“Save The Babies Or Save The Budget”: Dear Conservatives, Your Opposition To Family Planning Comes With A Huge Price Tag
Conservatives have long painted themselves as the guardians of fiscal sanity. But they have also fashioned themselves as the guardians of the innocent babies being preyed upon at Planned Parenthood. Even though abortions make up just 3 percent of the services Planned Parenthood provides—and many clinics don’t provide them at all because of restrictions placed on the funding they receive—conservatives have long held a legislative grudge against the organization and have even broadened their contempt to other family planning clinics.
That deep-held distaste for women’s health providers led Texas lawmakers last year to slash $73 million from all of its family planning services and shift the money to other areas of the budget. This blunt instrument hit all of the state’s women’s health providers, but was meant to target Planned Parenthood and deny it taxpayer dollars—even though the clinics that received state subsidies for care never performed abortions.
This may be in line with their staunch opposition to what they see as a baby-killer, but that ideology comes with quite the price tag. News has surfaced that for the two-year period between 2014 and 2015, poor women are expected to deliver nearly 24,000 babies that they wouldn’t otherwise have had if they had access to state-subsidized birth control. Those extra births will cost taxpayers as much as $273 million, with between $103 million to $108 million of that hitting the state’s general revenue budget alone. Much of the cost comes from caring for those infants through Medicaid.
Lawmakers may not care about what this means for the lives of the low-income women who are now bearing and raising children whose births they would have otherwise prevented had they had access to contraception. But conservatives, the fiscally responsible party, are now thinking twice about the budgetary implications. The New York Times reported last week that “a bipartisan coalition is considering ways to restore some or all of those family planning dollars, as a cost-saving initiative if nothing else.” It’s not like the budget hit should come as a surprise, however. When the cuts were initially debated, an estimate was circulated that they would lead to an extra 284,000 births at a cost of $239 million. Yet the cuts passed, “a price that socially conservative legislators were willing to pay in their referendum on Planned Parenthood,” as the Times reports.
And unfortunately, the ideological battle against Planned Parenthood will not be brought to a complete cease-fire, even in the face of these stark numbers. Planned Parenthood will almost certainly be excluded from any reinstated family planning funding because of an existing ban against taxpayer money going to providers who are “affiliated” with clinics that perform abortions, even if they don’t do so themselves. While there are other women’s health providers in the state, RH Reality Check’s Andrea Grimes set out to find out whether the hundreds of listings on Texas’s website actually provide the services women need. She found that “many of them don’t provide any kind of contraceptive care, don’t take Medicaid Women’s Health Program clients, or are simply misleading duplicate listings.”
And the ones that do offer the right services likely won’t be able to meet the huge increase in demand. Grimes cites a study that found that Planned Parenthood accounted for half of the state’s women’s healthcare, serving nearly 52,000 clients. The remaining providers mostly serve ten or fewer patients. That’s just not going to cut it for all of the women who now need to find care.
Continuing to deny funding to Planned Parenthood will keep costing the state, even if other clinics see their funding reinstated. To the tune of an estimated $5.5 million to $6.6 million as a result of paying for the entire women’s health program on its own, rather than receiving the 90 percent federal matching funds, as well as paying for a higher number of births that will have to be covered by Medicaid funds.
Texas is a huge state, so its case sticks out like a sore thumb. But it’s not the only one to go after family planning services and Planned Parenthood. As the Guttmacher Institute reports, last year some states felt compelled by the federal push to ban federal funds from going to Planned Parenthood to look at whether providers in their states that use private funding for abortion should be barred from receiving state funding or, in some cases, federal Medicaid reimbursements. Currently, six states prohibit some providers from receiving family planning funds and in three the restrictions apply to those that provide abortion or are affiliated with agencies that do.
So conservative lawmakers across the country will now be faced with a choice: save the babies or save the budget. Because it’s clear that you can’t do both. Organizations that provide contraception—and, it must be said, abortions—not only do great service to the women who need to control their fertility and their lives. They do great service to taxpayers. By giving women access to contraception, publicly funded family planning organizations save us $3.74 for every dollar we spend in avoided Medicaid costs associated with unplanned births. Their services saved federal and state governments $5.1 billion in 2008.
As Texas has just found out, those aren’t imaginary numbers. They are very real. Whoever says that contraception and abortion aren’t economic issues should take a second look. They have a huge impact on women’s financial situations. But, perhaps higher on conservatives’ checklist, they have an enormous impact on the budget.
By: Bryce Covert, The Nation, December 10, 2012
“Still Under Women’s Clothes”: Michigan Abortion Legislation Package Moves Forward
State lawmakers in Michigan are using their lame-duck session to pass a bundle of bills that would significantly restrict women’s ability to access and pay for abortions in the state.
The state Senate passed three bills on Thursday that would ban abortion coverage in state-based health insurance exchanges and all private insurance plans, and another bill that would allow employers and medical professionals to refuse to cover or provide health treatment to which they morally object. State lawmakers are also expected to pass a so-called omnibus bill on Thursday that would impose prohibitive building regulations on abortion clinics and ban the use of telemedicine to prescribe abortion medication.
“It feels like [state legislators] are completely tone-deaf to what Americans want in general, which is for legislators to pay attention to the economy, particularly in Michigan, and to women and their power to say, ‘This is what we want, and this is what we don’t want,'” Desiree Cooper, a spokeswoman for Planned Parenthood Advocates of Michigan, told The Huffington Post.
Senate Bills 612, 613 and 614, which passed along party lines in the State Senate on Thursday, will prevent all insurance plans in Michigan from covering abortion unless a woman would die without the procedure. The measures do not include exceptions for rape, incest or pregnancy complications that would jeopardize the mother’s health. Private insurance companies will be given the option to carry a separate abortion coverage policy that the woman would have to pay for in addition to her regular coverage.
Republicans said they support the bills because they allow people who morally object to abortion to ensure that their money doesn’t feed into a pool that pays for the procedure. Reproductive rights advocates argue that the bill is unreasonable, because insurance companies are not likely to offer that separate rider.
“It’s somewhat of a false promise,” said Meghan Groen, director of government relations for PPAM. “No insurance company currently offers a rider for abortion coverage, and no woman is going to purchase a separate rider for something she hasn’t planned. You’re talking about an unexpected pregnancy, or a fetal anomaly.”
State senators also passed a bill on Thursday by a vote of 26 to 12 that would allow employers, doctors, nurses and pharmacists to conscientiously object to providing or paying for certain medical services, including birth control and abortion. Senate Republicans argued that the bill protects religious freedom. The Detroit Free Press reports that one Republican doctor, state Sen. Roger Kahn (R-Saginaw), broke with his party to oppose the bill.
“I don’t know how this doesn’t violate the oath I took, when I promised to resuscitate someone with TB or treat someone with AIDS,” he said.
The House is expected to consider those bills next week. In the meantime, it is expected to pass an omnibus bill that would further restrict abortion access. House Bill 5711 would regulate abortion clinics as surgical centers by imposing strict physical building requirements on them, such as minimum doorway sizes and minimum square footage. The regulations could effectively shut down some clinics in the state.
The omnibus bill also includes a provision that ends telemedicine abortions, which are commonly used by women in rural and medically under-served areas of the state. According the Groen, 21 out of 83 counties in Michigan have no local OBGYN, so telemedicine allows doctors to prescribe medication abortions to women in early stages of their pregnancies through a phone or internet consultation. Michigan Gov. Rick Snyder (R) recently signed a bill that expands the use of telemedicine in other areas of health care.
State Sen. Coleman Young II (D-Detroit) sharply criticized his Republican colleagues on Thursday for pushing forward with the anti-abortion agenda. “Get the government from underneath women’s clothes,” he said. “We’ve already had this conversation. Obama won, Romney lost, get over it.”
By: Laura Bassett, The Huffington Post, December 6, 2012
“Whose Body Is It?”: Pharmacists Can’t Be Allowed To Deny Women Emergency Contraception
Women deserve the chance to prevent pregnancy after birth control failure, sexual assault, or unprotected sex. Emergency contraception, also known as the “morning-after pill,” is FDA-approved and prevents pregnancy after sexual intercourse. But it is time-sensitive; it only works if women are able to obtain it without delay or discrimination.
Unfortunately, healthcare providers are refusing to dispense emergency contraception based on their own religious or moral beliefs, thereby overriding women’s decisions about their bodies and lives. Pharmacists in at least 24 states have refused to sell birth control or emergency contraception to women. Some hospital emergency rooms refuse to provide emergency contraception to rape victims.
Some healthcare providers even lie to women—for example, by saying it will cause an abortion. In one case, a woman believed a Wisconsin pharmacist who called her a murderer. Although it will not work once a woman is pregnant, she did not fill her prescription and got pregnant. In a California incident, a couple with a newborn sought emergency contraception after birth control failure. The pharmacist called them irresponsible, refused to fill the prescription, and did not enter it into the system so that it could be transferred elsewhere.
Laws should require all hospitals and pharmacies to establish a system to ensure that women in need of birth control, including in emergency situations, receive it without discrimination and delay. Individual healthcare providers with religious objections may be accommodated—for example, by making sure two pharmacists are on duty—but not at the expense of patient access to critical healthcare. This approach is consistent with long-standing protections for individual religious beliefs in the workplace. Refusing providers must treat patients with respect and ensure that patients receive care from another provider. They cannot—as one Wisconsin pharmacist did—leave customers waiting indefinitely for assistance in the store and on the phone. A patient should not even know her healthcare professional objects.
Refusals often result in women feeling judged, shamed, angry, and vulnerable, and they reduce women’s trust in the healthcare system. Additionally, refusals violate informed consent, restricting women’s information and options. Delays or denials of emergency contraception can lead to pregnancy. For some women, pregnancy can entail severe health risks and even life endangerment. A refusal to provide emergency contraception can further traumatize an already traumatized woman—like a rape survivor. Refusals are most burdensome on people in rural areas, or those with low incomes and no job flexibility. For example, an Ohio woman refused emergency contraception at her local pharmacy had to drive 45 miles to find another pharmacy. And some women may be limited by their insurance plan to a particular pharmacy or provider.
Recognizing the harm of refusals, states, national professional associations, and pharmacy chains have acted to protect women’s access to emergency contraception. Twenty-three states and Washington, D.C., have laws and/or policies that improve women’s access to it, such as requiring hospitals to provide it to rape survivors. Major pharmacy chains have adopted policies ensuring that women leave the pharmacy with contraception in hand. Professional healthcare associations have issued guidance protective of patients’ right to receive care. The religious beliefs of pharmacists, doctors, nurses, or other healthcare providers should not trump a woman’s ability to make decisions about her reproductive health. Those decisions are personal, and they should stay that way.
By: Gretchen Borchett, U. S. News and World Report, October 15, 2012
“Terrifying Implications”: Texas Says “No Thanks” To Women’s Health Care
If you haven’t been worn down reading about Todd Akin’s bizarre and ignorant views about the female reproductive system, now turn to Texas, where women’s uteruses may soon have to move out of state to find health care. Late Tuesday night, a federal court of appeals ruled that Texas can exclude Planned Parenthood from the Women’s Health Program, which provides basic preventative care—like birth control and cancer screenings—for low-income women. The decision has terrifying implications in a state where women’s access to health care is already poor.
One in four women in Texas is uninsured, and the state also has the third-highest rate of cervical cancer in the country. In Texas, women’s health-care clinics serving low-income populations rely on two sources of funding: the Women’s Health Program and general state family-planning dollars. Lawmakers have attacked both streams.
In 2011, the state legislature slashed state funding for family planning—you know, the thing that prevents abortions—by two-thirds. A recent report from the Texas Observer revealed that 60 family planning facilities have already closed as a result of the cuts. While a full picture of the effect is still emerging, the Legislative Budget Board, a bipartisan committee, had estimated that when all was said and done, the cuts would lead to 20,000 additional births (which Medicaid would have to pay for). Projections show that around 180,000 women would lose health services.
Then there’s the damage to the state Women’s Health Program (WHP), a separate program that serves 130,000 low-income women. Created in 2005, the WHP is a crucial state service that provides preventative health care and family-planning services. It’s run through Medicaid, so the feds paid for 90 percent of the $40 million program. While it only serves women who are not pregnant, it saved around $75.2 million in 2009 by preventing a projected 6,700 births. The program seemed like a win-win; it decreased unplanned pregnancies and abortions, while increasing access to health care.
But the WHP may soon not exist, or at least not in a recognizable way. Lawmakers added new rules in 2011 that excluded Planned Parenthood from receiving funding. The trouble is, Planned Parenthood provided services to nearly half the women covered under the program and received about 25 percent of the program’s total funding last year. Barring the organization leaves many wondering whether those clinics left would meet demand.
Furthermore, the state violated federal policy by slashing Planned Parenthood funding, which means Medicaid can no longer foot the bill for the Women’s Health Program. Texas supposedly has a plan to transition to a state-run program by November 1; that plan will continue to exclude Planned Parenthood. The influential organization is fighting the state’s decision, and in October, the two parties begin court proceedings on whether Texas can permanently exclude the main provider of women’s health from its Women’s Health Program.
Yesterday’s decision means that between now and the court case, Texas can halt funding to Planned Parenthood clinics. It’s only a few months, but the clinics are already reeling from the family-planning cuts. The loss of WHP funding is a double whammy. Twelve Planned Parenthood clinics have already shut down, alongside the many clinics with no relation to the organization. Meanwhile, if the courts ultimately decide Texas cannot exclude Planned Parenthood from the WHP, the state may opt to shut down the program entirely.
Many, including the attorney general and Governor Rick Perry, celebrated the decision, and the state Health and Human Services Commission announced it would immediately halt funding to the group. Meanwhile, for the hundreds of thousands of low-income women in the state, there are fewer and fewer health-care options.
By: Abby Rapoport, The American Prospect, August 22, 2012
“Unexpanded Medicaid”: Millions Of Women Could Remain Uninsured If States “Opt Out”
It can seem like just a mirage created by the summer heat: only a few weeks ago the Supreme Court actually handed down a decision that progressives could celebrate. It held that the Affordable Care Act is constitutional, including the individual mandate, meaning that implementation can roll on full steam ahead. I was one of the first to celebrate, in particular for all the ways that the law will help women who need healthcare (which is all of us). As Katha Pollitt recently wrote here, women will benefit dramatically from the ACA. The law bars practices like charging women more just for being women, dropping women’s coverage if they become pregnant or sick, and denying coverage due to “pre-existing conditions” like having had breast cancer or being a victim of domestic violence. It adds new benefits like birth control coverage at no cost to the patient, expanded coverage of preventative services like prenatal care, mammograms, pap smears, and bone-density screenings through Medicare, and requiring insurance companies to cover maternity care.
But one aspect of the Supreme Court’s decision could have some very bad results for women: the ruling that states can opt out of the Medicaid expansion. While this could end up harming men and women, women in particular stand to suffer if states refuse to participate in the program.
The Medicaid expansion is a crucial component of the law’s overall goal of extending coverage to over 30 million uninsured Americans by 2019, covering almost half of the total number of people the bill promised to insure. Originally, the law included a provision that the federal government could take away all of a state’s Medicaid funding if it refused to go along with the expansion, which all but ensured participation. But the Court ruled that such a maneuver was unconstitutional. Just a few days after the decision was announced, seven Republican governors said they would flat out reject the money to expand Medicaid rolls, with at least eight more looking to follow suit. More have said no since then.
This could create a no-man’s land for those who earn less than 100 percent of the Federal Poverty Line, making them ineligible for tax subsidies to help them buy insurance, but don’t qualify for their state’s (unexpanded) Medicaid program. These Americans are surely struggling to get by, but not quite enough to get health coverage promised to those above and below them.
And women are likely to fall into this chasm. Remember that unexpanded Medicaid does not cover most childless adults. Currently, a woman must meet both categorical and income criteria to qualify for Medicaid: she must be pregnant, a mother of a child under age 18, a senior citizen, or have a disability, and each category has income criteria, which differ state by state. Given that women are more likely to be pregnant (duh) but also to fall into the other categories, they are already the majority of enrollees in the program. However, given that many women don’t meet categorical criteria, many don’t qualify no matter how poor they are. Over 17 million women lived in poverty last year, compared to 12.6 million men.
By 2016, 13.5 million women were expected to get coverage under the Medicaid expansion. That figure is now in danger. As the Kaiser Family Foundation reported before the Supreme Court decision, “Medicaid will be the foundation of health coverage expansions to very low-income women.” But not if some Republican governors get their way.
Many of the states already rejecting the expansion are home to the greatest number of women who would benefit. Texas and Florida top the list for the most uninsured women in their states: about 2.4 million and 1.5 million, respectively, and both states plan to refuse the expansion. (Some of these women were supposed to get coverage through the Medicaid expansion, but some will still qualify for the subsidies and be able to buy insurance in the state exchanges.)
Using Kaiser’s predictions, I calculate that there are over 4.2 million women who would be eligible for the Medicaid expansion by 2014 in the states either refusing or indicating they will refuse to participate. That’s a huge chunk of the 10 million women that were expected to be covered by that time through Medicaid.
Those are the immediate impacts on low-income, uninsured women. The ruling may have other far-reaching impacts on women’s lives, however. As Jessica Mason Pieklo writes at RH Reality Check, the idea that the federal government can’t withdraw all Medicaid funds from states that don’t follow federal requirements might have other consequences. The first may be states that are trying to prevent Medicaid from contracting with providers that also offer abortions (i.e., in many cases, Planned Parenthood). Such a case is going on in Indiana right now. As Pieklo writes,
Thanks to the majority in NFIB v. Sebelius, conservative states looking to enact state-wide funding bans may have the framing necessary to pin the federal government. That’s because the language of Roberts’ opinion as to the Medicaid expansion is vague enough to argue that the federal government can’t coerce a state into funding Planned Parenthood by threatening to withhold all of that state’s federal Medicaid money, especially, since conservative states argue, they believe cutting Medicaid funds is the only way to guarantee state dollars do not fund abortion services.
Planned Parenthood and its affiliate centers provide services to 3 million people annually, including 4 million tests for sexually transmitted infections, 770,000 Pap tests, and 750,000 breast exams. Banning Medicaid from contracting with Planned Parenthood will hurt the low-income women who need these services—but states may now have a legal leg to stand on if they try to do just that.
Perhaps the worst thing of all? The excuse that Republican governors are using to get out of the Medicaid expansion may not even hold up. They claim to be worried that even though the federal government will pick up the whole tab for the first few years, the portion they’ll have to pay after that (10 percent) is too burdensome on their budgets. Yet there is evidence that expanding Medicaid could actually help their finances. Rejecting the Medicaid expansion may not even make fiscal sense, but no matter what it doesn’t make moral sense. It could leave millions of women exposed, unable to afford health insurance but not able to participate in Medicaid.
By: Bryce Covert, The Nation, July 17, 2012
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