A Doctor's Take on the Stimulus Package
One cannot help but wonder whether congressional Republicans actually want to maintain the current rates of abortion, teen pregnancy, unnecessary public spending, or decreased productivity. Their policy on contraception suggests that they do.
House Republicans dogmatically refused to vote for any stimulus program that permitted states to fund contraception for Medicaid eligible citizens and those living off incomes just above the poverty level. This policy will lead to more unplanned pregnancies (with the associated abortions) and will block billions of dollars in savings.
To understand how this works, it is helpful to look at California's experience with a state-funded contraception and family planning initiative for women with incomes between 100% and 200% of the poverty level:
Four years after implementing the program, California saved an estimated $500 million in public health care spending, net of what they spent on the program itself. In fact, for every dollar invested in the program, the state of California saved an estimated $5.33, over a period of five years. These are conservative estimates that do not include money saved through increased productivity and cost savings from reductions in paid medical leave and sick days that result from unplanned pregnancies. Few other public spending plans can boast such a positive return on investment.
While I respect the opinions of those who oppose abortion, I do not understand why those same leaders would oppose policies proven to reduce abortions. Modest estimates put the number of undesired pregnancies averted in California at over 108,000 with over 41,000 abortions prevented within the first 4 years after expanding access to contraceptive options. Over a quarter of those pregnancies would have been in adolescents under the age of 20, accounting for over 11,000 prevented abortions.
A proven path to fewer abortions and marked reductions in federal spending, what is a conservative not to like? Perhaps it is the mistaken belief that the availability of contraceptive access will increase premarital sexual activity. This belief simply fails to stand up to the evidence. In 2002, the Department of Health and Human Services (under Republican Secretary Tommy Thompson), released a report documenting an increase in contraceptive use with a decrease in sexual activity between 1995 and 2002. Supplying contraceptives and educating adolescents about sex during the late 1990s did not increase their likelihood to engage in sexual activities; it did keep them from getting pregnant. Even supplying emergency contraception to adolescents, prior to sexual activity, has been proven not to affect sexual behaviors.
Following conversations with republican leaders, President Obama requested that the contraceptive waiver, which would allow states to fund such programs through Medicaid, be removed from the stimulus package. While I appreciate the President's attempt to find a bipartisan compromise and show goodwill, only evidence-based health policies should be supported. Access to contraception is proven to decrease unintended pregnancies, abortions, and reduce overall health expenditures.
Now that house republicans rejected the stimulus bill, I hope President Obama and congressional leaders will consider writing this provision back into the bill. It makes economic, social and public health sense.