Senate Democrats are pushing to expand Medicaid coverage for contraception, breast pumps, and more with new legislation they're calling the "21st Century Women's Health Act." The "ambitious pro-choice" bill would also devote more federal money to things like campus rape-prevention programs and mandate that federal officials report regularly on state-by-state abortion access.
"At a time when the GOP congress is trying to drag women back to the last century, we are offering a bold agenda to strengthen women's health in this century," said Sen. Barbara Boxer (D-California), one of the bill's three co-sponsors, in a statement. This seems to be the key talking point. In a Thursday press call, Washington Sen. Patty Murray, another co-sponsor, called it an effort "to fight back against those who miss the Mad Men era" to lay out "important ways we can and should move forward on women's health."
While Obamacare requires private health insurance plans to cover all costs for contraception, whether and how it is covered under Medicaid is determined by individual states. The majority of states do cover it (though not necessarily at no-cost to enrollees), but 21 states still prohibit Medicaid programs from covering contraception. Boxer et al.'s bill would require state Medicaid programs to cover 100 percent of birth control costs for all female enrollees, and this is beig pushed as the cornerstone of the legislation. However, there are a lot of other funding promises tucked within. The bill would also:
- Require hospitals to provide any woman seeking care after a sexual assault with information about emergency contraception and the medication itself if so desired (a move sure to go over poorly with religious hospitals). The federal government would pick up the tab for this medication in all instances, even if the victim had private insurance that would cover the medication.
- Fund campus-based programs on sexual assault prevention
- Fund emergency contraception on college campuses
- Require the Department of Health and Human Services to conduct a study every five years on abortion access across the U.S. and state laws regarding abortion and family planning
- Fund training for nurse practitioners who specialize in women's healthcare
- Require state Medicaid programs to cover breast pumps and "breastfeeding support services"
- Provide more federal funding for clinics and health centers addressing family planning services
- Require all states to start "maternal mortality review committees" and report on the findings
- Launch a public awareness campaign to inform women about access to mammograms, immunizations, "domestic violence screening," and other services
- Create a database for women to report insurers trying to charge them for birth control
Though the bill has little chance of passing a GOP-dominated Congress, you can see why it holds political appeal for Democrats. It's easy to portray opposition to the bill as opposition to women's health and to rape victims, or as a play to "drag women back to the last century." And at least some Republicans are likely to take the bait, playing up arguments about how taxpayers shouldn't have to pay for anybody else to have sex.
But the birth control coverage seems the least offensive part here. Perhaps states should be left to decide for themselves how they run their Medicaid programs, but I support state decisions to cover contraception as they do other medications. One recent study found the federal government covers birthing costs for two-thirds of unplanned pregnancies, and that's just the start; once born, those kids are going to need health insurance too, at the very least. Whatever the other benefits, it's also cost-effective to help prevent unintended pregnancies in low-income populations, rather than cover them.
The other elements of the senators' plan, however, are where things really start to go wrong. Why should the federal government cover emergency contraception for victims with private insurance willing to pay? Aren't college campuses already awash in sexual assault prevention programs? Why does HHS need to conduct its own abortion-law reports, when there are myriad reputable groups—from women's health nonprofits to academic research programs—preparing yearly reports on the same? Why do Washington bureaucrats think they're better equipped to address healthcare access and outcomes in diverse communities than the people that live and work in them? The "21st Century Women's Health Act" mostly seems to stick the federal government in a lot of things being handled perfectly well by community, city, state, university, nonprofit, and private initiatives. Adding D.C. oversight can only make these measures more expensive and less efficient.