The fiscal prudence of reproductive rights

The suddenly tumultuous debate about family planning has been grim and brutal. Issues legally resolved decades ago (contraception, 1965; abortion, 1973) reared their heads (or had them lifted) via conservative politicians trying to score points in an election year.

This has emboldened Texas in daring the feds to mess with it. It told the Centers for Medicare & Medicaid Services last week it would no longer pay for abortions through the Medicaid program--in defiance of program regulations. The state also wants to reject $35 million in federal funding to provide contraceptives and cancer screening to poor women because some of those services are provided via Planned Parenthood.

Whatever your thoughts about reproductive rights, unplanned pregnancies and births cost the healthcare system--and taxpayers--minivan loads of money. According to a study released last year by the Guttmacher Institute, about two-thirds of unplanned births in the United States are covered by the Medicaid, CHIP or other public health programs. That data has been verified by the non-partisan Brookings Institution.

The taxpayer tab for such pregnancies by Guttmacher's calculations was $11.1 billion in 2006, a sum that has no doubt risen in the years since. About 60 percent of that bill was covered by federal dollars, with the remainder coming from states just like Texas.

"At a time when policymakers everywhere are looking for ways to cut costs under Medicaid, these findings point clearly to a way to achieve that goal by expanding access to healthcare, not cutting it," said Guttmacher Institute researcher Adam Sonfield when the study was released.

By the way, Texas has one of the highest rates of unplanned births in the U.S. According to the Guttmacher/Brookings data, it cost $1.3 billion in taxpayer funds in 2006 to pay for them--more than 10 percent of the entire nationwide cost. That 74 percent of such births in Texas are covered by public programs may have something to do with that.

The Lone Star policymakers seeking to choke off federal largesse for family planning no doubt have concrete plans in place to cover the additional resultant costs.

Indeed, many of the same politicians who have led this recent reexamination of reproductive rights are constantly carping about how the government throws away taxpayer money. A sterling example is Rep. Darrell Issa, R-CA, chairman of the House Oversight Committee. He convened earlier this month an all-male hearing on preventing women from being able to obtain contraception if their employer has a religious or even moral objection to doing so. But he has focused most of his energy in recent years to cutting jobs in the post office and denying federal benefits to the Sept. 11 first-responders--efforts claimed by Issa to be in defense of fiscal probity.

Yet if Issa and his colleagues are successful in their latest efforts, the number of unplanned government-funded births would skyrocket--along with the associated taxpayer bill.

Hospitals make out OK in such a scenario. Few provide abortions or contraception services, and they generally operate close to break-even on Medicaid or CHIP payments for maternity care unless the child is premature.

But let's extend this a step further and assume Issa's like-minded allies on the U.S. Supreme Court throw out the Affordable Care Act. That would lead to millions fewer Americans enrolled in Medicaid over the next couple of years.

Should that come to fruition, it is also likely Texas will be successful in what will be a battle in federal court to defy the existing Medicaid guidelines. Such a victory will no doubt be furiously copied by other states.

Not only will the number of unplanned births hit the stratosphere, the funding mechanism for covering them will be seriously degraded.
Who will then get left holding the bill? Hospitals, of course. Hopefully their voices--and charity care provisions--won't get drowned out by all the additional bawling. - Ron (@FierceHealth)