Support Medicaid Legislation To Reduce Unintended Pregnancy

Why Is the Bill Needed?

The Clinton-Lowey bill has two related goals that are critical to the nation’s effort to help reduce its high rate of unintended pregnancy and abortion.  First, it addresses changes made by the recently enacted Deficit Reduction Act (DRA) that may jeopardize women’s ability to obtain family planning services and supplies through Medicaid.  Until the DRA, Medicaid had guaranteed coverage for family planning services and supplies for all who participated in the program since 1972.  The DRA removed that vital guarantee, by allowing states to offer stripped-down “benchmark” plans to some populations without family planning — including many parents and even pregnant women who historically would have been entitled to family planning services as part of postpartum care.  The Clinton-Lowey bill would restore that vital protection in place for more than three decades, thereby once again ensuring that women who are eligible for Medicaid will receive the family planning services and supplies necessary for them to avoid unintended pregnancy. 

Second, the Clinton-Lowey bill would require states to provide coverage of Medicaid family planning services to women (and men) up to the same income level used to determine eligibility for pregnancy related care.  (States are required to provide coverage of pregnancy-related care to women with incomes up to 133 percent of the federal poverty level, and many states go up to 185 percent of poverty and beyond.)  Recognizing the cost-effectiveness of helping women avoid unintended pregnancies, 20 states have already chosen to go this route, but have had to jump through the bureaucratic hoops of seeking federal permission (by obtaining a “waiver”) to expand their family planning programs in this manner¹.   This legislation would build on this existing state effort and establish as a nationwide principle that those low-income women who would qualify for Medicaid if they became pregnant should have the opportunity and means to avoid pregnancy if they so choose. 

Poor women Are disproportionately Likely to Have an Unintended Pregnancy

The Clinton-Lowey bill would go a long way in addressing some of the disturbing economic disparities raised by a recent report by the Guttmacher Institute, Abortion in Women’s Lives, which showed that poor women in our country are losing critical ground when it comes to avoiding unintended pregnancy and abortion.  A poor woman is four times as likely to have an unintended pregnancy, five times as likely to have an unintended birth, and more than four times as likely to have an abortion as her higher-income counterpart.

• Eight percent of poor women at risk of unintended pregnancy were not using a method of contraception in 1995; by 2002, that proportion had grown to 14 percent.
• Between 1994 and 2001, poor women’s rate of unintended pregnancy increased by almost 30 percent, even as the rate declined by 20 percent for more affluent women.
• The unintended pregnancy rate for poor women is nearly four times that of more affluent women (112 v. 29 per 1,000 women).
  

As a Result, Abortion Is Becoming Increasingly Concentrated Among Poor Women

• Between 1994 and 2000, abortion rates increased among poor women, even as they continued to decrease among more affluent women.
  
  
• In 2000, the abortion rate among poor women was more than four times that of more affluent women (44 v. 10 per 1,000 women).
  

Expanding Medicaid Coverage of Family Planning Services Is Proven Effective

Medicaid coverage of family planning services is proven effective in helping low-income women avoid unintended pregnancy, thereby saving money for the state and federal governments. In 2002, California’s effort to expand access to Medicaid-funded family planning services averted 213,000 unintended pregnancies, 82,000 of which would likely have resulted in abortions. Moreover, every dollar spent on family planning services saves three dollars in pregnancy- and birth-related costs for Medicaid alone. A 2003 U.S. Department of Health and Human Services (HHS)-funded evaluation of six states that expanded access to Medicaid-funded family planning services found that each state realized substantial net savings. For example, the Arkansas’ program resulted in a savings of nearly $30 million in a single year, while the program in Oregon saved $20 million.

¹AL, AR, CA, IA, LA, MI, MN, MS, NM, NY, NC, OK, OR, SC, WA, WI already have such a waiver, while IL, MA PA, TX have a waiver application pending with the federal government.