A co-blog with Claire Brindis, DrPH, UCSF
What’s included in reproductive health?
Reproductive health care is mainly for women. It includes family planning (birth control; contraception), pregnancy assessment and counseling, maternity care referral, and breastfeeding support. It also includes breast and cervical cancer screening, testing and treatment for sexually transmitted diseases, and screening for domestic violence.
Medicaid (federal-state health insurance for the poor) is the largest funder of reproductive health care. The federal “Title X” (“title ten”) program funds many reproductive health services for lower income women (up to 250% of poverty). There is disagreement about whether abortion counseling should be permitted in Title X-funded clinics (more on this below). The Affordable Care Act requires these health care services as part of essential health benefits in approved health plans, with no cost-sharing by patients.
How many people are affected by federal policy on reproductive health?
Medicaid covers family planning in more than 40 states. It insures 12% of women of reproductive age and one-third of those women who are poor.
Title X supports services for 4 million persons per year. For example, 1 million receive breast exams, and 700,000 receive pap smears. Two-thirds of clients are poor and 42% are uninsured. The racial breakdown is 35% white, 33% Hispanic, and 20% black.
An estimated 80 million women have received free family planning services under the Affordable Care Act.
There were 13.5 million abortions in the U.S in 2017 (down from 29.3 million in 1981). Women with an unintended pregnancy may be counseled in Title X programs, though no longer about abortion (see next section).
How has reproductive health care changed under Trump?
The Trump administration instituted a strict version of the “gag rule” under the “Hyde amendment” — programs funded by Title X cannot recommend, counsel or provide information on, or even mention abortion. As a result, Planned Parenthood, which delivered 36% of the care in publicly-funded family planning clinics, stopped offering services under Title X. Overall, administration policies decreased Title X support and thus family planning access among the neediest populations.
The barebones “non-compliant” health plans encouraged by Trump under the Affordable Care Act have no waiver of cost-sharing for reproductive care services.
Trump has promised to appoint Supreme Court justices who will reverse “Roe v. Wade”, the 1973 decision that prohibits states from banning abortion. So far, he has made two such appointments.
What does Biden want?
Biden proposes to revoke the Hyde amendment “gag” on discussing abortion in Title X-funded clinics. He says he will reauthorize the Violence Against Women Act, currently stalled in the Senate. He will end non-compliant health plans in the Affordable Care Act, thus keeping reproductive health services free. He promises Supreme Court justices agreeable to preserving the 1973 Roe v. Wade decision on abortion and place this protection into law and regulation.
Does the choice of President matter?
A second Trump term would lead to lower financial support for reproductive health overall, as well as reduced access to family planning under the Affordable Care Act if it is dismantled. It would continue the “gag” on discussing abortion within Title X and may lead to overturning Roe v. Wade. A Biden presidency would permit abortion counseling under Title X, and protect abortion rights. It would preserve free reproductive health services under insurance plans.
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