As the Affordable Care Act helps more Americans get health insurance, it’s time to increase funding for Title X, because the need for family planning services is only going up.
For more than 40 years, Title X has provided family planning and reproductive health services to millions of American women. More recently, conservative lawmakers have targeted Title X as part of their obsession with shrinking the social safety net and restricting access to women’s health care. Those same opponents are now likely to argue that the Affordable Care Act’s (ACA) focus on women’s health renders Title X unnecessary. But as I argue in my new paper published by the Roosevelt Institute, that is simply not the case. In reality, the success of the ACA and the health of women across the country are dependent on even greater support for existing family planning programs.
Title X is the nation’s only program solely dedicated to family planning. It was passed into law in 1970 with overwhelming bipartisan support and can in fact be credited to two Republican presidents: Richard Nixon, who signed the bill into law, and then-congressman George H.W. Bush, who led the legislative effort. It provides critical medical care to low-income, immigrant, and young women and enables clinics to pay for and maintain facilities, train and hire staff, and purchase equipment and supplies.
Despite being perennially underfunded, the program delivers incredible health results. Last year it served 4.76 million women, preventing an estimated 996,000 unintended pregnancies, 200,000 of which were among teens. Research has shown that services provided at Title X clinics save federal and state governments more than $3 billion every year.
As millions of Americans gain health coverage for the first time thanks to the ACA, clinics funded by Title X will become an even more critical building block of our nation’s health system. Even when individuals obtain coverage, many will continue to choose publicly funded clinics as their main source of care. In the four years following the implementation of Massachusetts’ health care reform, which served as the model for the ACA, publicly funded health centers experienced a 31 percent increase in patients, even though the number of uninsured visiting those facilities fell by more than 15 percent.
Even women who are already fully insured will continue to rely on Title X clinics for family planning because they can do so in complete confidence. Issues like intimate partner violence and religious beliefs of employers, family, and partners, cause many women to circumvent their insurance plans when accessing family planning services and instead rely on public providers.
The fact is, despite the GOP’s relentless strategic misinformation campaigns and the technology problems that bedeviled the rollout this month, the ACA is good for women. It mandates that insurance plans fully cover all methods of contraception, prohibits gender discrimination and denial of care based on pre-existing conditions, and enables young people to stay on their parents’ plans until they are 26. It requires plans to cover pap tests, STD screening, preconception and prenatal care visits, postpartum counseling and breastfeeding support, and one well visit a year. Make no mistake: this is groundbreaking.
Despite these historic advancements, many women will remain uninsured in the years to come. There are lots of reasons for this, not the least of which is the refusal of many states to accept federal funding for the expansion of Medicaid.
The ACA was intended to be a path to health care for all Americans, and a major pillar of the law was the expansion of Medicaid to all individuals who fall below 138 percent of the federal poverty level ($15,415 for an individual or $26,344 for a family of three), with subsidies for individuals above that level to buy insurance in the marketplaces. But last year the Supreme Court ruled that the federal government could not constitutionally require states to expand Medicaid, and conservative lawmakers pounced on the opportunity to block a major component of the ACA.