The Family Planning Fracas

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There’s been a lot of huffing and puffing this week about a provision to expand access to Medicaid-covered family planning services. First it was Republicans, who grew faint at the idea of voting for a stimulus package that contained such a provision (not that they rushed to vote for it without the provision). Then it was Democrats, who grew faint at the idea that their new liberal president would betray women, family planning, and the republic by removing the provision from the stimulus bill.

I decided to take a look at what the provision actually would have done and at what the deal is now that it isn’t part of the stimulus bill that just passed the House.

The short version? Everyone needs to chill out. Republicans: The provision would have allowed states to cover family planning services–but not abortion–that they already cover for low-income women who don’t otherwise qualify for Medicaid, just without first requiring states to obtain a waiver from the federal government. That’s it. It wouldn’t have permitted new services to be included under “family planning.” It wouldn’t have required states to cover anything or anyone that they didn’t want to. It just would have allowed them to do what they’re already doing without first going through the red tape of obtaining a waiver.

And Democrats: States can still provide the same family planning services to low-income women by applying for a waiver. Twenty-six of them already have waivers. The others–and this is important–wouldn’t have been required to expand their Medicaid coverage even if the provision had gone through. The only thing the provision would have done is eliminate the waiver requirement for states that changed their minds and decided to start covering low-income women under Medicaid.

Now. The waiver process is burdensome–it can take as long as 24 months, states have to reapply after five years, and because the program was originally set up kind of as a demonstration project, states have to prove that the impact would be cost-neutral. We’re 26 states in now and the evidence is that the program is more than cost-neutral. The CBO score of a similar provision back in 2007 was that it would save $400 million over ten years; a new CBO score of this provision adjusted that total to $700 million over the same time period. So the waiver hoop should be unnecessary now.

What’s more, expanding Medicaid coverage to give low-income women access to family planning services before they get pregnant should be a no-brainer. When bright blue states like Texas, Mississippi, and Alabama already use waivers to provide family planning through Medicaid, you have to wonder what it was about the provision that made John Boehner hyperventilate.

In the end, this week’s fight came down to symbolism. Republicans thought they could paint the stimulus bill as a gift to “the abortion industry” when in fact the provision changes virtually nothing about current law. And Democrats chose to interpret Obama’s decision to remove the provision once it became a political football as a signal that he doesn’t care about preventative health care or family planning or women. Everyone needs to chill out. And when this issue comes up again in the next few months, maybe we can rely on fact instead of fiction.