Legislation would offer more women care while saving taxpayer dollars

It might seem counter-intuitive that the state could save money by providing more women access to health care, but that’s exactly what a coalition of family planning services providers are prepared to argue during the 2010 legislative session.

Ortho-Tricyclen is a common daily birth control pill (Photo: Wikipedia).

The coalition, which includes Planned Parenthood of the Heartland and other medical providers that utilize federal monies through the Iowa Family Planning Network (IFPN), would like to see the legislature make changes to its waiver request to the Center for Medicare and Medical Services that would result in an expansion of Medicaid coverage in Iowa.

“The bill we are proposing this year would not only renew our IFPN — our Medicaid waiver — but it would also try to improve its eligibility,” said Kyle Carlson, staff attorney for Planned Parenthood.

The proposed changes include increasing access for under-insured women, adding a 10-year cap to the current age limitations, expanding eligibility from 200 to 300 percent of poverty level and including men who desire family-planning services.

“Right now Medicaid serves as a type of wrap-around program for those who have private insurance,” Carlson said. “If private insurance doesn’t cover a particular service, those eligible for Medicaid can use the program to access what is needed. This is not true, however, for family planning services. If you get private insurance today, you are automatically not eligible to get on IFPN. We want to fix it so that if you get private insurance, but that insurance won’t cover birth control, that you can can still enroll in IFPN.”

Although some women continue to be able to become pregnant and bear a child well into their 40s, the program currently has a cap on services once a woman reaches the age of 44.

“We know that there are women above the age of 44 that are still able to have children, so that sort of age limit is arbitrary,” Carlson said, noting that the proposed bill includes bumping the age cap to 54. “Women in need of contraception, regardless of their stage of life, should be able to access it.”

Men, even those who meet current income guidelines, have few, if any, options when it comes to family planning services. If the proposed package is accepted, low-income men would also have services, such as vasectomies, covered by Medicaid.

Although few organizations or agencies are proposing expansion of programs due to current state economic realities, Carlson and the coalition believe that this particular expansion is one that is in the state’s and the taxpayers’ best interests.

“We believe this piece of legislation is cost-positive to the state,” he said. “The Medicaid waiver is a 90-10 match — the best match in Medicaid, I believe. So, for every $1 the state kicks into this program, the federal government will provide $9. You turn a $1 investment into $10 right off the bat.”

Family planning organizations were able to fight for and win a state line-item in 2008 using research out of Minnesota and other Midwestern states that showed that for every dollar placed in a family planning fund, the state experiences a $4 Medicaid cost savings. This is because providing contraception services is much less expensive than paying for an unintended pregnancy, and, eventually, a larger family that might not be able to provide for its own future health care and living costs.

The potential cost savings is significant for Iowa, a state that has ranked 39th in terms of state assistance and where roughly half of all pregnancies are unintended.

The state originally placed $750,000 into the fund, which was used to indirectly address Medicaid gaps in coverage for low-income Iowans. The new legislation, which takes a more direct approach with Medicaid, was prompted by both a changing federal political climate and the decimation of the state fund by budget cuts and lax revenues. That is, one year after the state fund was established, the legislature decreased it from $750,000 to $10,000 — although language was included that allowed any unused money from the previous year to be carried over. When this year’s across-the-board 10 percent cuts were mandated by Gov. Chet Culver, the fund was all but bare. All contracts in relation to the line item were terminated Jan. 1.

The changes are anything but certain, though. Recent history has shown that the state’s most conservative legislators have an immediate knee-jerk reaction to any legislation supported by Planned Parenthood or containing the words “family planning.” During debate over $750,000 line item back in 2008, Republicans attempted to use opposition to abortion to stall the bill, even though no money would go towards abortion services. Advocates of the state fund were able to overcome that hurdle by using research from other states that had invested in such services. That same research continues to provide a real boost for those who seek to change and expand the existing federal waivers, Carlson said.

“We are in a situation where if we can get the state [to act] then we can get more people and more services covered under this program at a 90-10 match. … Every time the state spends $1 it is going to get $40 in return,” he said. “That is a major cost savings. At a time when revenue is down and more patients are in need of services this is exactly the right time to do this and save the state money.”

At last estimate, roughly 12 percent of all childbearing-age women in Iowa were in need of, but unable to receive, public assistance for family planning services. Federal law mandates that taxpayer funds, which include Medicaid assistance, cannot be use for abortion services.