Keep Politics Away from the Promise of Family Planning

Here in the nation’s capital, the fiscal stimulus package is the hottest game in town. The House voted recently to approve an $819 billion stimulus bill that was supported by President Obama and by almost all of his party’s members but was unanimously opposed by the Republican minority. A measure of compromise will likely be the order of the day now that the legislation has moved on to the Senate, where there are enough Republican votes to mount a filibuster.

Democrats have, however, already compromised on one important front. When the bill came to the floor of the House for debate, the Rules Committee stripped a provision from it that would have given states the option to expand a Medicaid-funded program subsidizing family planning services for low-income women. Although eligibility for these services has traditionally been limited to pregnant women and mothers whose incomes fall below a relatively low threshold, about half of states have been granted federal waivers allowing them to serve all income-eligible women – regardless of whether they are or have been pregnant – and, in most cases, to raise their income-eligibility thresholds as well. The provision in question would have permitted the remaining states similar latitude in setting their eligibility criteria.

Republicans portrayed this provision as an example of wasteful spending and argued convincingly that it had no place in a bill whose purpose was to spur short-term economic activity and job growth. They also argued – incorrectly – that the program subsidizes abortion (in actuality, Medicaid regulations explicitly forbid these funds from being used to pay for abortions). When the controversy threatened to overshadow the broader discussion of how best to heal the ailing economy, the President successfully lobbied Democratic leaders to pull the family planning provision from the bill.

Because the program’s opponents appeared to be gaining political traction, we believe that the President’s decision was tactically smart. And because the goal of the overall legislation is to stimulate the economy as quickly as possible, we also believe it was an act of good governance. But we would hasten to add that, on its own merits, the family planning provision is good public policy. Not only would it reduce abortions – which is the exact opposite of what its opponents have argued – but it would also save the government money by reducing unplanned and out-of-wedlock childbearing. In fact, it promises to produce greater long-term returns than many of the programs that will ultimately be retained in the final stimulus package.

A recent Brookings Institution policy brief concluded that, in states that have already been granted income-eligibility waivers, this policy led to a significant reduction in the number of sexually-active women who have unprotected sex. We have incorporated this finding into a cutting-edge simulation model of family formation. Our results suggest that a similar expansion in contraceptive services in the remaining states would reduce the annual number of children born out of wedlock by more than 25,000, would reduce the number of pregnancies to unmarried teenagers each year by 19,000, and would reduce the annual number of abortions to unmarried women by nearly 12,000.

These effects are substantial, and they have important social implications. Children in single-parent families are more than four times as likely to be poor as children in two-parent families. Moreover, children who were born as the result of an unplanned pregnancy are less likely to have received adequate prenatal care, are more likely to have a low birthweight, and are more likely to perform poorly in school. Unintended pregnancies are also expensive. A recent study by Princeton University’s James Trussell found that unplanned pregnancies generate $5 billion annually in direct medical costs. Many of these expenses are borne by society in the form of subsidized medical care. Indeed, the Congressional Budget Office has estimated that the Medicaid family planning provision, if enacted, would result in a net government savings of $700 million over ten years.

In short: while we agree with the Democrats’ decision to remove the family planning provision from the stimulus bill, we strongly urge the President and Congress to return to this issue as soon as possible. We would also note that President Obama has already voiced his strong support for this policy, even if he ultimately decided that now is not the appropriate time to pursue it. Efforts to expand access to contraception have the potential to limit the number of unplanned pregnancies, reduce the incidence of abortion, and improve child well-being. And we can achieve all of these goals while improving our fiscal situation. If we hope to enhance children’s prospects and build stronger families, the smart money over the long run is on policies that empower couples to plan their pregnancies as carefully as possible.