Rand Paul, a candidate for the U.S. Senate from Kentucky, caused a stir last week when he argued that too many births in Kentucky are paid for by Medicaid, the joint federal-state insurance program for low-income Americans. According to Kentucky’s Cabinet for Health and Family Services, Medicaid pays for about half of the state’s 57,000 annual births. Paul is <http://www2.wnct.com/news/2010/oct/04/rand-paul-medicaid-has-turned-into... quoted by the Associated Press as saying that “Half of the people in Kentucky are not poor. We’ve made it too easy.”
In reality, paying for a pregnancy can be anything but easy. According to the March of Dimes, <http://search.marchofdimes.com/files/MOD_Maternity_fact_sheet_final_(2).pdf>maternity care costs more than $8,800, on average, and these costs can quickly escalate into the tens of thousands of dollars if complications arise (for instance, in the case of a premature birth). That’s why having insurance coverage is so critical. Employer-based group plans usually have good maternity care coverage, but most low-income women don’t get insurance through the workplace. And the National Women’s Law Center has documented that in the individual insurance market, few plans include maternity care coverage at all.
The recently enacted health care reform law would require all private insurance plans to cover maternity care starting in 2014. Meanwhile, however, insurance trends are moving in the wrong direction. According to a Guttmacher Institute analysis of new Census Bureau data, 2.3 million reproductive-age women lost private insurance coverage between 2008 and 2009 alone, bringing the total covered to fewer than six in 10.
That’s where Medicaid comes in. While income eligibility ceilings under the program in general are usually well below the official federal poverty line, federal Medicaid law requires all states to cover pregnancy-related care for women with incomes up to 133% of poverty. Kentucky and most other states have—wisely—decided to raise that level even further. Still, Kentucky’s eligibility, at 185% of poverty (which is typical among the states), amounts to only about $34,000 a year for a family of three.
Medicaid’s role in providing quality care for low-income pregnant women and their infants is not only a moral imperative. It’s also sound public health policy, considering the many negative health consequences that await mothers and children if they do not obtain appropriate care. Financial hurdles—particularly for the uninsured and underinsured—can lead to delayed or substandard care, and are an important reason why the United States lags behind most other developed countries in rates of maternal mortality and preterm births.
Another reason is that so many pregnancies in the United States, particularly among low-income women, are unintended—making Medicaid coverage of family planning services equally critical. Publicly funded contraceptive counseling and services empower low-income women to prevent pregnancies they don’t want to have and become pregnant only when they want to be, thereby maximizing their chances of having a healthy pregnancy and giving birth to a healthy infant.
Realizing these significant health benefits, 21 states have also increased their Medicaid income eligibility ceilings for family planning services, often pegging them to the same income level they have for pregnancy-related care. (Kentucky, unfortunately, is not one of them, but nearby states like Virginia, Arkansas and Missouri are.) The impact is significant: Publicly funded family planning services—the bulk of which are provided by Medicaid—avert 1.94 million unintended pregnancies each year. These pregnancies would result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages.
Given these benefits, conservatives of all stripes, including Paul, should strongly support publicly subsidized contraceptive services. Fiscal conservatives should applaud the fact that, by helping low-income women prevent births they themselves do not want to have, these services save almost $4 in public expenditures for every $1 invested. Social conservatives should be reassured that without them, the U.S. abortion rate would be two-thirds higher than it is. And pro-business conservatives should appreciate the value of enabling women to postpone childbearing while they complete their education, undergo job training or establish themselves in their career.
In short, Medicaid’s role as the safety-net insurer of both pregnancy-related care and family planning services is essential to the health of millions of American women and infants. It truly is smart, fiscally responsible government at its best—and it deserves support from across the political spectrum.
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