Family planning bill moves forward with slight bipartisan support

A bill to expand Medicaid family planning services in Iowa continues to chug forward in the Iowa legislature, and has garnered at least limited bipartisan support in the wake of a positive economic impact study.

Creative Commons photo by jimmywayne via Flick

The bills — Senate File 2219 and House File 2281 — are identical, and both have been approved by their respective legislative committees. Although the House bill passed on a party-line vote, the Senate version has one Republican supporter, Sen. Merlin Bartz of Grafton.

Bartz did not respond to a request for comment concerning his vote. The House version is now ready for full floor debate while the Senate bill has been referred to appropriations.

If passed as currently written, the legislation would expand Medicaid coverage for family planning services to women who meet the income guidelines and who have insurance that does not cover such services. For the first time, men meeting existing income guidelines would also be eligible for family planning services, and income guidelines for all services would be increased to 300 percent of the poverty level. While the existing program arbitrarily cuts off services for women over the age of 44, the new legislation would keep women on the program up to the age of 54.

“The bottom line, from our perspective, is that this is a bill that helps patients,” said Kyle Carlson, staff attorney for Planned Parenthood of the Heartland. “This is a bill that includes a lot of people who are currently excluded from receiving services. For instance, women who have insurance, but are under-insured. Women who are 44, but can still become pregnant. And, of course, men. Why are we excluding men from access to family planning services? That’s what the current program does. We are trying to stop cutting people out [from services], who shouldn’t be cut out.”

To date the only opposition declaration made by a lobbyist against the bill has come from Tom Chapman, representing the Iowa Catholic Conference. Lobbyists for the Family Planning Council of Iowa, Planned Parenthood, Iowa/Nebraska Primary Care Association, AARP Iowa, the March of Dimes and the Iowa Department of Human Rights have all signaled their approval.

The measure received a boost earlier this month when researchers at the University of Iowa’s Public Policy Center and the University of Northern Iowa released a study showing the cost of unintended pregnancy in the state. The researchers — Dr. Belinda Udeh, Dr. Mary Losch and graduate student Erica Spies — determined that publicly funded family planning services are cost-effective for women who would use Medicaid and other public assistance programs if they became pregnant and gave birth. Using data from women being served by Iowa’s publicly funded family planning clinics during 2009, the study reported a weighted average of $3.78 saved for every $1 spent on family planning services in the first year for women newly eligible for assistance, and $15.12 when the savings are forecast for five years.

The savings are even more significant given that funds used by the Iowa Family Planning Network (IFPN) are assigned via a waiver request to the Centers for Medicare and Medicaid Services, and carry a 90-10 federal match. That means that for every $1 invested into the program by the state, the federal government kicks in $9. If the state puts in $1 million, the federal government contributes $9 million, making the total investment $10 million.

Using the study’s weighted average, that $10 million could then be translated to a total cost savings of$37.8 million in the first year alone.

“This is not just a little cost-savings initiative,” Carlson explained. “This is a major cost-savings initiative.”

In its fiscal review of the bill, the nonpartisan Legislative Services Agency estimated that an additional 35,491 women would be eligible, and that roughly 75 percent of those eligible would use the services during the first two years. The additional cost to the state’s general fund would be $332,000 in fiscal year 2011, and $901,000 in fiscal year 2012 — both well below the estimated cost savings.

“According to the Congressional Budget Office, providing family planning services to women between the age of 15 to 44 with incomes under 200 percent of the federal poverty level saves more than the program costs,” wrote analyst Jess Benson. “It is difficult to quantify what the savings will be by expanding age and financial eligibility requirements, but if there are fewer unintended pregnancies there will be some cost avoidance in the future considering Medicaid currently covers pregnant women and infants up to 300 percent of the federal poverty level.”

According to The Iowa Initiative, a program that aims to reduce the rate of unintended pregnancies among Iowa women ages 18 to 30, roughly half of all pregnancies in Iowa are unintended.

“Approximately one-half of the 52,000 women who will become pregnant in Iowa this year will become pregnant unintentionally,” said Christie Vilsack, executive director of the Iowa Initiative. “Helping low-income or uninsured women to avoid unintended pregnancy can save taxpayers thousands of dollars in health care costs, food assistance and child care assistance for women, infants and children.”

Vilsack notes that more than 170,000 Iowa women and teenage girls qualify for publicly funding contraceptive services. However, only 41 percent of them are served by family planning clinics. The Guttmacher Institute estimates the 72 clinics operating in 49 Iowa counties help women avoid as many as 16,000 unintended pregnancies annually. Yet the state ranks 48th nationally in the availability of family planning services. Patients who qualify for services under IFPN are free to access services from any Iowa provider that accepts Medicaid funding.

Federal law mandates that taxpayer funds, which include Medicaid assistance, cannot be use for abortion services.