During consideration this week of major legislation to expand health insurance for low-income children, the 110th Congress took important initial steps towards advancing two items at the center of the federal sexual and reproductive health policy agenda: expanding low-income women’s eligibility for Medicaid family planning services and making significant inroads against rigid abstinence-only-until-marriage policies.
Included in the House version of the legislation to reauthorize and expand the State Children’s Health Insurance Program (SCHIP) is a provision that would allow states—without having to go through a cumbersome waiver process—to expand Medicaid coverage for contraception up to the level of Medicaid coverage for pregnancy-related care. The Congressional Budget Office estimated that the state option to expand family planning likely would produce savings to the federal government of $200 million over five years and $400 million over 10 years.
The House SCHIP bill also includes a two-year extension of the controversial Title V abstinence education program. Title V would no longer be linked, however, to the Temporary Medical Assistance (TMA) program, which would be extended for four years. Abstinence-only advocates have long been effective in using the linkage with the popular TMA program as a shield against efforts to attack Title V. Decoupling the two programs would allow Congress to reconsider Title V on its own merits and reauthorize the program—or not—in the first year of the next presidential administration.
More immediately, the measure would make substantive modifications to Title V by requiring funded programs to provide “medically and scientifically accurate” information and by giving states flexibility either to continue supporting abstinence-only-until-marriage programs or switch to more comprehensive sex education programs that promote abstinence but also discuss the benefits of contraception. Since 1996, the federal government has poured more than $1 billion into rigid abstinence-only-until-marriage education programs, including Title V, even though there is compelling evidence that these programs are not effective in stopping or even delaying teen sex.
Meanwhile, the Senate approved its version of the SCHIP renewal bill late Thursday night. However, the Senate bill did not take on either TMA or the Title V abstinence program, and it did not include the Medicaid family planning eligibility expansion—leaving all of these issues to be resolved in a House-Senate conference. Significantly, however, the Medicaid family planning expansion provision did not draw any fire, either in committee or on the floor of the House, and it was not mentioned in the official Statement of Administration Policy formally relaying the list of White House objections to Congress.
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