Beliefnet
Steven Waldman

I’m depressed about this whole flap over contraceptives being in the stimulus package. It reflects much about what’s wrong with politics and policymaking in Washington. Here are my top three reasons to be depressed:
1) Democrats are still not committed to the new abortion politics. Democrats have to make a decision between which approach they’re going to take to abortion. Approach #1 is “we won; get used to it.” In that approach, they push forward with pro-choice policies that they’ve always wanted.
Approach #2 is to take seriously Obama’s rhetoric during the campaign about seeking common ground. Under this scenario, one does not insert into the stimulus bill money that goes to Planned Parenthood until after you’ve come up with a bigger “deal” promoting abortion reduction. The Democrats’ move comes on the heels of Obama repealing the Mexico City “gag rule” and — just as important — issuing a Presidential statement that had abandoned a key part of the abortion “compromise” they’d proudly touted during the campaign.
The one bit of good news: Obama apparently has thrown this provision overboard.
2) The Republicans first impulse was to massively exaggerate. They had a good issue: stimulus money should be reserved primarily for job creation. And if you’re going to do some non-job-creating moves, they should be non-controversial (i.e. education spending). But, as usual, Republicans got carried away. When Pelosi defended the practice because it reduced costs — which it probably does — Republicans made it sound like Pelosi was arguing that contraceptions stimulate the economy. “PELOSI SAYS BIRTH CONTROL WILL HELP ECONOMY , declared Drudge Report in a typical headline.
She never suggested contraceptives — or Barry White music or oysters, for that matter — would stimulate the economy. She said, it would “reduce costs.”
Then, conservatives turned this into proof that Pelosi was anti-baby. Since Pelosi never explained how it would reduce costs, conservatives filled in the blanks, saying that saving would come from people having fewer babies.
Jim Pethokoukis at US News writes:

“This is wrong on so many levels, one of which is looking at children born to the “wrong people” as economic burdens rather gifts, the music makers, the dreamers of dreams. She sees them as a cost instead of blessed benefits. Wow.”

Some of the cost savings does come from reducing the number of unintended pregnancies. (And is the conservative position that that’s bad?) But some of it comes from improving the health of new babies. If you intervene earlier with low income pregnant women, clinics can improve the maternal nutrition and thereby create more healthy babies who need less emergency health care. Are conservatives really against that?
Then, conservatives exaggerated the exaggeration. The Family Research Council declared yesterday that the measure would cost not $200 million but rather $87 billion.
That is in exaggeration on such a massive scale that my calculater kept giving me an error message when I was figuring it out. The Family Research Council calculations were off by a mere 43,500% Does that break some sort of exaggeration record?*
3) The abortion-family-planning conflation continues, harming millions of babies in the process. Conservatives now refer to any money that goes to family planning as subsidies for the “abortion industry” because some of the money will invariably go to places like Planned Parenthood, which also provides abortion services. Any type of family planning becomes thereby demonized.
Yet none of the family planning money goes to directly fund abortions and much goes to services to improve the health of mothers who are having babies, and reduce the number of babies who die in their first year. In arguing to the Obama transition team in favor of the family planning measure that made it into the stimulus, that well know Left Wing Socialist Organization called The March of Dimes wrote:

“By allowing Medicaid programs to cover primary care and family planning services without having to obtain a federal waiver, low income women will be under the care of a health professional before pregnancy, increasing the likelihood that when they do become pregnant, they will obtain timely prenatal care as recommended by the American College of Obstetricians and Gynecologists.
• Numerous studies have shown that pregnancies spaced too closely together present a
medical risk factor for preterm birth. Appropriately spacing pregnancies — for which
counseling by a healthcare provider is recommended — has been shown to reduce the
risk of preterm birth.
• Approximately 1 in 5 infants born preterm have ongoing health problems, including
cerebral palsy, mental retardation, chronic lung disease, and vision and hearing loss. A
recent Institute of Medicine (IOM) report estimates that the societal economic cost of
preterm birth (medical, educational, lost productivity) totaled at least $26.2 billion in
2005.5

(Full memo below the fold)
In addition, there’s a reasonable argument that spending more on family planning actually reduces more abortion than it causes. Yes, some people go to family planning clinics to get abortions but some go to get contraception, reducing the number of unintended pregnancies. It’s not an impartial source, of course, by the Gutthmacher Institute estimates that “Each year, the contraceptive services provided just at publicly funded clinics help women avoid 1.4 million unintended pregnancies, which would result in 640,000 unintended births and 600,000 abortions.”
Conservatives willfully refuse to grapple with the possibility that better family planning reduces the number of abortions — and pro-choice people seldom make the argument because they don’t want to concede the idea that reducing the number of abortions is a goal worth discussing.
On the other hand, the pro-family-planning folks have never, as far as I know, come up with a way of promoting family planning services that wouldn’t also lead to indirectly subsidizing abortion. And since they support direct federal funding for abortions, the pro-life forces are not wrong to fear some of this money will end up promoting abortion.
If pro-family-planning forces were willing to de-couple abortion from family planning, they could improve maternal health care and reduce infant mortality — but that would mean retreating a bit on abortion services.
So, pro-life forces end up supporting policies that lead to more abortions and liberal pro-choice forces end up fueling a political dynamic that leads to greater infant mortality.
Kudos all around.
* UPDATE: The Family Research Council explained the $87 billion figure by saying that’s how much the feds might pour out to help states with Medicaid. “We are saying it COULD be used for family planning – there isn’t much direction and throughout the bill it seems the Democrats are saying ‘trust us’ on where the money will go. Considering during President G.W. Bush years spending on this program grew from $252 million to $759 million just in the 14 states that were granted waivers (this on a program started under President Clinton that was supposed to SAVE money.) The Democrats’ bill removes the waiver necessity so all 50 states plus territories will be able to expand their family planning programs to people who aren’t normally considered poor (likely including more teenagers – with no parental consent protections). All the states need do is come up with a $1 to get $9 more in family planning/contraception funds. Current spending on family planning/contraception in Medicare is 1.3 billion – so $200 million increase actually sounds low – relatively. ”


March of Dimes Memo to Obama-Biden Transition
MEDICAID FAMILY PLANNING STATE OPTION

Proposal
The March of Dimes strongly supports the creation of an explicit option allowing states to
provide primary care and family planning services to women under Medicaid without having to obtain a federal waiver. This provision is included in legislation developed by the March of Dimes — “Prevent Prematurity and Improve Child Health Act” — first introduced in 2003 and re-introduced this Congress (S.794/H.R. 2746) by Senators Lincoln (D-AR), Lugar (R-IN), Bingaman (R-NM) and Snowe (R-ME) and by Representative Diana DeGette (D-CO).
According to the Congressional Budget Office (CBO), a version of this provision that was
approved by the House would yield a cost savings of $200 million to the federal government (and additional savings to states) over 5 years.
Current Law
Under current law, women of child-bearing age (15-44) are not eligible for Medicaid coverage until after they become pregnant, unless they are disabled or they have children who are enrolled in Temporary Assistance for Needy Families (TANF). Among the second group, income eligibility varies by state but is, on average only 41% of the Federal Poverty Level (FPL). The U.S. Census Bureau estimates that 1 in 5 women of child-bearing age — 12.6 million women — was uninsured in 2006. As the Institute of Medicine (IOM) and others have shown, lack of insurance poses a significant barrier to accessing health care services, including family planning.
A central purpose of family planning is to promote healthy births. As a condition of federal
reimbursement, Medicaid requires states to provide family planning services to women who meet the eligibility guidelines. However, because most low income women cannot enroll in Medicaid until they become pregnant, 26 states have obtained waivers from the Centers for Medicare and Medicaid Services (CMS) to provide primary care and family planning services to low income women of child bearing age before they become pregnant. Specific services covered include examination and treatment, laboratory tests, medically approved contraception and infertility services, as well as patient education and counseling. Enrolling these women prior to pregnancy has resulted improved access to preventive care, reduced the risk of poor pregnancy outcomes and generated Medicaid savings.
In addition to the services described above, an increasing number of states are using the their waiver authority to provide ‘preconception care’ — recommended by the American College of Obstetricians and Gynecologists and defined as, “the identification of those conditions that could affect a future pregnancy or fetus and that may be amenable to intervention.” Such care includes tobacco cessation counseling and pharmaceuticals, nutrition and folic acid counseling, and controlling pre-existing medical conditions that could impact a pregnancy (such as diabetes or hypertension).
Potential For Improving Maternal and Child Health
• Approximately half of all pregnancies in the US are unplanned, and there is a strong
correlation between unintended pregnancy and failure to obtain timely prenatal care.3 By
allowing Medicaid programs to cover primary care and family planning services without
having to obtain a federal waiver, low income women will be under the care of a health
professional before pregnancy, increasing the likelihood that when they do become
pregnant, they will obtain timely prenatal care as recommended by the American College
of Obstetricians and Gynecologists. (ACOG).
• Numerous studies have shown that pregnancies spaced too closely together present a
medical risk factor for preterm birth.4 Appropriately spacing pregnancies — for which
counseling by a healthcare provider is recommended — has been shown to reduce the
risk of preterm birth.
• Approximately 1 in 5 infants born preterm have ongoing health problems, including
cerebral palsy, mental retardation, chronic lung disease, and vision and hearing loss. A
recent Institute of Medicine (IOM) report estimates that the societal economic cost of
preterm birth (medical, educational, lost productivity) totaled at least $26.2 billion in
2005.

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