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Unintended Pregnancy Reduction Act introduced
By Cynthia Dailard
Senior Public Policy Associate
In May 2006, Hillary Clinton (D-NY) and Harry Reid (D-NV) — two senators with vastly different positions on abortion — stood together to introduce landmark legislation promising to significantly reduce the number of abortions in this country. Their bill, the Unintended Pregnancy Reduction Act, would build on state-level initiatives designed to extend Medicaid coverage of family planning services to additional low-income women.
A new analysis confirms that the approach would significantly reduce this country's high rate of unintended pregnancy, and therefore the need for abortion, by helping to reverse disturbing trends in contraceptive use that are placing more American women — and low-income women in particular — at risk of having an unplanned, and often unwanted, pregnancy. The need for this legislation became clear following the release of a groundbreaking new report by the New York City-based Guttmacher Institute, Abortion and Women's Lives, which paints a disturbing picture of two very different Americans — one in which middle and upper-class women are continuing decades of progress in reducing unintended pregnancy and abortion, and the other in which poor women are facing more unplanned pregnancies and growing rates of abortion.1
According to the institute, between 1994 and 2001, the unintended pregnancy rate for poor women shot up by 29%, even as it fell 20% for more affluent women. A poor woman in the United States now is nearly four times as likely as a more affluent woman to have an unplanned pregnancy, five times as likely to have an unintended birth, and more than three times as likely to have an abortion as her higher-income counterpart.
These trends can be explained, in part, by patterns of contraceptive use. Between 1995 and 2002, contraceptive use fell slightly among all women at risk of unintended pregnancy (women who are sexually active and able to become pregnant, but who are not seeking a pregnancy), but precipitously among poor women.
These dramatic findings struck a chord with Sens. Clinton and Reid, who quickly moved to introduce legislation designed to rectify this situation. Their bill would require states to provide coverage of Medicaid family planning services to individuals using the same income levels used to determine eligibility for Medicaid-funded prenatal, labor, delivery, and postpartum care. States are required to provide coverage of pregnancy-related care to women with incomes up to 133% of the federal poverty level, and many states go up to 185% of poverty and beyond. This stands in sharp contrast to the regular income eligibility ceiling set by most states for Medicaid, which averages only 67% of poverty nationwide, and dips as low as 20% in Alabama, Arkansas, and Louisiana.
In so doing, the Clinton-Reid bill, and companion legislation introduced by Rep. Nita Lowey (D-NY) in the House, would establish the nationwide principle that 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.
This legislation builds on the examples of a number of states that have already adopted such a "parity" approach. In fact, 16 states already have expanded their Medicaid programs in this fashion; these states, however, have had to jump through bureaucratic hoops of seeking federal permission (by obtaining a "waiver") to do so. These states include Alabama, Arkansas, California, Iowa, Louisiana, Michigan, Mississippi, New Mexico, New York, North Carolina, Oklahoma, Oregon, South Carolina, Washington, and Wisconsin; Minnesota extends eligibility for contraceptive services to women with an income up to 200% of poverty, but extends eligibility for pregnancy-related services to 275%. Four states (Illinois, Massachusetts, Pennsylvania, and Texas) are awaiting federal approval for their waiver applications.
Fortunately, these states are being rewarded for their efforts. A 2003 federally funded evaluation of six states' Medicaid family planning expansions found that each state realized substantial net savings associated with the costs of unplanned births.2 For example, Arkansas saved nearly $30 million in a single year, while Oregon saved $20 million. Similarly, a recently published evaluation of California's program found that in 2002, its program alone helped women avoid 205,000 pregnancies, including 79,000 abortions and 94,000 births, including 21,4000 to teens.3
Furthermore, a new analysis by the Guttmacher Institute suggests that the Clinton-Reid approach of expanding Medicaid coverage for contraception so that it matches Medicaid coverage for pregnancy-related care on a national level would have a dramatic impact on unintended pregnancy and abortion rates. It would enable low-income women to prevent a total of nearly 500,000 unwanted pregnancies annually, including 200,000 abortions. By helping them to prevent an estimated 225,000 unplanned births, such an effort also would save $1.5 billion in annual federal and state expenditures.4 The impact of all this on women's lives, the lives of their families, and low-income communities would be enormous.