Mr. President: Save Medicaid Family Planning

Lon Newman

Medicaid Family Planning Waivers save money by reducing more costly Medicaid-paid births by preventing unintended pregnancies, and Congress has an opportunity to improve the program.

Congress and family planning advocates could take a lesson from Princess Dagmar of Denmark. Wife of Russian Tsar Alexander III, the princess moved the comma in a prisoner's written condemnation and changed the meaning from "Pardon impossible" to "Pardon, impossible to be sent to Siberia."

The grateful prisoner was freed and the princess demonstrated that to get results in the empire, a technically subtle approach might be successful where a direct approach might fail.

Now how about freeing access to reproductive health care for women in a half-dozen states who are receiving services under Medicaid Family Planning Waivers that will end before the term of the current "tsar" on January 20, 2009?

On December 7 Senator Hillary Clinton (D-NY) distributed a letter for cosigning to senators from the 26 states currently authorized to provide family planning services through Medicaid 1115 Family Planning Waivers. These Family Planning Waivers allow low and moderate income women who would otherwise be ineligible for Medicaid coverage until pregnant to receive Medicaid-paid family planning services before they become pregnant and before they have children. In the joint letter to House and Senate Leadership, she described the Waiver approval process states must go through:

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Unfortunately, the current waiver process has proven increasingly unworkable. Over the last decade, only seven of the 20 proposals for income-based eligibility expansions approved by CMS have been approved within a year of when they were submitted by the state. Six applications took between one and two years for approval, and seven languished for two years or more before finally being approved. Particularly given the well-established value of these demonstrations, the current approval and re-approval required under federal law wastes critical staff resources, hamstrings states' ability to meet changing needs, and limits our efforts to reduce unintended pregnancies and meet reproductive health needs in our states.

Wisconsin is first up to the chopping block and our Department of Health and Family Services is locked in eleventh-hour plea-for-pardon negotiations with the Centers for Medicare and Medicaid Services (CMS) on behalf of health care for the 75,000 women enrolled in the program ending December 31, 2007. Beyond Wisconsin there are hundreds of thousands who would be helped in the six other states and beyond that, if Senator Clinton's proposal passes, women in the other 43 states and territories could quickly benefit as well.

Medicaid Family Planning Waivers save money by reducing more costly Medicaid-paid births by preventing unintended pregnancies. By expanding the program as Senator Clinton is proposing, the Congressional Budget Office has estimated an annual federal savings of up to $400 million. The Guttmacher Institute estimates even greater savings as well as benefits to maternal and child health.

It would be better to have a reasoned discussion of Medicaid-paid family planning services through full Congressional deliberation and passage of the Unintended Pregnancy Reduction Act (S. 1075 – H.R. 3162). But in the waning days of this empire, the women in the seven states with "Waiver execution dates" won't care whether it's a comma's position or a full debate that renders the result.

So pardon us, Mr. President.

Help win a pardon for family planning programs and a reprieve for women everywhere:

Let legislators know that the family planning expansion and access provisions of the Unintended Pregnancy Reduction Act (S. 1075 and H.R. 3162) must be included in the Medicaid physician reimbursement bill.

1) Contact members of the House Energy and Commerce subcommittee on Health and in the Senate Finance Committee. Use the ‘contact us' link at the House Energy and Commerce Committee subcommittee on Health's website at: http://energycommerce.house.gov/Subcommittees/health.shtml

2) Contact members of Senate Finance Committee at its website at http://www.senate.gov/~finance/.

3) Visit the ‘Write Your Representative" website at http://www.house.gov/writerep/ and the "Find Your Senator" website at http://www.senate.gov/general/contact_information/senators_cfm.cfm.

4) Ask friends and organizations who support expanded access to primary care, including reproductive care, to contact Congress. Direct them to this website and ask them to help spread the word.

Visit our website at www.FPHS.org if we can be of help or to learn more about us. If you do contact your legislator, let us know at info@fphs.org. Thanks for your help!

News Law and Policy

Kentucky Governor Backtracks on Pledge to End Medicaid Expansion

Teddy Wilson

Republican Gov. Matt Bevin said last week that he would not eliminate the state’s expansion of Medicaid and the kynect health-care exchange.

Kentucky’s new Republican Gov. Matt Bevin had promised to dismantle the state’s effort to implement the Affordable Care Act (ACA), and his defeat of Democratic Attorney General Jack Conway in November appeared to be a death knell for low-income residents’ health-care coverage.

However, Bevin said last week that he would not eliminate the state’s expansion of Medicaid and the kynect health-care exchange, but rather reform how the state has implemented the programs.

Bevin repeatedly said during the 2015 campaign that he would eliminate Medicaid expansion in the state. Bevin proposed transitioning residents on Medicaid through kynect to the federal health insurance exchange by 2017, when the ACA’s federal health-care subsidies are reduced.

“Absolutely. No question about it. I would reverse that immediately,” Bevin told reporters during a February 2015 press conference, according to the Associated Press. “The fact that we have one out of four people in this state on Medicaid is unsustainable, it’s unaffordable and we need to create jobs in this state, not more government programs to cover people.”

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Bevin changed course and announced his plans for reforming the Medicaid expansion program during a December 30 press conference. “We are going to transform the way in which Medicaid is delivered in Kentucky, and this transformation, I think, will be a model for the nation,” Bevin said.

The details of Bevin’s plan will be hammered out over the next six months, after which people “will have a very clear understanding of whether this is going to work or no.” The governor said that the new system could be implemented by the beginning of 2017.

The Kentucky program has been widely praised as a success, and it has been credited with reducing the uninsured rate in the state from 20.4 percent in 2013 to 11.9 percent in mid-year 2014. Kentucky’s 8.5 percent drop in the uninsured rate over the past two years is higher than any other state with the exception of Arkansas.

Bevin was joined in December by Vickie Glisson, the secretary of the Cabinet for Health and Family Services, and Mark Birdwhistell, the former secretary of the Cabinet for Health and Family Services.

Birdwhistell said during the press conference that low-income residents needed a Medicaid system that was “affordable and sustainable,” and that other states have created programs that could be an example for the plan that may be proposed.

“We’ve looked at other models in other states,” Birdwhistell said. “One of the things we keep talking about is the Indiana model. My personal preference is that we need a Kentucky model: a model that meets the needs of Kentucky.”

Indiana Gov. Mike Pence announced in January 2015 that the state will expand Medicaid under the ACA, becoming one of many GOP governors to cede to some form of Medicaid expansion after opposing Obamacare since its passage through Congress. The expansion will cover 350,000 low-income Indiana residents, or about 46 percent of the state’s 765,600 uninsured residents.

Bevin said that the need to reform the Kentucky program was mostly about its cost.

“It comes down to several things,” Bevin said. “Cost is primary among them. Ultimately it does not matter what the solution is. If there is not a way to pay for it then it would not be an option for the long term.”

The federal government pays 100 percent of the cost of expanding Medicaid in the state, and beginning in 2017, federal funding will decrease to 90 percent. A 2013 analysis by the state health department projected that Kentucky’s expansion of Medicaid would create a $15.6 billion positive economic impact, as well as nearly 17,000 jobs across the state.

Bevin claimed in December that full Medicaid expansion under the ACA was unaffordable “despite all the happy talk that came out of the previous administration.”

Bevin’s proposal to reform Medicaid expansion due to the cost of the program was announced a week before the governor released a budget proposal that would slash the state’s revenue. Bevin has proposed eliminating the state’s inventory and inheritance taxes, which would cost the state an estimated $55 million per year, according to reporting by McClatchy.

Bevin dismissed a reporter’s question to respond to the concerns of the thousands of state residents who may lose their health insurance under the governor’s proposal. “I really hope you’ve been listening to what I’ve just said, and I’m not sure that you have in light of that question,” he said.  

Whatever plan Bevin proposes will need the approval of the federal government. The Centers for Medicare and Medicaid Services (CMS) must approve waivers from states seeking to implement plans that differ from full Medicaid expansion under the ACA.

“I had a very extensive and substantive conversation with Health and Human Services Secretary Sylvia Burwell,” Bevin said. “She and I had a good conversation about what solutions would look like for Kentucky. It is our intention to work with CMS as we have said we would.”  

CMS officials approved a waiver allowing Indiana to implement its plan after months of negotiations between Pence and the Obama administration.

News Law and Policy

Senate GOP Wants to Gut Family Planning, Teen Pregnancy Prevention

Emily Crockett

Senate Republicans released a funding proposal on Tuesday that would significantly cut funding for women’s health, including Title X low-income family planning and a key evidence-based teen pregnancy prevention program.

Senate Republicans released a funding proposal on Tuesday that would significantly cut funding for women’s health, including low-income family planning and teen pregnancy prevention.

House Republicans recently proposed completely eliminating Title X, the nation’s only low-income family planning program.

The spending bill proposed by the Senate Appropriations Subcommittee on labor, education, and health and human services would cut Title X by 10 percent, or $28.7 million.

A vulnerable population that is 90 percent women, about half Black or Latino, and mostly uninsured or young relies on Title X clinics for birth control, testing for HIV and sexually transmitted infections, and cancer screenings. Some recipients have no other contact with the health-care system except through Title X.

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The Senate did not propose completely eliminating the program like the House did. But such deep cuts to Title X, which is already languishing under the arbitrary budget cuts from sequestration, could have serious consequences.

A 10 percent cut to Title X would increase the number of unplanned pregnancies by more than 82,000 next year, according to a summary of the new budget proposal released by the committee’s Democrats, and would deny 430,000 people access to comprehensive family planning and preventive health services.

The spending bill also guts the Teen Pregnancy Prevention (TPP) program by about 80 percent, an $81 million cut to a $101 million program.

If conservative legislators are interested in funding government programs that are proven to work, cutting the TPP is the exact opposite of what they should do, Sarah Brown, CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy, told reporters on a Tuesday press call.

“One of this nation’s greatest success stories is the extraordinary decline in teen pregnancy and childbearing,” Brown said. “I often ask people if they can think of any other major social indicator that has improved to this degree.”

The teen birth rate is down 61 percent since its most recent peak in the 1990s, including a surprising 29 percent drop just between 2010 and 2014.

And “it just so happens,” Brown said, that this decline coincides with the start of a focused federal investment in evidence-based teen pregnancy prevention. The TPP only funds programs that are proven to change teens’ behavior, not just their knowledge or their intentions.

“Why are we messing with success?” Brown said.

Brown was quick to add that one program alone can’t be held responsible for solving an issue as complex as teen pregnancy, but that the TPP has played a “leading role” in efforts to use research-based approaches over the past five years, and that the program is considered the “gold standard” of evidence-based policymaking.

The Senate bill eliminates the Women in Apprenticeships program and significantly cuts other job training programs. It also eliminates a community health program for communities with racial health disparities and cuts funding for substance abuse, mental health services, and numerous agencies responsible for enforcing labor laws related to wages and safety both in the United States and abroad.

The bill eliminates funding for the Affordable Care Act too. President Obama has threatened to veto not only any bill that hurts his signature health-care program, but also any bill that doesn’t roll back the deep spending cuts from sequestration.

“I am deeply disappointed with this bill, which would hurt families and communities and would double down on the automatic budget cuts that Republicans and Democrats agree are bad policy and need to be fixed,” said Sen. Patty Murray (D-WA), the Senate subcommittee’s top Democrat.