Forecast: More women need publicly funded care, but will monies be there?
Economy to test safety net of family planning services
Take a look out into the waiting room of your family planning clinic. If you see an influx of patients, know that you are not alone. Planned Parenthood health centers across the country report an increase in patients who have lost their jobs, health insurance, or who no longer have the money to pay for medical care.1
The economic downturn is having a direct impact on women. Results from a 2009 Gallup Organization survey conducted for The American College of Obstetricians and Gynecologists (ACOG) show that women are delaying pregnancy, as well as their annual well-woman exam, due to troubled financial times.2 More than 1,000 women ages 18-44 were surveyed by the national group. Overall, 14% said the economy has had an effect on their plans to increase the size of their family, with the number increasing to 17% in married women. One in seven (14%) reported they have postponed an annual OB/GYN checkup, while 15% said they had cut back or stopped taking some medications because of the cost.
"When women are increasingly worried about their financial situation, they are more apt to skip much-needed routine health care and cut back or stop taking their medications," says Iffath Abbasi Hoskins, MD, ACOG vice president and senior vice president, chair, and residency director of the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, NY. "These are disturbing trends amid the tough economy that could have a negative impact on the long-term health of women."
Women are more vulnerable to high health care costs, points out a 2009 U.S. Department of Health and Human Services report.3 Women's reproductive health requires more regular contact with health care providers, including yearly Pap smears, mammograms, and obstetric care.3
One in four women who obtained contraceptive services in the United States in 2006 — including 50% of poor women who did so — received care at publicly funded family planning centers.4
At the recent 2009 National Family Planning and Reproductive Health Association (NFPRHA) national conference, members from across the country expressed concerns about a recent increase in the number of patients seeking services due to a variety of factors, particularly an increasing number of newly uninsured and newly unemployed patients, reports Sloane Kuney Rosenthal, MPP, NFPRHA director of public policy.
Rosenthal says while the Fiscal Year (FY) 2009 Omnibus Appropriations bill provided a sorely needed $7.5 million increase for Title X, a substantial investment of federal funds for family planning will be needed in FY 2010 and beyond to serve the 17.5 million women who are in need of publicly funded contraceptive services.5 Six in 10 clients consider family planning centers their main source of health care, according to a 2009 Guttmacher Institute report.5
Medicaid is playing an increased role as a source of insurance coverage for family planning services.4 Medicaid now accounts for more than seven in 10 public dollars spent for family planning in the United States.4 State-initiated Medicaid eligibility expansions allow family planning services to be made available to individuals with incomes above the cutoff for program eligibility.4 The joint federal-state Medicaid program spent $1.3 billion for family planning services in FY 2006; the federal government pays 90% of the cost of services, and the states pay the remaining 10%.6
A total of 27 states have obtained federal approval to extend Medicaid eligibility for family planning services to individuals who would otherwise not be eligible.7 Currently, states seeking to expand eligibility for Medicaid-funded family planning services may do so through a cumbersome and time-consuming waiver process, which takes an average of 19 months, says Rosenthal. "We were pleased to see that the president's FY 2010 budget request includes a proposal to give states the option to do so without going through the waiver process, a provision which, if enacted into law, could save substantial state and federal dollars while increasing access to health care for millions of uninsured women," Rosenthal says. "We were thrilled to see that this provision was also included among the proposals in the policy options paper recently released by the Senate Finance Committee regarding options for increasing access to health care coverage."
A total of 46 million Americans have no insurance.8 More than 21 million of those without insurance are women. Even for women with insurance, there are barriers to accessing contraception. Private insurance often does not include comprehensive contraceptive coverage, states a NFPRHA position paper.9
Cost can affect a woman's choice of family planning options. According to the 2009 ACOG survey, among women currently using birth control, 12% reported they switched or changed birth control methods in the past year. Among those women, 14% switched because of the cost.2
Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta, has been concerned about the cost of contraceptives for decades. He would like to see contraceptives provided at no cost to certain groups of women unable to pay for them. If women can pay for contraception, through self-payment or insurance, without disrupting their education or purchase of food and lodging, then they should do so, says Hatcher. On the other hand, women who would have difficulty paying for contraception should receive them completely free, he states. "This would be comparable to how individuals and families obtain immunizations: those who are able to pay, pay for their immunizations; those who can't pay, receive immunizations at no cost," Hatcher observes. "Contraceptives and condoms to prevent infection are too important to be unavailable to anyone."
Look to the results of the St. Louis Contraceptive Choice Project to show the importance of providing free contraceptive services and free treatment for sexually transmitted infections, Hatcher predicts. The cohort study of 10,000 women is providing birth control at no cost to all participants for three years to study the impact of reversible long-term methods of birth control such as subdermal implants and intrauterine contraception. "The St. Louis project, directed by Jeff Peipert, MD, is going to prove without a shadow of a doubt the extraordinary benefits to women and their families of free contraceptive services," reports Hatcher.
References
- Planned Parenthood Federation of America. Planned Parenthood Applauds New HHS Report Underscoring Need for Inclusion of Reproductive Health in National Reform Efforts. Press release. May 13, 2009. Accessed at www.planned parenthood.org.
- American College of Obstetricians and Gynecologists. Bad Economy Blamed for Women Delaying Pregnancy and Annual Check-Up. Press release. May 5, 2009. Accessed at www.acog.org.
- U.S. Department of Health and Human Services. Roadblocks to Health Care: Why the Current Health Care System Does Not Work For Women. Accessed at healthreform.gov/ reports/women/index.html.
- Guttmacher Institute. Facts on Publicly Funded Contraceptive Services in the United States. Fact sheet. Accessed at www.guttmacher.org/pubs/fb_contraceptive_serv.html.
- Gold RB, Sonfield A, Richards CL, et al. Next Steps for America's Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System. New York City: Guttmacher Institute; 2009.
- Gold RB. An enduring role: The continuing need for a robust family planning clinic system. Guttmacher Policy Review 2008; 11:6-10.
- Guttmacher Institute. State Policies in Brief. State Medicaid Family Planning Eligibility Expansions. Fact sheet. Accessed at www.guttmacher.org/statecenter/spibs/spib_SMFPE.pdf.
- Rowland D. Health care and Medicaid — weathering the recession. N Engl J Med 2009; 360:1,273-1,276.
- National Family Planning and Reproductive Health Association. Family Planning: An Essential, Cost-Effective Part of Health Care Reform. Accessed at www.nfprha.org/images/pdf/TransitionPaper.pdf.
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