As the economy stagnated in the early 2000s, more women needed publicly funded family planning and the number of women without insurance increased dramatically, according to new research released today by The Alan Guttmacher Institute. Researchers estimate that one in five women of reproductive age were uninsured in 2003--a 10 percent increase in uninsured women since 2001--and roughly 400,000 more women joined the ranks of those needing publicly subsidized care in just two years. However, 27 states and the District of Columbia have seen family planning funding decline or stagnate since 1994--a trend that could be exacerbated by new Medicaid cost-cutting proposals and greater hostility to reproductive health issues in Congress and state legislatures.
"Today, half of all women who are sexually active and fertile but do not want to get pregnant need publicly funded services to help them access birth control," said Rachel Benson Gold, director of policy analysis at The Alan Guttmacher Institute. "Yet in Congress and the states, we are facing a potential 'perfect storm' that could make it harder for these women to get contraceptives, counseling, and STD testing that help them plan their pregnancies and protect their health."
In 2002, 16.8 million women are estimated to have needed publicly supported contraceptive care, yet clinics were able to serve just 4 in 10, or 6.7 million women. As funding for programs dedicated to family planning--such as Title X of the Public Health Service Act--has decreased or leveled off, the burden of meeting women’s health care needs has shifted to Medicaid. Medicaid funding for contraceptive services has tripled since 1980, and the program now accounts for almost two-thirds of all federal and state family planning funding nationwide.
The budget President Bush presented to Congress in early February would drastically cut Medicaid as a whole, and the Administration is hoping to change the program’s rules to allow states to reduce benefits for some enrollees--possibly including eliminating the guarantee that family planning services are provided at no cost. Yet The Alan Guttmacher Institute estimates that every $1 spent on contraceptive services saves $3 for pregnancy-related and newborn care alone, and a government analysis shows that states that got federal approval to expand Medicaid coverage for family planning saved money while serving more women.
"Ironically, Medicaid is on the chopping block even as evidence mounts that it can be used to both improve access to contraception and reduce health care costs," Gold continued. "As we grapple with the future of Medicaid, we should consider how to encourage states to expand their investment in family planning because it makes for sound fiscal and public health policy."
In recent years, policymakers have also taken aim at the two other primary sources of publicly subsidized family planning--Title X and dedicated state revenues--each of which accounts for roughly 15 percent of government spending in this area. In Congress, family planning funding has become increasingly bogged down in debates over abortion--even though no Title X monies can be used for abortion services. Last year, Congress passed an appropriations rider that effectively negates Title X’s guarantee that clinics provide an abortion referral, upon request, to a woman facing an unintended pregnancy. This year, congressional abortion opponents have indicated that a ban on Title X funding for women’s health clinics that use private funds to provide abortions is a top priority. Meanwhile, in the states, long-running controversy over a similar provision has led one state--Missouri--to stop funding contraceptive services entirely. These kinds of restrictions were introduced in nine states last year, and similar proposals are expected in other state legislatures in the coming months.
Click here for federal and state trends in public funding for family planning.
Click here for national and state-level data on contraceptive needs and services.
Click here for a state-by-state breakdown of the key role Medicaid funding plays in family planning and the proportion of women who are uninsured.