Expanding Contraceptive Access for Women on Medicaid.

While much of the of the discussion around reproductive rights in the debate over the Affordable Care Act focused on the amendments of Rep. Bart Stupak and Sen. Ben Nelson, anti-choice Democrats who sought to ban or restrict abortion coverage in government-subsidized health insurance plans, there's another element of health-care reform that serves as a win for women's reproductive health.

Today the Guttmacher Institute released a report that examined an aspect of the health-care bill that would streamline access to contraception for women who are on Medicaid. Previously, if states wanted to include contraception coverage in Medicaid (22 states opted to do so), they had to complete a complicated waiver process that would allow them to have an "expansion program." But obtaining an expansion waiver could take up to two years.*

The expansion programs have helped women avoid unintended pregnancy by enabling them to improve their use of contraceptives. In Washington state, for example, the proportion of clients using a more effective method (defined as hormonal methods, IUDs and sterilization) increased from 53% at enrollment to 71% one year later, according to the state’s program evaluation. Similarly, in California, Family PACT clients were both more likely to use any method and to use a more effective method than they were before enrolling in the program.

The report also notes that short interverals between births, a factor known to have adverse effects both on maternal and child health, also decreased in states with expansion programs and, in some states, delayed the age of first birth by as much as three years.

What's really interesting about this report is essentially that the Medicaid expansion program, while frustrating for women caught in that two year web of bureaucracy, served as an amazing experimental model rarely seen in public policy. You had women who were in expansion programs and women who from the same geographic areas and socioeconomic classes as those who weren't in the program. Comparing the two groups of women side by side allowed policy makers to see the effects of doing something like making contraception accessible to low-income women had on overall cost and health of women; it ultimately made the case for expanding that benefit to all women on Medicaid. On top of that, the Affordable Care Act eliminates paperwork through a more streamlined process for a state to obtain an expansion of contraceptive care. You'd think small-government conservatives would be behind such a provision, but somehow, I'm not holding my breath.

-- Kay Steiger

*Correction/Clarification: Medicaid has always offered family planning services to women up to 133% of the poverty line, but the expansion programs extended these family planning services to higher income levels, with most states expanding coverage for women below 185% or 200% of the federal poverty level.