Family planning & Medicaid

Expansion of Medicaid has been one of the most controversial provisions in health reform. With the Supreme Court’s June 2012 ruling that states could opt out of the Medicaid expansion, nearly half the states in the country are leaning towards foregoing expansion.

Just as controversial a topic is women’s reproductive health, and in particular, family planning services.   A recent article in AJPH found that by virtue of expanding Medicaid, states would also increase access to women’s reproductive preventive (repropreventive) services, such as cervical and breast cancer screenings, by nearly 20% and 11%, respectively – particularly for lower income women.  The study also found that the disparity between lower income and higher income women in utilization of screening tests would be decreased by 25% for cervical cancer and 10% for breast cancer.

While the debates about the Medicaid expansion continues, women’s repropreventive services remains at the heart of robust discussions both at the federal and state levels. Decreasing access has been the stance of conservatives, including defeated Presidential candidate, Mitt Romney, who put Title X programs alongside the Affordable Care Act on his chopping block wish list.  State bills putting restrictions on abortions and abortion providers have motivated liberals, like Wendy Davis, to take as much as a 13-hour stand against decreasing access.

There is likely consensus that the overarching goal of the repropreventive services debate is to decrease the number of unwanted pregnancies and abortions.Unfortunately, important cancer screenings are frequently casualties of restricting access to family planning and abortion services – disproportionately for lower income women. We know that access to contraception helps to lower unwanted pregnancies and abortions. We also know that cervical and breast cancer screenings save lives. So, what exactly are we fighting about?

Wherry, LR. Am J Public Health. 2013; 103: 1577–1578.

by

Renée Volny, DO, MBA