Guttmacher Institute Grades Health Care Legislation on Reproductive Rights

March 31, 2010

Now that Congress has finally passed its health care legislation and President Obama has given it his seal of approval, many are wondering what will change as a result of the bill. However, most of the focus thus far has been on issues such as banning pre-existing conditions, the individual mandate, and capping insurance premium increases. Very little mainstream attention has been focused on what was generally considered a major stumbling block to the bill’s passage in the first place—reproductive rights. One group however has composed an extensive report on exactly what the new health care law will change regarding coverage for abortion, sex education, and other reproductive health concerns.

The Alan Guttmacher Institute—once an autonomous division of Planned Parenthood and now one of the leading advocates for reproductive health policies based on sound scientific and social scientific research—has released a report grading the law on provisions that affect reproductive and sexual health issues. The full report, available here , discusses changes to insurance coverage for abortion, sex education programs, and expansions of Medicaid to cover family planning services.

On the issue of abortion coverage, Guttmacher states that private insurance coverage of abortions may now be an “endangered species” because of the complex restrictions and requirements that the legislation puts on individuals and insurance companies to ensure that no federal money is spent on abortion services. The language requires that any individual receiving a government subsidy to purchase health insurance would need to make two separate payments to their insurer—one for abortion coverage and one for all other premiums—if they elect to choose a plan that covers abortions. Guttmacher reports that this system will force insurance companies to “jump through numerous hoops to estimate the cost of abortion coverage and ensure that the abortion payments never mix with other funds.” As a result, “the more logical response would be not to sell products that cover abortion services.” While this does not necessarily mean that insurance companies will choose to stop covering abortion services, it does increase the likelihood that women may find it more difficult in the future to find health insurance that offers comprehensive reproductive coverage. (More than likely some insurers will continue to cover abortion services because there is an economic argument to be made that if demand exists for abortion coverage, some insurers will supply it.)

With regard to comprehensive sex education, Guttmacher states that while the new health care legislation offers both a “step forward and a step back.” The reform provides $75 million per year over the next five years for a new “personal responsibility education program.” This program will mainly consist of comprehensive sex education that includes instruction in both abstinence and contraception as a method of preventing teen pregnancy and sexually transmitted infections. Guttmacher reports that this program is “similar to the $114.5 million teen pregnancy prevention initiative signed into law by President Obama in December 2009,” and that the money will “focus on programs that are evidence-based, age-appropriate, and medically accurate.” On the flip side however, as part of a deal to get the comprehensive sex education funding into the bill a compromise was reach that would also reauthorize funding for the Title V abstinence-only-until-marriage program for a further five years. The reauthorization provides $50 million per year to the states, so the total amount spent on comprehensive programs will be around $190 million per year, compared to the $50 million per year for abstinence only.

The greatest win for reproductive health in the reform law came in an unexpected location, however—Medicaid. First, Congress expanded Medicaid eligibility to include all Americans whose income places them below 133% of the federal poverty level. Medicaid currently provides as part of its benefits family planning services and comprehensive reproductive care—excluding abortion, of course. The benefits do not stop there. As Guttmacher reports, “the legislation goes one step further. It allows states to expand Medicaid coverage solely for family planning services for women and men to the same income eligibility level states use for pregnancy-related care, typically at or near 200% of [the federal] poverty [line].” What this means is that women and men who are not eligible for full Medicaid benefits may still be eligible for family planning services if their incomes fall between 133% and 200% of the federal poverty definition. This represents an expansion to a sizable group of people and will hopefully improve reproductive health for millions of Americans.

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