Pennsylvania bill doesn’t fine women for miscarrying, but costs could trickle down to patients

Are lawmakers trying to pass a bill in Pennsylvania that would fine women for miscarrying?

That’s what several viral social media posts are claiming after the bill, HB 118, was advanced by the state’s House Health Committee in late May.

Here’s what one Instagram post, shared on May 27, said:

"The Pennsylvania state legislature today voted to advance a bill by Republican state legislator, Frank Ryan, that would essentially fine women who miscarry, force them to apply for a #FetalDeathCertificate" (and pay a filing fee), and then require a formal burial or cremation of the remains (which the woman would also have to pay for) — no matter where in the pregnancy the miscarriage occurs."

"If this were to pass, if you miscarry in Pennsylvania, say at six weeks, then by law you would be fined, penalized, and required to hold a burial for (a) handful of non-viable cells that are essentially indistinguishable from menstruation."

This is rooted in some truth: the bill has raised concerns about its implications for women who miscarry. But the claim exaggerates the literal effect of the legislation, which has since been amended. What’s more, Gov. Tom Wolf has vowed a veto should it reach his desk.

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.)

Given the widespread nature of the claims regarding this bill, we wanted to take a closer look.

First, HB 118 doesn’t mandate that women be fined for miscarrying, as the post alleges. 

Instead, it requires that health care facilities bury or cremate fetal remains, regardless of how or when a pregnancy ends. The costs of the new requirements — and fines for failing to comply — would be on the health care facilities. However, experts say that costs could be handed off to patients or their insurers.

The legislation was amended on June 8 to clarify that the Department of Health would not be required to issue a death certificate. Also, the bill does not address miscarriages that occur outside of a health care facility, like at home.

The bill was first introduced in 2019, when it passed the state’s House of Representatives, but became stalled in the Senate. 

Reintroduced in January 2021, the legislation was advanced by state Republicans in the House Health Committee before it passed the state’s House of Representatives on June 9 by a vote of 118-83. Eight Democrats supported the bill.

Calling it "anti-choice legislation," Gov. Wolf lumped it in with bills that he said "would undermine the doctor-patient relationship and limit an individual’s right to decide what happens to their body."

The bill specifies that health care facilities must "cremate or inter the fetal remains" if the parents choose not to conduct their own burial.

A "fetal death" is defined by Pennsylvania law as "the expulsion or extraction from

its mother of a product of conception after sixteen (16) weeks gestation, which shows no evidence of life after such expulsion or extraction."

But HB 118 removes the 16-week timeframe in its definition, and defines "fetal remains" as simply, "the fetus expelled or extracted in the case of a fetal death." A fetus is typically defined as the stage more than eight weeks after conception. 

Opposing the bill, the American Civil Liberties Union of Pennsylvania argued in part that it’s redundant and burdensome. Nothing currently prevents parents from having a ritual burial for a miscarriage that happens less than 16 weeks into pregnancy. Additionally, the organization said the state already regulates fetal death and disposal requirements following abortion, miscarriage, or stillbirth.

ACLU Pennsylvania also took issue with the bill’s expanded definition of "fetal remains," saying it includes "all medical tissue from the moment conception — not just fetal tissue, but also embryonic tissue and tissue containing a fertilized ovum or blastocyst" and that it would only encumber health care clinics and women seeking abortions.

HB 118 specifies that its health care facilities must pay for the burial or cremation of all fetal remains, and that parents would only be responsible for any associated costs if they select a burial location other than the one that is customarily used by the facility.

But experts have taken issue with that, and say that facilities faced with mandated increased costs will likely transfer those costs to the patient or the insurer.

"Everything that's required for a healthcare facility to pay for tends to get passed along to patients," Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation, told PolitiFact. "And it’s not always transparent on how that happens, but it does. It won’t show up in the charges because by law they have to cover it, but it will show up somewhere."

When we reached out to Rep. Frank Ryan, the bill’s sponsor, for a response, his staff sent us information about the amendment that clarified the health department would not be required to issue a fetal death certificate. Ryan did not respond to our question about charges being passed to patients.

Sobel also said the bill’s silence on miscarriages that occur at home could discourage women from seeking medical help.

"Most people won’t ever tell anyone and go about their lives," Sobel said. Most miscarriages occur in the first trimester. Often, the "remains" of a misscarriage at that stage is often blood, clots and tissue that pass naturally. If that happens, Sobel said, "and then you go to your doctor for a follow-up, does your doctor then have to ask you where the remains are?"

She added: "And if you have a provider who believes in this bill, and the patient isn't aware and says they disposed of the remains at home. Are they then held financially responsible? It could make people who miscarry hesitant to seek health services."