Reproductive health: Where does it stand?
Reproductive health: Where does it stand?
Reproductive health is in for a bumpy ride in 2012, if new 2011 legislative actions are any indicator, according to a new Guttmacher Institute analysis.1 Case in point: 68% of 2011 state legislative provisions (92 in 24 states) restrict access to abortion services, and three states (Montana, New Hampshire, and Texas) imposed stringent budget cuts for family planning.
The family planning escaped major reductions in nine of the 18 states where the budget has a specific line-item for family planning. The nine are Colorado, Connecticut, Delaware, Illinois, Kansas, Massachusetts, Maine, New York, and Pennsylvania. However, the story was different in the remaining nine states, the report notes. In six states (Florida, Georgia, Michigan, Minnesota, Washington, and Wisconsin), family planning programs sustained deep cuts, although they were generally in line with decreases for other health programs. However, the cuts to family planning funding were disproportionate to those to other health programs in the remaining three states, the report notes. Montana eliminated the family planning line item. New Hampshire and Texas cut funding by 57% and 66%, respectively.1
Last year was indeed a rough year for family planning providers, acknowledges Clare Coleman, president and chief executive officer of the Washington, DC-based National Family Planning and Reproductive Health Association (NFPRHA). "State legislatures made serious cuts to public health and family planning programs, under pressure both to balance budgets and achieve blatantly ideological aims," observes Coleman. "At the federal level, the U.S. House of Representatives voted to eliminate Title X, specifically targeted providers that offer abortion care, and even tried to undermine Medicaid."
Get ready for battle
The budget battles of 2011 will persist through 2012, which means that the best-case scenario is to maintain present funding, states Coleman. In 2011 alone, Title X sustained two funding cuts totaling $20.7 million.
"In real terms, reductions in funding mean reduced access to basic and preventive health care," says Coleman. "Health centers have already reported having to reduce center hours, lay off staff, and even limit the range of services made available to patients."
NFPRHA expects the partisan hostilities on family planning, abortion, and sexual health services to continue, given that 2012 is an election year, says Coleman. These inherent challenges will make sustaining funding for family planning and reproductive health that much harder, she states.
Expansions might hold key
Given the difficult fiscal and political climate states are confronting, it is especially noteworthy that significant interest continues in expanding Medicaid eligibility for family planning, says Rachel Benson Gold, MPA, director of policy analysis at the Guttmacher Institute Washington, DC office. Gold points to three significant developments in 2011:
- The Maryland legislature directed the state to extend coverage to individuals with an income of up to 200% of the federal poverty level. The state previously had a more limited expansion that extends coverage only to women following a Medicaid-funded delivery, states Gold. The state's request was approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicaid. The program went into operation at the first of January 2012.
- The legislature in Washington state directed officials to raise eligibility under the program from 200% to 250% of the federal poverty level. The action reversed an earlier attempt by the state agency, as part of a larger effort to cut state expenditures, to discontinue its existing Medicaid family planning expansion.
- The federal CMS approved Ohio's request to expand eligibility for its family planning program to individuals with an income of up to 200% of the federal poverty level. This move is particularly significant because Ohio is the first totally new state to utilize the authority under healthcare reform to expand Medicaid eligibility for family planning; all the other states that have done so had previously expanded eligibility by obtaining a federal waiver, says Gold.
Guttmacher Institute analysts are seeing continued interest in other states in expanding Medicaid eligibility for family planning moving forward into 2012, reports Gold. Several states are moving to extend waivers that are nearing their expiration dates; at least one state with a waiver nearing expiration is seriously considering significantly expanding its program, and another state that has not expanded at all appears close doing so, she notes. All of these moves underscore the benefits seen in states that have expanded, says Gold.
"As we discussed in our recent report, these benefits include increased contraceptive use, including both increased use of more effective methods and improved continuity of use, which has translated into measurable declines in unplanned pregnancy and teen pregnancy, and the births, abortions, and miscarriages that would otherwise have resulted," Gold states. "It has also helped women to plan and space their pregnancies, which has positive implications for the health of pregnant women and newborns, as well as the economic and social well-being of families; at the same time, these programs have generated significant cost savings for the federal and state governments." (Readers can download the Guttmacher Institute report on Medicaid expansions at http://www.guttmacher.org/pubs/Medicaid-Expansions.pdf.)
Reference
- Guttmacher Institute. States Enact Record Number of Abortion Restrictions in 2011. Accessed at http://www.guttmacher.org/media/inthenews/2012/01/05/endofyear.html.
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