillips chairman white house, ranking minority member grassley, members of the subject committee. Thank you for inviting me here today. Imally phillips and live in clarksville, tennessee. My husband works for a Forklift Company and i run a stphaul daycare out of our home. Together we are raising my 6yearold daughter. We are not a wealthy family. We work hard to pay our bills on time each month. I spent the first several years of her life as a sing many mom working three jobs while also finishing up my bachelors degree. Brian and i were excited to learn i was pregnant in the fall of 2022. Even more thrilled to find out that we were having a little girl. Miley rose. Everything was going perfectly until the day of my routine anatomy scan. At 19 weeks, when my doctor told us that they have found multiple concerning fetal issues. Several days later, as i waited to meet with the fetal specialist, i had no way of knowing the next 10 minutes would change my life forever. The fetal specialist came in to go over the results, and that list was extensive. Mileys kidneys, bladder, and stomach were not functioning. Only two of the four chambers in her heart were not working. There was no amniotic fluid protecting her, she had a rare brain condition. Her growth was a month behind. And she had no lung development. We were told that miley was not compatible with life. Completely broken i asked, what do we do now . The doctor suggested i had two options. I could terminate the pregnancy, but due to tennessees ban on abortion i would have to travel out of state for that health care. My second option would be to continue my pregnancy, but risk a miscarriage, still birth, or giving birth for her to be put right into hospice care. And then the doctor warned that the longer i stayed pregnant, the worse mileys condition would get, and the more atrisk my health would become. Knowing i had a daughter and a family to live for, we made the difficult decision to seek an abortion. So instead of tkpwraoefbg this devastating news grieving this devastating news, my mother and i began researching clinics for states that allowed abortions after 20 weeks. Many did not have open appointments for weeks, and the longer i waited, the more extensive and expensive the procedure became. Ultimately i found a clinic in new york city that could get me in the following week. Then i had to book flights, find a hotel, arrange ground transportation, and childcare for my daughter. We had to quickly figure out how to afford all of it. We didnt have thousands of dollars sitting in our bank account. I had to start a go fund me effort online to help cover the unexpected medical and travel costs. Without the help of strangers on the internet, i would not have had the freedom to leave tennessee or to make my own medical decisions. Rights that my state denied me. Days later, i arrived at a new york city clinic alone. Due to security concerns only patients are allowed in. I was there for several hours when a new ultrasound showed that mileys was no longer beating. Chair whitehouse take your time. Mrs. Phillips distraught i called brian, my husband, to tell him over the phone that our much wanted daughter was already gone. And that the abortion scheduled for the following day would be done immediately. I went into surgery alone, and i sat in recovery alone. I grieved her loss alone. In a city i have never been in. Far away from the comfort of my home, my family, and my friends. No one should be treated this way. Not in tennessee, and not in the other 13 states that now criminalize abortion. This standard of care that i needed in my situation. Two days later i flew back home to tennessee. I had to go back to my life like nothing ever happened. I have never felt as small and inconsequential or unsupported as i did then. I was so depressed that i couldnt go to work for another week after we got back. And all together brian and i lost three weeks of pay, which is rough for a family that lives paycheck to paycheck. My parents had to help us pay our bills the following month so we didnt lose our home. We want to have another child. But we are terrified because tennessee still bans abortion, and criminalizes doctors for providing essential health care for pregnant patients. Thank you for letting me honor mileys memory by sharing our story today. Millions of people live under these laws just like tennessees. And i know i was lucky to get the care i needed, but no one should have to rely on luck to get essential health care. We must have a federal right to access the health care we need, no matter where we live or how much we earn. Thank you. Chair whitehouse thank you very much, mrs. Phillips. Our next witness is mrs. Ford. Mrs. Ford chairman white dust house, Ranking Member grassley, and committee members. Thank you for the opportunity to testify today. My name is lesley ford, im an adjunct fellow for the American Enterprise institute. My Research Helps vulnerable families to find pathways of opportunity. Id like to make a point about mothers having an unwanted preg tphapbcy. Many women facing abortion face challenges. But thats not the answer. We have a duty to focus on real solutions. We should hesitate to make policy that says abortion results in Better Outcomes for women. It is difficult to isolate the effects of an abortion on womens longterm outcomes. At best the studies only point to correlations. We should not draw conclusions from them. Instead, we should focus on the factors that lead women to consider abortion. Nearly nine in 10 women who choose abortion are unmarried. Over half of women who choose abortion are in their 20s. Another 8 are in their teens. Many women who seek abortion do so because they fear economic hardship. And a majority of post aborive women say they chose that option because they experienced pressure to abort from the important people in their lives. We must address the socioeconomic challenges that push them towards abortion. This leads me to my second point. The safety net should be reformed to address many of the challenges that women considering abortion face. The safety net does robustly support vulnerable lowincome mothers, giving them access to food assistance, cash assistance, health insurance, in many cases Housing Assistance and childcare. Yet despite good intentions, the safety net often impedes the path back to selfsufficiency. Most notably, the safety net broadly discourages work. Even though employment is the best way for moms to break the cycle of poverty and a key indicator of whether their children will end up in poverty as adults. Major programs also have benefit cutoffs or phase outs that disadvantage married couples. In other words, the safety net traps people in poverty by discouraging work and marriage. The safety net should be reformed to promote what social scientists call the success sequence. This is a completion of at least a high school education, fulltime employment, and marriage before welcoming children. But even when an unplanned pregnancy may interrupt the completion of these milestones, there is still immense benefit to completing the steps after giving birth. When following up with mothers 15 years after nonmarital birth, there is nearly a 70 difference in the likelihood of being in poverty between those who complete the milestones and those who dont. We can and must do more to encourage these mothers to find a pathway back to selfsufficiency. My final point is that the government cant do anything. Mothers need the support of their communities. This means that Child Support Services Must do even more to ensure noncuss toadam fathers contribute to their childs needs. We should engage Nonprofit Community partners that support women through and after unplanned pregnancies. Id like to highlight here the more than 2,700 Pregnancy Resource Centers nationwide that provide wrap around services for mothers in crisis. Including essential care from cribs to housing and so much more. I want to conclude by reiterating that unplanned pregnancies present real challenges for mothers, but abortion isnt the answer. We can and must support these women, empowering them to overcome the challenges they face. Reforming the safety net is a crucial step. Like every american, lowincome mothers deserve and desire real opportunity for themselves and their children. Its absolutely essential to support mothers with the power of community. All mothers, particularly single mothers, deserve a consistent and Supportive Community to walk alongside them, helping them welcome their children to the world and giving those children the brightest future possible. Thank you. I look forward to answering your questions. Chair whitehouse thank you very much. And next we have mrs. Call. Mrs. Call thank you, chairman whitehouse, and Ranking Member grassley, and the other members of this committee for giving me an opportunity to testify today. My name is tamra call, im the executive director at obira Medical Clinic of ames. Our mission is to provide Reproductive Health care and support women in a way which empowers them to make informed life affirming decisions. Ames is home to iowa state university, and 30,000 university students. I also want to note there are several Medical Clinics around our country. Obira has been certified by the aconsidered asread taeugs association for ambulatory health care, which credits outpatient clinics, surgery centers, and College Student health centers. Certification reflects a dedication to high quality Client Health care. We operate in khraoeupbs with all hipaa laws and our clinic is staffed by obgyn, nurse practitioners, and highly trained registered nurses. We have the privilege of working with smart, strong, and resilient women. Overwhelmingly the needs women communicate to our staff is not much different than what we all need. Healthy relationships with people who will support us without judgment, and empower us on the journey to being successful. We provide health Care Services at no cost, including pregnancy testing, early ultrasound imaging, monitoring for possible Ectopic Pregnancy or miscarriage, and providing medical and emotional support, as well as after abortion care. We see hundreds of women at obira every year. We see women who are in college and afraid they will have to drop out if they choose to carry their pregnancy. Some are professional women who already have children but werent planning to have more. Some women are struggling to make ends meet and adding a child fees impossible. Others do not have support from the father of the baby. I am extremely grateful and hum to be have the opportunity today to share a story that is representative of the hundreds of women we have seen at obira. Her name has been changed to protect her identity. Id like to introduce you to asa who moved from pakistan to the United States along with her two Young Children for a job at iowa state university. She made the move because her husband was not supporting her or her children. Her husband came to the u. S. To visit the children and during this visit asa became pregnant. She knew her husband would not provide support and she felt very overwhelmed at the thought of caring for three Young Children. She felt an abortion was her only option. She scheduled an appointment at our clinic to get more information about the decision she needed to make. The nursing staff performed a pregnancy test and provided her with information about abortion, adoption, and parenting. I have copies of those brochures with me today and am happy to sheur them with you. The staff listened to her concerns and provided support. She had an ultrasound, when she saw her babys heartbeat she knew she wanted to parent. She felt heard, understood, and supported, which empowered her to carry her pregnancy. She is now successfully parenting her three children and has maintained her job at iowa state university. We provide numerous support services and referrals for women. Obira is a qualified entity in the state of iowa to provide presumptive eligibility insurance. This means prenatal care is covered immediately while the full medicaid application is being processed. We also assist women in applying for w. I. C. , the supplemental nutrition assistance program, the Family Assistance Program in iowa, and childcare assistance. The seat of iowa has a live map of childcare providers and opening. We connect women with housing resources. We provide women with referrals to childbirth classing, parenting class, early head start, and parent as teachers. A Community Comes group to foster connection and support young women with Young Children. We have referral partners to assist women with food stability, applying for jobs, basic finance classes, transportation needs, and medical care. A woman shed never feel abortion is her only should never feel abortion is her only option. When a woman walks into a clinic she feels abortion is her option. The staff prioritize open communication, allowing the woman to actively participate in her Reproductive Health care decisions. The woman is met with a holistic approach that considers her physical, emotional, social, and financial wellbeing. This approach not only supports the woman in making an informed choice, but also reenforces her autonomy and empowerment in navigating her reproductive journey. The support a woman receives instills in her the confidence she needs to be successful. Most of our clients, whether they choose to carry their pregnancy or not, return to obira for care. What starts as a positive pregnancy test ends in a trusting relationship where we can provide support to women for years. Thank you. Chair whitehouse thank you. I think its bit of Human Experience that when extremists want to take away rights and freedoms they speak in plat twod and platitudes and again ralitys and jargon, if you will. Mrs. Phillips, thank you very much for bringing home the real, immediate, and practical consequences of that on your particular family. Obviously it was horrible for you. I understand it was a pretty difficult period for brian and your daughter as well. Mrs. Phillips thank you again for allowing me to share my story. Brian is not my daughters biological father, hes her stepdad. He was beyond thrilled to have his first biological child. Adalie who is an awe tus particular adhd child full of energy and sp upbg has always said when she grows up she wants to be a big sister. So she was over the moon excited. She would sing to my belly every night. And she would make little toys for her sister to have when she was here. Trying to explain death to a then 5yearold is already hard. Trying to explain death of an unborn fetus, unborn baby is even harder. I had to explain to her that miley was very sick. And that she was causing mommy to be very sick. And that we had to let miley go for mommy to stay. And as hard as it was, she understood that she needs her mom and that her mom can potentially, if we decide to try again later down the road, its very hard for our family. Matter of fact, im in the year mark of when it happened. March 7 is when i arrived to new york city. February 24 was the day i found out it wasnt compatible. Its very hard for me to be here today. To talk about it. I know how important it is because my experience isnt exclusive. Its not unique. Millions of women face what i do every day. Chair whitehouse in your testimony you used a phrase, standard of care, which is a medical phrase. And id like to turn to dr. Dr. Zahedispung to describe a little bit what standard of care means in the context of mrs. Phillips experience. And discuss a little bit, if you will, the conflict that this extremism has created between the established medical standard of care for certain situations, and laws that have been forced on to these families. Dr. Zahedispung thank you so much, chairman whitehouse. For that question. Standard of care is a phrase thats used within medical societies in order to determine what is best to take care of a patient. How we move forward. What the evidence supports. What science supports. In the situation like what mrs. Phillips went through, standard of care is a deeply personal decision for what that family wants. But ultimately when we have a pregnancy that is not going to result in a live birth, the risks of continuing that pregnancy far outweigh the benefit of continuing it for many families. Because of the risks of pregnancy itself. Pregnancy is not a benign condition. We already know that we are one of the few industrialized countries that has a worsening and increasing Maternal Mortality across this country. And abortion care is very Necessary Health care in order to provide the standard of care. Not to mention the same procedure that is used, d and c, for abortion care is also used for miscarriage management. During my time in tennessee, because of the way that the law was written, ectopic pregnancies, treating them, which are pregnancies that are dangerous and life threatening because they implant outside of the uterus, was technically an abortion in the state of tennessee. You have providers who were deferring care that was lifesaving because of their fear of criminalization. When someones water breaks early, the standard of care is to end that pregnancy because of the risks to that preg tphapb person. Pregnant person. We have evidence across the country, including in places like texas that say if you continue a pregnancy where the water is broken, you increase their likelihood of maternal morbidity, mortality, fivefold. Chair whitehouse senator grassley. Senator grassley ill start with mrs. Call. Your clinic provides post abortion care. Could you tell us a little bit about the care for these women. Include the types of medical complications and emotional hurdles that abortion in these women can experience. Mrs. Call yes, thank you, senator grassley. When a woman initially comes to our clinic, one thing we prepare them for is just what the abortion procedure will entail. We give them factual information on that. We let them know what the signs and symptoms of complications may be so that they know if they need to seek care after an abortion. We have had women come to us that are continuing to have pregnancy symptoms after abortion. Well provide them with an ultrasound to check for any retained products following that abortion. If there are, they are at risk for infection. So we will treat them with a medicine to help them. We also provide women with emotional. By far the complications we hear most often from our clients are difficulty sleeping, depression, and difficulty in their relationships. We once had a woman call us after an abortion. She was struggling with feeling suicidal. Her family knew that she had had an abortion, and they were supporting her, but she just didnt feel like they fully understood. Our nurse was able to connect her with resources to help her as she worked through the emotions she was experiencing following that abortion. We also have women who come to us after an abortion or a miscarriage, and they say they just felt completely unprepared for the products of conception that would pass in their home while they are alone when they see faces and eyes in their bathrooms at home, they are shocked and grieved at the loss of the child that they were carrying. Senator grassley mrs. Tpo rbgsd you made a point in our testimony about our safety net system being disjointed and difficult for women and new mothers to navigate. Are these programs and agencies that are more complicated than others . What can agencies currently do to make these programs easier for women to navigate . Mrs. Ford thank you, Ranking Member grassley. Yes, i would say that women normally experience a safety net thats deeply terrible. If they go to one they go to several agencies filling out application f they are looking for help turning away a situation from domestic violence. Thats a different application. If they are looking for assistance getting back into the workforce and looking workforce opportunity act funding, it is not just a different application, but a different location. I would point to the state of utah as being the most fully integrated state. Their department of Workforce Services has integrated more than 50 federal programs into the single agency. Caseworkers are empowered in the state of utah to be able to connect the person in front of them to any one of 50 programs that fits their needs and eliblible eligible for. Most states are not able to do that. Even in the state i serve on, state of virginia, the department of labor is disconnected from the department of social services. You must fill out two applications and be treated by two different i. T. Systems to access the services to treat the circumstances that normally one family would face. Looking at integration should be a top priority to be able to assist families that are in need. Senator grassley mrs. Call, i have a minute plus for you maybe to take any time that you didnt have time in your five minutes to tell us anything else that the committee ought to know about your work with helping women who are pregnant or want to be pregnant. Mrs. Call yes. Thank you. I know we are talking about economics today. Women do often tell us when they come to our clinic that they are considering an abortion because of the financial concerns of adding a child to their family. One of these women was actually a teen age mom who came to our clinic with a 3yearold son already. She was her and her son were living in her car. She did not want to bring another baby into that situation. So she felt, abortion was her only option. After meeting with our staff and being listened to and heard and understood, the staff was able to give her information about adoption, which she considered, but decided not to choose. Then also was able to just help her find housing in our community, help her to get on to w. I. C. , to apply for medicaid, to receive food assistance. And when she had those resources, she felt empowered to carry her child. We have the pleasure of continuing to have a relationship with this woman. And the father of the baby initially was in and out, but he has chosen to be involved and to assist her. Just last week, we were able to help him find a job that has full benefits and will enable him to provide for his family. We are able to be that safety net for these women and children and men. We never have a woman come to us and say, i wish i would have aborted my child. Every woman who comes to our clinic who is financially strapped or in difficult situations, they want to keep their children. And they just need the resources to be able to do that. The network of people around them who will support them and walkthrough that with them without judgment or shame. Thank you. Chair whitehouse im particularly grateful chairman murray is here because shes at the point of trying to head off a House Republican caused government shutdown. The fact shes here is very significant. Chairman murray. Senator murray i appreciate you having this hearing today. Since republicans overturned roe v. Wade, reproductive rights have really been under attack like never before in our country. Im really glad that we are here today to talk about something that doesnt get enough attention. And that is the strong connection between reproductive rights and Economic Security. Because when republican politicians take away a womans control over her own body, they are also taking away womens ability to plan their families, their finances, and their futures on their own terms. The connection is more painfully clear than ever in the post Dobbs America where your ability to get an abortion depends on where you live and whether you can afford to travel out of state. Can you take the day off . Can you afford transportation . Do you have a place to stay . Do you need childcare . Mrs. Phillips just described all of that that happened to her. And there is a deeply cruel irony faced by women who are unable to get abortion because of cost. Women who are forced to stay pregnant by republican politicians. In someone cannot afford to get the health care she needs, what do they think is going to happen when shes forced to have that child . How will she make ends meet . Republicans antiabortion extremism doesnt just mean forcing women to stay pregnant. Ultimately it often means women forced out of the workforce and into Financial Hardship with no support to speak of. Here we are, where republicans want women to stay pregnant, but they dont want to address the childcare crisis. They want to force women to stay pregnant, but today House Republicans want to not fully fund w. I. C. Republicans want to force women to give birth, but they dont want moms to have paid leave so they can recover from childbirth and spend time with their newborn. Its pretty clear that republicans want to force women to stay pregnant, but wont lift a finger to help new parents. I want you to know that democrats are working hard to help make sure women are able to decide when and how they start a family. And we actually support those programs that families need. That is a pretty big difference to me, mr. Chairman. Mrs. Phillips, i want to start with you. Thank you again for herring you. I want to make it clear that you are not alone. There are literally hundreds of women out there, probably thousands who are facing the same choices you do. You are sitting next to a witness who just described a totally different scenario that doesnt even apply to you. And wanting a rule of this land that will keep you from getting the health care you needed. That story is not alone. Everyone needs to understand that. Can you talk to this committee again about the financial barriers that are out there for women who seek abortions, such as you had to do, through no want in your life but because thats what happened to you and what that meant to you and your family when you were forced to go out of state all alone . Mrs. Phillips yes. Thank you so much for the question and the opportunity to continue to speak on my story. I will start by addressing the committee by saying pregnancy isnt a one size fits all situation. Every pregnancy is different. Every reason to need an abortion is different. My fellow witness over here explained did not apply to my situation. This was a planned pregnancy. And unfortunately for us it wasnt in the cards for to us bring that baby into this world. As a lowincome family, as you spoke, i was a single mom for the first three years of my daughters life. I took two weeks off of work when she was born, unpaid, and had to go back because i didnt have any other option but to work to take care of my child. I actually started the inhome daycare in my home to be home with miley because we couldnt afford the infant childcare, which is about another mortgage payment in the state of tennessee. Without the platform that i had online and without sharing my story, and thank god it went viral when it did, because without the help of complete strangers, i would not have made it to new york. I dont know if i would be sitting here today talking to you. Senator murray thank you. I appreciate that. Dr. Myers, just in the last few seconds i have, women of color, especially black women, this is really worsened longstanding inequities they have faced. Can you talk about how abortion bans and restrictions have created new Financial Burdens for women, especially women of color. Prof. Myers thank you for that question. Every single study of which i am aware that isolates and pressures the effects of abortion restrictions on peoples lives that women of color, spaoerpbs experience greater effect of those restrictions, greater barriers an thon hispanic white women. The reasons are complex. Women of color, particularly black women, have higher rates of unintended pregnancy driven by lower access to contraception, insurance, more likely to live in contraceptive deserts. Raise poverty in complex way that is create greater financial barriers of traveling, taking time off work, accessing childcare for women of color. So we often see much greater effects on that population. Senator murray thank you very much. Chair whitehouse senator kennedy, then senator stabenow. Senator kennedy thank you, mr. Chairman. Professor myers, you are here at the invitation of my democratic colleagues, is that right . Prof. Myers thats correct. Senator kennedy in his opening statement, my good friend senator whitehouse said, i want to quote, reproductive justice is Economic Justice, close quote. Do you agree with that . Prof. Myers i might as an economist use the word rights. But, yeah, i do agree with that. Senator kennedy thats not true for the baby, is it . Prof. Myers first of all i would refer to a fetus senator kennedy a fetus. I refer to it as a baby. Thats not true for the baby, is it . Prof. Myers the evidence i presented to you, senator kennedy, was evidence about measurable effects on the lives of women senator kennedy thats not true for the baby, is it . Prof. Myers im sorry i dont understand senator kennedy lets prof. Myers as an economist i measure effects using data. Im not here to talk about ethics, assignment of personhood. Senator kennedy you said you agreed with the chairmans statement that we roddive justice is Economic Justice. There is no Economic Justice for the baby. Because the babys dead, right . Prof. Myers i wouldnt refer dont know how to answer your question. I would refer senator kennedy was the baby dead or alive. Prof. Myers a fetus. Senator kennedy is the fetus dead or alive after an abortion . Prof. Myers the fetus would be dead after an abortion. Senator kennedy if the mother is healthy, and the baby is healthy, do you support abortion up to the moment of birth . Prof. Myers i think thats thats a hard question to answer because that just doesnt happen. You are asking me about something that simply doesnt happen. I will tell you senator kennedy its legal in vermont, new jersey, oregon, colorado, new mexico, alaska, and the district of columbia. And the wing of the Democratic Party supports abortion up to the moment of birth. Do you support that or oppose it . Prof. Myers i dont think let me say im here to talk about the economics of abortion. Senator kennedy you are here as an expert. Prof. Myers you are asking me a question as a person. Which ill answer as a person. I will tell you as a person i have ambivalence about abortion. I will tell you as a person, i havent personally had an abortion. I will also tell you as a person looking at the evidence around me and understanding how complex the decisions are that people face, im just simply uncomfortable senator kennedy i got to move on. I dont think youre going to answer my question. Prof. Myers i trust women and their Health Care Providers. Senator kennedy its simple you either support abortion for a healthy mother and baby up to the moment of birth or you dont. I dont think its a difficult question. How about you, dr. Doctor, do you support if the mother is healthy and the baby is healthy, do you support abortion up to the moment of birth . Dr. Zahedispung its not a simple yes or no. Not to mention mention when you make statements like that you are erasing the grief and the trauma that my patient senator kennedy youre not going to answer my question, either. Dr. Zahedispung i think i know your answer. Senator kennedy mrs. Ford, lets take a baby at 21 weeks. This is a baby at 21 weeks. Ok. The baby can feel pain, right . Mrs. Ford yes. Senator kennedy the baby is pretty developed, right . Mrs. Ford yes. Senator kennedy do you know the name of the procedure the doctor would use to abort that baby at 21 weeks . Mrs. Ford im not a doctor. I believe its a d and r. Senator kennedy dilation and evacuation. Mrs. Ford as far as i understand. Senator kennedy first, the doctor would dilate the cervix and then the doctor would take whats called the doctor would call it a clamp, its a pair of pliers with sharp teeth on the end. And without giving the baby any pain medication, the doctor would go through the vagina, through the uterus, and start tearing the baby apart, is that right . Mrs. Ford as far as i understand the procedure. Senator kennedy she might start with the legs and pull them out. And the arms, pull them out. She might go for the heart or the spine and just pull the baby out piece by piece. Is that right . Without giving the baby pain medication. Mrs. Ford thats what i understand the procedure to be. Senator kennedy then you got to get the head out. The babys dead. Maybe not. Maybe its still in pain. Then you got to get the head out. Even with the cervix vie dilated you dilated you have to get the head out. Then the doctor would go in and use those pliers to crush the bab babys head. Then she would pull the head out, crushed skull out, satellite mrs. Ford yes. Chair whitehouse senator, kennedy your time has expired. Senator kennedy you gave the others time. Chair whitehouse your time expired. Senator kennedy i was waiting, when you were letting others. Chair whitehouse i dont think anybody else is has gone over. Senator kennedy this is what we are talking about. Chair whitehouse some of the witnesses went long but on both sides. Senator kennedy i thought we were here about chair whitehouse i turn to senator stabenow. Senator kennedy im sorry you dont want to hear it. I know its ugly but its the truth. Senator stabenow mrs. Phillips, im sorry you had to hear that. Particularly as you are talking about the oneyear anniversary of what you had to go through. It was shameful and im very, very sorry. No one here should be judging you or any other woman who has to make decisions. Based on their life and whats happening in their pregnancy. Thank you so much for being here. This is about the freedom to make decisions, Health Care Decisions for women. Half the population. Freedom to make our own Health Care Decisions. In michigan after roe v. Wade was overturned, women, people across michigan, put this on the ballot for our michigan constitution, and 2022, overwhelmingly, democrats, republicans, people of all ages, voted to put that in michigans constitution. The freedom to make our own Reproductive Health care decisions. Which is great except now we hear with the National Abortion ban being talked about by republican colleagues, if we have a republican president , a National Abortion ban takes that all away. And we also know that i. V. F. Now, which is the choice to have a baby and go through i. V. F. , that also potentially is being taken away. Probably Birth Control is next. So this is about basic freedom. I just want to start, though, a little differently than i had planned. You talked about no woman should feel alone. I couldnt agree more. I work on nutrition issues, health care had been issues. I have been at the forefront of all these issues. But listening to mrs. Phillips story today, do you think she had another option . Mrs. Call thank you for the question. I am not a medical doctor. But i do know our obgyn has worked for over 30 years and delivered over 4,000 babies. I know he has cared for multiple women who were in a similar situation to mrs. Phillips. And i know that he worked closely senator stabenow in the interest of time. Her baby was dead. But she had another option. Mrs. Call when her baby is dead its no longer an abortion. At that point its a d and c. Senator stabenow i appreciate your work. Again there is a lot of different stories to tell here. Also, i wanted to ask mrs. Ford, you talked about the safety net. I couldnt agree more. Right now we have a situation where we need we are working to fully fund w. I. C. For pregnant moms and babies, healthy food, nutrition, so on. Do you support w. I. C. . Mrs. Ford wick is an important reforce for mothers. Senator stabenow we shouldnt have waiting lists f theres a nine month pregnancy, you cant have a waiting list. Mrs. Call, i would assume you mentioned w. I. C. As being a support. Thats something you would support. Mrs. Call yes. Senator stabenow i have been trying for years, senator grassley and i, to put in place quality standards for labor and delivery under medicaid. Half our babies are born with Medicaid Health care and republican colleagues have stopped that here in the senate. For years. We dont have Quality National quality standards. I assume as part of a safety net, mrs. Ford, you would support having quality standards for labor and delivery . Mrs. Ford yes. Across labor and delivery, especially post aporive care. Fewer than 20 states actually track post aporive aborive outcomes. Most abortion clinics, people who are experiencing 2rub8 are referred to a hospital. Senator stabenow healthy babies. We should have that. Colleagues should be working together to do that. Mrs. Ford yes. Senator stabenow i assume, mrst having quality standards as well. Mrs. Call i agree. Senator stabenow which is not happening because of folks in this body. Mrs. Phillips, let me go back to you. Thank you again. How has this horrible experience you had to go through change the way you think about your familys future and the kind of world you want your daughter to grow up in . Mrs. Phillips thank you for that question, senator. It has been extremely difficult. As i stated before this was a planned and wanted pregnancy. We still want to expand our family. Thats something we plan to do. Unfortunately while the ban still sits in tennessee, we are terrified. It was a very traumatic experience that hi to go through, that my family had to go through. My card here says mom and activist. Since what happened to me happened, i turned activism because my daughter is growing up in a state without bodily autonomy. In state that lawmakers are telling her that she doesnt have a choice. Its one thing to put me through it. Im a 29yearold woman. But to put a child through Something Like that is inexcusable. I would say that im hopeful that we can come to an agreement, nonpartisan agreement, and our state capital and restore Abortion Access so i can continue my plans of my future in expanding my family. Thats something i desperately want to do but im terrified to do. Senator stabenow american Women Deserve their freedom. Mr. Chairman, this side of the dais trust women. Chair whitehouse senator lee. Senator lee thank you, mr. Chairman. Chair whitehouse sorry to interrupt. Followed by senator merkley. Senator lee i feel to he i need to point out something that the casual observer might miss from some of the comments. The Dobbs Decision did not criminalize abortion. The Dobbs Decision didnt do anything to affect the legal status of abortion other than to return the decision. The primary decision on abortion back to the states. It concluded that this has always been an issue that was before the states prior to roe vs. Wade and its progeny. The Supreme Court in dobbs simply undid roe and said this is a decision that most of the time, that is unless we are dealing with something the disdistrict of columbia, military installation, using Government Funds or Something Like that, isnt normally going to be federal action. So they returned it back to where it was. States have been more or less out of this arena for about 50 years. They had been out of the arena for about 50 years. As most abortions occurring in america couldnt be meaningfully restricted in light of roe vs. Wade and its progeny. States are getting back to that business after it had been usurped by a judicial oligarchy of sorts for nearly a half century. Yes, states will handle this differently. But states handle many things differently. Everything from occupational licensing to what procedures might be performed in certain states, even the criminal laws of one state differ from those of another. Those laws are made by men and women elected the as citizens of the states. Those laws can have unforeseen consequence, sometimes tragic ones. Those laws could be changed from time to time. But its important to focus on what this is about and what it is not. It is at the end of the day something that is in the hands of the american people. This is part of what having a democratically elected government means. Its what it focuses on. I have heard several mentions made to the idea that there is suddenly going to be a National Abortion ban, a federal abortion ban enacted. To my knowledge republicans who now control the house havent pushed for a vote on that elsewhere. Same cant be true of the born alive protection act. Its a different circumstance. Once a child is born alive, i would hope, i would hope we could all agree, regardless what your religious, moral, or policy feelings about abortion are, i would hope we could all agree once a child is born there are all kinds of protections and that allowing someone to be killed raises all kinds of other ramifications. Mrs. Ford, start with you. Talk to us a little bit about the marriage pents that exist in our penalties that exist in our current tax code and social safety net at the federal level and what harmful effects it might have on things like family formation. How do they harm, for example, married couples with children in a way that doesnt affect other families . Mrs. Ford i would like to start by pointing out marriage penalties in the safety net which exists primarily in a program like the earned income tax credit, you can earn thousands more if you are unmarried and have children versus if you are married. But there are also implicitly throughout the rest of our programs. For instance, if you dont declare the partner who you are not married to within the home, you can receive thousands more in snap benefits or tanf benefits or any other number of benefits of the the effect we see this has had on our culture is within the unmarried birth rate. We have the highest tpheupl percentage of children living in single parent homes in the world. It is about a quarter of u. S. Children live in single parent homes as compared to 7 around the world. Senator lee we have incentivize the out of wedlock birth and child rearing. Mrs. Ford the information seems to be falling that way. When we track c. D. C. Data, if you are looking at College Educated women, fewer than 10 or 11 have children out of wedlock. Thats roughly similar to what was happening in the 1960s. When you are looking at less educated women it comes close to 60 . It does hit on education levels and income levels whether a child is going to be born out of wedlock. We know very clearly from the data there is an impact to having two parents in the home. This is why most the two parent privilege was published. This is following the data. There is a huge benefit to having two parents in the home with a child. Senator lee how does that contribute to the perpetuation or even exacerbation of existing inequities along racial, economic, and other demographic lines . Mrs. Ford we know that if there is a single mom or paeurpt who is raising her child alone, she is more likely to experience economic hardship. Much more likely for her children to experience intergenerational poverty. The 60 years that aid to dependent children with families run in this country showed that economic outcome. This program provided cash assistance to mothers by the mid 1990s, one in 10 were unemployed. After it was reformed to focus on work, the outofwedlock birth rate stabilized. Women returned to work by nearly 20 points and Child Poverty in this country hopped tkro pd by 60 . Senator lee human, are rational actors. When we stphefdize the wrong things, and sometimes they harm a lot of people. Especially the most vulnerable. Thank you, mr. Chairman. Chair whitehouse thank you, senator lee. The order i have at this stage is senator merkley, senator braun, senator padilla, senator kaine, senator wyden. Thats the see kwpbs, if people arent here you can be bumped up. Senator merkley thank you. Dr. Zahedispung, in somes states i want to understand if an ultrasound reveals that the fetus does not have a heartbeat, some states, would it be basically the law now require that a woman to carry that child until there is miscarriage . A child who cost not does not have a heartbeat . Dr. Zahedispung i dont know of any straits that require people to carry pregnancies that are true miscarriages what can i say with procedure bans around d and c answer and d and es it can require paeurb kwrpbts who experience add miscarriage where the fetus heart stops beating to deliver that fetus and undergo an induction instefd a medical procedure that could end their suffering quickly. Senator merkley that was the situation we were in with our first child. We lost our first child at four months. I think it would have been extremely difficult for mary to be required by the state to carry that child post that point. Dr. Zahedispung im sorry. Senator merkley i want to talk about the riders, including one that is restrict access to medication abortion. What would be the Economic Impact of passing appropriations bill with some of the these extreme antiabortion riders . Prof. Myers thank you for that question. I would like to talk about medication abortion for just a second because mifepristone has become incredibly important to abortion in this country. Even before dobbs, more than half of all abortions provided were provided as medication abortions. And right now about 40 of the brick and mortar abortion facilities in this country only provide medication abortion. The remaining facilities with few exceptions provide medication and procedural abortions. If mifepristone access were meaningfully reduced, it would upend the provision of abortion in this country. It could in teleend provision which has become extraordinarily important to people. It could shutter provides, brick and mortar providers across the country, including the states that have been supportive of abortion rights and not understand the threat that faces them t would create limited appointment availability as many many of the facilities that remain. Senator merkley thank you very much. Dr. Zahedispung, i want to turn to you. Based on your experience now in colorado, say with the expanded access to abortion after the Dobbs Decision, have you seen an increase in the number of folks coming into colorado from out of state . Dr. Zahedispung we have seen thank you for that question. We have certainly seen an increase in the number of abortion care that we are providing. Our group has seen an eight times increase in Care Provision in the last year and a half since the Dobbs Decision. In a addition about a 40 increase in procedural abortion care thats been seen. Its hard to quantify how much of that is from out of state versus just more patients needing the care and not being able to access it. Senator merkley has that created delays in the state . Dr. Zahedispung there is only certain a number of us that can provide this care given you have to have specialty training to do it. None of us ever want to delay a patient receiving necessary medical care, but there is only so many hours in the day where we can actually provide that care. Senator merkley oregon has seen that. Its reported as much as 1,000 increase in patients crossing the stateline from idaho. Mrs. Tpeup lips, thank you for sharing your story mrs. Phillips, thank you for sharing your story. A story i could connected with my own familys experience. Not all the pieces of it that were so powerful. Because of the restrictive laws in tennessee, is it the case that your doctor was not even able to offer advice to you on how to obtain an abortion . Mrs. Phillips thank you for that question, senators. My doctor had taken an oath to provide the utmost care for her patients. And at that point in time the way she understood tennessees law was that she could not offer me resources. She stated i would have to do the research on my own. And then i was left to essentially defend myself and my own life and fertility. Senator merkley thank you very much. Thank you, mr. Chairman. Chair whitehouse senator braun followed by senator padilla. Senator braun thank you, mr. Chairman. This question will be for mrs. Call. Im going to preface it with these comments. Colleagues before me have had questions about the nature of life and human essence. I think it made the point that its hard to distill that into economic terms. When you try to do it, especially through an institution, that is now become one that has no problem with borrowing and spending money from future generations, just to tell you where we are at there, this is the Budget Committee, we are now borrowing 1 trillion every six months. You know whose back thats going to be upon . Our kids and grandkids. Thats to what were talking about today. On the subject matter here, that has no good ending to it. Thats about as bad a Business Plan as anyone would ever want to be a part of. But here, to try to speak about this in economic terms, i think from the state im from, this is a question of being profamily, pro mother, and that would be a place i think would be a legitimate place to have a discussion, just not trying to even do anything about it, when youre borrowing it from your kids and grandkids. Indiana has effective public and private Health Care Networks to help women without urging them to destroy an innocent life. The general assemblys fulfillment of the culture of life includes the decision to disburse tanf funds to pregnancy clinics and abortion programs. Mother shoes not feel alienated from existence and forced into abortion. Sadly, the Biden Administration embraces a culture that wants to do the opposite, to strip support for pregnant women and their unborn babies. I just think its the wrong place to go. My question is, what do you tell young families and worried mothers when they need help with an unexpected pregnancy should they be leaning towards that, taking the tools away from states that want to maybe talk about life and preserving it, whats your opinion on that . Yes. Your question is what we tell families about that could you repeat exactly what you want me to answer . Sen. Merkley when you have young families confronting these issues, whats your advice as opposed to what the Biden Administration is pushing, to take funds, borrowed money, to facilitate ending life . What should be the message . Anyway, i believe the message should be that there are people here who are very ready and willing to support you, and the state is ready and willing to support you. Our local community is ready to support you. In the state of iowa they recently passed the moms program which provides state funding to centers like ours so that we can truly support these women where they are. Let me be clear, we never suggest to a woman what she should or should not do but give her the Resources Available to her because it can be tricky to navigate all these systems and institutions and so were just there to be an advocate for her and help her walk through that as she considers her decision. Sen. Merkley have you had any outreach from the Biden Administration to help you in your programs . Ms. Call no. Zero. Sen. Merkley thats one thing if youre pushing one dynamic at least to be fair, it ought to be something youre willing to do with the other point of view as well. Thank you. Ms. Call thank you. Senator padilla and then senator contain. Senator cain. I want to thank you for your consideration today and your time youve taken. 42 of adults up from 33 , just from five years ago say that theyve either used fertility treatments or know who has. Sen. Padilla theres an estimated 1. 5 million frozen embryos nationwide. The recent ruling in alabama effectively bans i. V. F. In certain states because it would subject people involved in all steps of the process to unreasonable criminal liability. As republicans continue to squabble over the elements of reproductive rights, what i see happening is realizing its one thing to say that euro posed to abortion in theory and its a whole other thing to try to legislate in this new reality. Its offensively hypocritical for so many house g. O. P. Members, for example, lining up to pledge support for i. V. F. While simultaneously signing on to socalled parenthood legislation with no carve out for embryos and clinics. My first question, dr. Zahedisprung, how would you support republicans for i. V. F. With support for legislation like the life at conception act . Dr. Zahedisprung thank you, senator. If im understanding your question, i think the hardest part about all of this discussion is that reproductive justice is about choosing when to have a family and choosing when not to and its around how you choose to parent your children as well. And the argument around i. V. F. , theyre in conjunction with around why abortion care is necessary medical health care, youre taking away the autonomy of families to make the decisions that are best for them. And youre erasing grief and trauma for those families that are having to make decisions that are very difficult. Having known many colleagues as well as friends having to go fertility treatment, thats a difficult road and then for them to have their time and energy and, you know, responsibility taken from them by the state and told what they can and cant do with that is just as scary as what were seeing with the patients who are coming to us for abortion care. Sen. 5 sen. Padilla i appreciate your position because for a party that claims to be about rights and freedoms and terribles, theyre taking away rights and freedoms and liberties from families across the country. Dr. Myers, can you talk more about the society willal and Economic Impacts of banning i. V. F. Dr. Myers yeah, ill preface it by saying its been a mixture of the personal and professional. My oldest child is a i. V. F. Baby and the product of a frozen embryo transfer and hits really close to home for me seeing whats happening in alabama. Reproductive autonomy is not just about young people avoiding parenthood until theyre ready, its about all people being able to become parents when they want to. And i. B. F. Has helped millions of people, including me, and the economic evidence suggests it allows women to spend more time seeking the right partner, investing their education and investing in their careers. And in a country and moment when were increasingly seeing people delaying parenthood, a lack of access to i. V. F. Is very concerning from an economist perspective. Sen. Padilla thank you very much. In my brief time remaining, i want to touch on another topic. Because as dr. Zahedisprung exempli face, across exemplifies. Across the country there are doctors and nurses leaving their practices in states like idaho, texas, oklahoma, and tennessee, while new doctors are avoiding those states altogether, facing the departure of respected and talented physicians, many hospitals have since closed their labor and delivery units in these red states. So the brain drain extends beyond just maternity care, following the dobs decision, a growing number of countries have upgraded their policies to include abortion travel benefits because they recognize state laws restricting abortion care has on their ability to attract and retain talent. Dr. Zahedisprung, you left georgia and tennessee as you shared in your testimony as a result of dobbs and the state abortion restrictions. I can imagine attacks are driving obstetricians and others from states. How does it impact access to health care Services Including prenatal visits and access to contraception, including maternal, fetal medicine and postpartum care cesarean and those being left behind . I have a deep concern as to what will happen in this country as rights be being taken away. We know prior to dobbs states that had abortion care restrictions had worsening Maternal Mortality and morbidity and was still divided and worsened across racial lines as well. Now were adding in the factor that physicians are afraid to be in states where there are significant abortion bans, youre eliminating an entire work force. And in addition, almost 50 of the obgyn residents in this country are training in states with abortion care restriction. Dr. Zahedisprung well graduate an entire generations of obgyns who dont know how to do d cs for abortion Care Management and arent able to speak to them about their pregnancies and wont be able to provide Emergency Medical Care in these communities and im very afraid of what it will mean for these patients. Idaho, for example, has had multiple maternity wards close over the last several years as much as 25 of their obgyn force and there are two maternal fetal medicine physicians left in the entire state. Patients are traveling 200 miles one way for prenatal care now in a state that already had, really terrible mortality and morbidity, i worry about the residents of that state and how well continue to watch women die sen. Padilla we have fiery debates and see what can happen to the states but the ultimate consequences are on women and families, and that needs to be the center of our actions here. Senator cain and van holland and senator cain . Sen. Cain mrs. Phillips, your testimony was very powerful and thank for you sharing it. The legal system in tennessee in this country has really failed you. I was listening to mrs. Call earlier saying in her work she tries to inform people and tries to be nonjudgmental and lets them do what they choose to do. Your state does not do that. Your state does not let physicians do it. The fact huh a physician who has taken an oath to provide patient care is so afraid of criminal liability or loss of licensing privileges that when youre given this devastating news, you and your mom have to go online and search to find a place thousands of miles of where you live, far away from any family that you ever visited, if i remember your testimony right, to terminate a failing failed pregnancy. The cruelty is astounding, astounding. I just would like to go back and clip that piece of the testimony from mrs. Call earlier. We want to accompany women and let them decide whats in their best interest, if thats what a Health Care Provider testifies, why wouldnt a state legislature or a court system or congress have that same attitude . I want to push back a little bit on senator brauns notion, he was pushing a line the Biden Administration is interested in abortion and not on moms, so let me correct that. The American Rescue plan was the first piece of legislation that was passed under the Biden Administration in the 117th congress, and my colleagues and i were here and it passed by one vote. One vote. Every democrat voted for it, every republican voted against it. The American Rescue plan included a really important provision for moms and kids. Prior to it, medicaid would cover a mom after delivery for 90 days, more than half the births in this country are medicaid births. Sen. Kaine prior the moms would be covered for 90 days. In the rescue plan we allowed states to expand it to 90 days to a year and a mom is covered for a year because there are so many challenges mothers face post delivery. That passed by one vote, joe biden and Kamala Harris did that. Every republican voted against mothers. They voted against mothers. Guess what states have done with that mandate . We extended it in an appropriations bill next year. 45 states have decided to embrace this optional mandate we allowed them to do, embracing the harrisbiden policy and embracing a policy the democrats supported and every last republican in the senate opposed. Mr. Chair, i imagine youve been here longer than me, there are days youre here and wonder if you do anything. Then there are days and something happens by one vote, the American Rescue plan, moms get medicaid coverage. We saved two million workers pensions, saving the Affordable Care act in 2017, happened by one vote. The Inflation Reduction Act to bring down prescription drugs happened by one vote. The American Rescue plan had another pro mom, profamily, pro kid provision, the Child Tax Credit that reduced infant poverty by 45 within six months, passed by one vote. Every democrat supported it. Every republican opposed it. I gather from your testimony, professor myers, that one of the reason women often site for terminating pregnancy is financial pressure, the financial pressure of health care expenses, the financial pressures of raising kids and finding childcare. Knowing that youre going to be covered for health care in the year after delivery, knowing can you get a Child Tax Credit to help you with the expenses, these are the kinds of policies that are pro mom and profamily and might even help the u. S. Deal with the declining birth rate and kind of turn it around and we could start to have a growing birth rate again if families felt they had a financial cushion and the financial pressure wasnt causing them to consider terminating a pregnancy. Am i right about that . Dr. Myers yes, youre right. Thank for you the question. American birth rates are plummeting and the reasons are very complex but we should all be very concerned about that through multiple lenses including a fiscal lens. And one of the reasons that people give for delaying, becoming parents or having fewer children is financial concern. So i agree with mrs. Ford we can bolster the social safety net and reduce marriage penalties. I think thats a really good idea. But you just cant leave out the other financial concerns that affect families, and the Child Tax Credit was an incredibly important piece of that social net and expanding medicaid was an incredibly important piece and making benefits more accessible and reducing child caps on them. There are so many things we need to do to bolster the social safety net and in doing so we would likely help against this trend of declining births. Senator van holland. Sen. Von hall and thank for you your testimony today. I wasnt in the room but saw your testimony on cspan as the hearing progressed, mrs. Phillips, and i want to thank you for being here and sharing your very personal story. Sen. Van holland and it does help millions of other american women. Now youve experienced a senate hearing, lots of things have been said inside. I just want to give you the opportunity as i close, i may be the last senator to ask questions. After youve heard everything here today, is there anything you would like to say in response . And make sure we can correct any misconceptions some people have expressed. Mrs. Phillips yes, thank so you much, senator, for giving me this opportunity. I will start by saying that i made a promise to miley that her name would not die with her. So that is why part of my activism is so important to me so people know who she is. I want to make two statements before i go into my final thing i would like the committee to know. I think it was senator kennedy came to this hearing knowing there was going to be a mother here who had to make the difficult decision to terminate a 20week pregnancy and he decided it was in his best interest to show a 21week fetus and his testimony was nothing but fear mongering. From my experience that wasnt my experience what he was trying to persuade. Also, mrs. Call, to answer your question to what he had asked, my procedure was an abortion. Its on my medical paperwork i had an abortion even though my daughter was deceased. It is not back and forth. An abortion is a medical procedure whether that fetus is deceased or not. But i would like to ask the committee to remember my story and to remember that im one of thousands if not millions of people in this country that need or needed Abortion Access and to remember its not black and white and one size does not fit all. We cant be putting politics into Health Care Decisions and to also remember the facts, that Abortion Access is essential health care no matter how you want to look at it, its essential health care for so many. And exceptions dont work. Im a living testimony to that. Tennessee had a very vague exception to protect life of the mother. My life was at risk and i did not qualify. I would ask the committee to consider passing a law that allows access without exception all across the board because when someone needs health care, they should be able to receive that health care when they need it and not have to navigate the hurdles like i did. Because like i said, i dont know if i made it to new york if i would be with you here today so is im very thankful for the opportunity i was given to get to new york and now this opportunity to fight back against the extreme bans were facing in many states. Sen. Van holland thank you for that earlier testimony and that powerful closing. Dr. Zahedisprung, if i could ask you to elaborate a little bit more on the real challenges doctors face in trying to navigate these legal areas. Senator padilla asked some of the questions i planned to ask about the impact on doctors and their decisions to have to move to other states and how that leaves women in the work force in states like tennessee at greater risk. But its because doctors dont want to end up being fined or worse, for their actions. So could you and i know from your testimony that you call upon your fellow physicians to when you were in tennessee and others do to try to navigate these things, and how its impossible standard. Can you just talk about that, that kind of experience of having to go through these difficult decisions when people are talking about imposing legal penalties . Dr. Zahedisprung im a physician and not a lawyer. I did 11 years of training in order to become a doctor and trust my own clinical gas tall. Then a law went into effect that took away my ability to care for my patients in a way that was necessary away from me and from so many others. Ill never forget after the days after dobbs the number of conversations i had with our hospital lawyers, my criminal defense attorney, the lawyers across the country who were trying to navigate the ever changing experience for patients and providers. And i wasnt able to care for patients because i was trying to figure out if i could even take care of them. I had a hematologist call me and ask if he could give chemotherapy to a Breast Cancer patient who he just found out was pregnant because he worried if she did and she miscarried hed go to jail for taking care of his patient. It is still terrifying. We navigate this on a regular basis with patients coming to us with some very complex care trying to make sure that they have all the followup and care they need back home while still protecting their privacy. Its untenable. And i am devastated i had to leave a place that i loved and a community that i cared deeply for but i knew i couldnt do any good if i wasnt able to Practice Medicine anymore. Thank you very much. Let me thank all the witnesses. There was a comment, a critique, professor myers, of your conclusions regarding the causal effect between reproductive care restrictions and the economy, he specifically the appropriate conclusions to be drawn from the turnaway study. Youve not had a chance to respond to that. In fairness, i should give you a chance to respond to that if you care to. Professor myers thank you chairman. I want to say, first of all, very clearly, that most of the evidence that i present and share in my testimony is not from the turnaway study. Theres ample evidence from multiple independent Research Teams using different natural experiments to isolate and measure the Abortion Access. Were not talking about the turnaway study by any means but when we are talking about the turnaway, its causal and to illustrate one of the most important studdies to come out of that research project, i want to be clear, its not mine but another team, took people in the turnaway, some found they were just past the gestational age limit to receive the abortion they wanted and were turned away and some were just under it and received the abortion. Hence the name of the study. The researchers connected all these people to their experian credit reports and followed what their credit reports looked like for months, years before this pivotal event in their lives and the two groups trended incredibly similarly and looked really similar right up until the moment this happens to them and thats when there is a incredible convergence and those that turned away have this enormous increase in adverse credit offense. I dont think a reasonable person can look at that evidence and say thats just a correlation, Something Else happened that day that caused their credit to fall off a cliff. Thank for you that response. Thank you all for your testimony here today. I know that mrs. Phillips, it was particularly difficult for you and one of our colleagues made it even more difficult and i apologize for that and thank you very much for being here. The record will remain open in case anybody issues to add anything for another week. With that, that hearing is concluded. [captions Copyright National cable satellite corp. 2023] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy visit ncicap. Org]