Washington Watch

Rocky road forecast for family planning in 2006

By Cynthia Dailard

Senior Public Policy Associate
Guttmacher Institute
Washington, DC

This promises to be a rocky year for federal family planning policy — with potentially serious implications for the millions of low-income women who rely on Medicaid, Title X of the Public Health Service Act, and other federal programs for their family planning care. It also may have serious ramifications for family planning providers who rely on these programs to sustain their operating budgets and the delivery of care.

The federal budget reconciliation bill signed into law by President Bush in February contains at least two changes to Medicaid statutory requirement that are likely to threaten the provision of family planning services and supplies to many low-income women. Most notably, the law ends the longstanding federal Medicaid statute that has required that all state Medicaid programs cover family planning for all program enrollees by allowing states to offer stripped-down benefit packages — possibly without family planning services and supplies — to certain categories of Medicaid enrollees that states cover at their option. These categories include many pregnant women (those with incomes above 133% of the poverty level), parents, childless adults, and possibly others.

Additionally, the law is likely to subject many low-income women seeking family planning through Medicaid to new cost-sharing requirements. Historically, the federal Medicaid statute has prohibited states from requiring cost-sharing for family planning. While the new law would continue to exempt family planning services from cost sharing requirements, it would allow states to impose cost-sharing for some brand-name family planning drugs, although the cost-sharing has to be low enough to be considered "nominal." Even a minimal cost-sharing requirement can, for some women, become a barrier to care. Overall, the nonpartisan Congressional Budget Office has projected that by 2015, 20 million Medicaid beneficiaries may be required to pay new or increased cost-sharing for prescription drugs and that new premiums and requirements to prove U.S. citizenship will prevent 100,000 people from participating in Medicaid.

Meanwhile, the president’s budget proposal for fiscal year 2007, released in February, suggests that more onerous Medicaid cuts may be on the horizon.

The budget includes vague language promising a "new waiver initiative that emphasizes market-driven approaches to health care" to allow changes to Medicaid beyond those allowed by the reconciliation law. Additional Medicaid reform proposals also are expected to emerge near the end of the year, when the Medicaid Commission is slated to release its long-term recommendations for the program.

The president’s budget also contains some unwelcome news for publicly funded family planning providers. Once again, the president has proposed level funding the Title X program, which now is set at $283 million. Federal block grants, which in some states provide important sources of family planning funds, fared similarly or worse: The budget recommends level funding for Maternal and Child Health Block Grant ($693 million) and a half-billion-dollar cut to the Social Services Block Grant (SSBG). This 29% cut, which is justified on the grounds that the program overlaps substantially with other programs and because it fails to ensure that the funds are directed toward activities that achieve results, could have serious repercussions for family planning providers who work in those 10 states that devote significant SSBG funding to family planning care.1 These states are Illinois, Indiana, Iowa, Maine, Mississippi, New Hampshire, New Jersey, Pennsylvania, Texas, and Vermont.

At the same time, the president recommended that total funding for abstinence-only education programs rise from $177 million to $204 million, and he established a goal to raise total funding for abstinence education programs to $270 million by the administration’s end. These programs are prohibited under law from discussing contraception in any positive way.

New legislation in play

In January, family planning opponents in Congress, led by Sen. David Vitter (R-LA), introduced the Title X Family Planning Act. The proposed legislation, which would amend Title X of the Public Health Service Act, seeks to disqualify family planning providers that perform abortions with their own nonfederal funds from receiving Title X family planning funding. The legislation clearly is designed to defund many Planned Parenthood clinics, as it specifically exempts hospitals from its reach.

While still serving in the House, Vitter attempted to offer similar language to an appropriations bill in 2001, but his timing was bad. On the heels of Sept. 11, House Republican leaders put the kibosh on highly controversial legislative initiatives. In contrast, the Washington, DC-based Family Research Council is highlighting the bill as one of its priorities for enactment for this election year.

Whether Vitter and the Bush administration will prevail on any or all of these fronts is unknown. One thing, however, is clear: The stakes for low-income women and the providers of subsidized family planning care are incredibly high.

Reference

  1. Alan Guttmacher Institute. Public Funding for Contraceptive, Sterilization and Abortion Services, FY 1980-2001. Accessed at: www.guttmacher.org/pubs/fpfunding/index.html.