I decided to write this in response to a note that a close friend had up about the House Democrats removing a provision in the American Recovery and Reinvestment Bill of 2009 from the Act of the same name (ARRA). (ARRA passed a House vote today.) While I think that particular section is necessary, I understand the reason for its removal. I hope it will be redrafted in another bill and passed as law soon. Note that this post is in favor of the specific part of the legislation dealing with family planning.
First, why I think it's worth approving, but also why I think it's worth removing from this particular bill to approve later.
I'd be happier with the state option to not have to seek waivers to provide family planning services for women who don't qualify under Medicaid. A decent economic/political/moral argument could go something like this: yes, you pay federal tax dollars and don't approve of how some states spend the money they receive from the US government, but it doesn't mean it's not a benefit for you to invest in the health and cost savings that contraception provides in another state.
Besides, if everyone did that, we'd be back to 1781 with the Articles of Confederation, or at best, the EU. (No one, Democrat or Republican, could reasonably claim to want to be like the EU, especially now.)
At the same time, I think it's important to recognize the severity of this crisis, and how absolutely terrible it would be for EVERYONE if the Democrats blew their political capital/mandate getting bogged down in a culture war.
Yes, there are lives at stake, and lives that will continue to be at risk by the failure to approve this part of the bill. I'm not saying it's not important. What I am saying is that, in my opinion, it's not worth destroying whatever chance of collective effort that is possible - and necessary - to navigate America through this egregious financial crisis.
I am happy to discuss this issue with someone who feels otherwise - it's the only way I refine my thoughts.
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The rest of the post will focus on understanding the system of Medicaid that exists and why such an exemption is needed.
A friend sent me two links that cover the concern from a progressive/liberal perspective:
Info here at TalkingPointsMemo (TPM)
and here at ThinkProgress (TP):
I don't watch TV, and so I guess I've missed a lot of the hubbub. But there appears to have been a lot of confusion and misinformation about the provision. Here's the original language:
State Option to Cover Family Planning Services. Under current law, the Secretary has the authority under section 1115 of the Social Security Act to grant waivers to states to allow them to cover family planning services and supplies to low-income women who are not otherwise eligible for Medicaid. The bill would give states the option to provide such coverage without obtaining a waiver. States could continue to use the existing waiver authority if they preferred.
Summary of bill prior to passage (pdf).
In short, it looks like it wouldn't remove any rights from individual states - it would simply transfer the decision-making capacity from the Secretary of Health and Human Services to the individual state to determine whether or not these women will be covered even if they are ineligible for Medicaid.
First of all, let me say that I've been looking at Medicaid (specifically, California's program, Medi-Cal) for my father over the last year. Eligibility requirements are limited to the disabled Should a person of limited means be ineligible for medicaid, they are liable for 20% of their hospital bills and some of their medication expenses (assuming they qualify for Medicare).
(This is based on my own, nonprofessional research, an, as with anything else in this blog, you should not take any of this information as comprehensive, or legally precise, or a recommendation in any way.)
A good start if you want a primer on Medicaid: HHS website,
California's Medicaid (Medi-Cal) eligibility requirements, and Wikipedia entry on Medicaid.
The long and short of it is that you qualify if you're 65+ years old, blind, disabled, under 21, pregnant, in a nursing home, a refugee, a caretaker of a child under 21 with certain conditions, have been screened for breast and/or cervical cancer, HIV, or part of one of five state programs mentioned on the site.
But, critically, you're disallowed if you have assets greater than $2000 (excluding a primary residence), even if you fall into one of the above categories. Also, there is a five-year look-back period, created by the Deficit Reduction Act of 2005, that means individuals can lose their eligibility if they gift assets within 5 years of going on Medicaid.
Medicaid is a means-tested program. It functions as a social welfare program, rather than social insurance for the elderly (e.g. Medicare). It is a program specifically designed to care for the least well off and most vulnerable, rather than insure elderly people who have "paid into" a system.
So, it does appear that you don't get an exemption for family planning without a waiver from the Secretary of HHS you're not (yet) pregnant, and/or are otherwise disallowed from your state's medicaid program.
As for abstinence education - it's been pretty heavily discredited as an effective way to prevent unwanted teen pregnancy. Hat tip to "hanshiro" at TP for linking in their comment to the Abstinence Clown. It has its place, of course, but only in conjunction with contraceptives and family planning. Maginot lines don't work simply by drawing a line in the sand against the face of data and pragmaticg oals.
(As if abstinence weren't scary enough as it is - it comes in clown form! You know what? I think it's working on me....)
I think it's also pretty repulsive that a lot of these private (but Federally sponsored) efforts to create Chaste Love covenants between parents and kids are at the least, creepy, and at the worst, reinforcing asymmetric treatment of the genders that is wholly inconsistent with modern civil liberties, or for that matter, actual economic stimulus. (Imagine how much US productive output would fall if all women became stay-at-home moms. I know some wonderful homemakers who work way harder than I ever could. But I'd be grateful to anyone who could point me to a longitudinal economic study that compared the economic productivity of children from one-salary vs two-salary households, and be interested to see the conclusion.)
For that matter, if there are any refereed studies that either support or refute any claims made above, feel free to bring them to my attention.
Few people are more vulnerable than a young, impoverished woman. For many reasons listed in the links above, such a woman may not qualify for medicaid until she becomes pregnant, and, depending upon the state, an abortion may not be covered or safely available. If we put aside the issue of abortion, proper contraception can help women take control of their reproductive status, enabling them to avoid the trap of becoming, for lack of a better idiom, "barefoot and pregnant".
I think many commentators are correct in saying that this bill is not necessarily the best vehicle for this proposal. It is interesting to note, however, that not a single Republican representative voted for ARRA, even without the amendment.
So much for compromise and bipartisanship.
It's worth Congress' time to approve a subsequent bill. As a practical matter, I'm inclined to say that yes, it may be necessary to prune this (and other) components from the bill in order to focus on economic stimulus. Yes, there's a lot that doesn't directly help with economic stimulus in this bill, and I feel leery about that too. But this is a particularly contentious/emotional/ideological issue that, in my opinion, is best resolved through a separate bill that is not tied to the overall economic recover act. I'm willing to discuss this with someone who feels otherwise - on one side or the other.
I don't have anecdotal experience from women who have directly benefited from Medi-Cal through contraceptives (probably because they had to depend upon Planned Parenthood for access to family planning during most of my adult political life). But for what it's worth, I'm damn glad the Medi-Cal program itself exists. Without it I'm sure my father would be living in a poor house or dead by now. If one were to look purely from a mechanical economic output perspective, it's true - my dad isn't a particularly productive member of society. But I'm glad I live in a country where we decided to support our most vulnerable members of society. My father, for what it's worth, did work as a mechanical engineer at what was Hughes Aircraft on various satellites - defense related and civilian. I think Khrushchev would've been hard pressed to replicate that social safety network in the USSR.
Aside: For those worried about the merits of tax cuts vs. government spending, I've yet to find a slam-dunk case for which has a higher multiplier (while spelling out all the assumptions involved), but Businessweek's Michael Mandel takes a first crack at it.
Part 2 addresses a broader issue - whether Obama will disappoint, and whether that's a bad thing.
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